Adult. EKG for nurses exam

Mr. James Wilson, a 34-year-old male, presents to the clinic with complaints of palpitations and anxiety. He has no significant medical history and is not taking any medications. He reports consuming 3 to 4 energy drinks daily over the past few weeks due to increased workload and stress.
His EKG shows sinus tachycardia with a heart rate of 110 beats per minute.

Vital Signs:

• Blood Pressure: 130/85 mmHg
• Heart Rate: 110 beats per minute
• Respiratory Rate: 20 breaths per minute
• Oxygen Saturation: 99% on room air

What is the most appropriate advice regarding the consumption of energy beverages for this patient?

A 60-year-old patient presents to the emergency department with complaints of severe, crushing chest pain radiating to the left arm, which started approximately 3 hours ago. The patient is sweaty and appears in distress.
A 12-lead ECG is immediately performed to evaluate the cardiac rhythm and potential ischemic changes.

What electrocardiographic changes might the nurse anticipate on this patient's ECG? Select all that apply

A 68-year-old patient is admitted to the telemetry unit for observation after complaining of occasional fatigue. The patient is otherwise hemodynamically stable with no complaints of chest pain, dizziness, or palpitations.
Given the patient's presentation, what would be the most appropriate nursing actions?

A 58-year-old patient in the intensive care unit suddenly becomes unresponsive during a routine vital signs check.
The nurse immediately checks for a pulse but cannot palpate one.
Upon glancing at the telemetry monitor, the nurse observes a flat line without any electrical activity.

In this scenario, which interventions are most appropriate for the nurse to consider?

A 58-year-old patient is rushed into the emergency department with complaints of chest pain, dizziness, and nausea that started several hours ago. 


Based on the observed cardiac rhythm, what is the nurse's two priority action for this patient?

A 78-year-old female with a past medical history of hypertension, type 2 diabetes, and a recent ischemic stroke 6 months ago presents to the outpatient clinic. She complains of increasing episodes of fatigue, occasional lightheadedness, and an "irregular heartbeat" over the last two weeks.
She states that she's been adherent to her antihypertensive medications and oral hypoglycemic agents.
On examination, her pulse is irregularly irregular, and the nurse suspects atrial fibrillation.

Given the patient's history and current symptoms, which of the following pharmacological interventions might be considered for her potential condition?   Select all that apply

Mrs. Emily Watson, a 76-year-old female with a history of heart failure, atrial fibrillation, and chronic kidney disease, is on digoxin therapy for rate control. She presents to the clinic for a routine follow-up.
She reports feeling generally well, with no new symptoms. Her EKG shows a characteristic "scooped" ST-segment depression

What is the most appropriate interpretation of Mrs. Watson's EKG findings?

A 68-year-old male undergoing a routine health check-up is hooked up to an EKG monitor. The nurse observes a strange and inconsistent pattern on the EKG tracing. The patient is calm and denies any chest pain or discomfort.
What are the appropriate nursing interventions to identify the cause of this EKG tracing? Select all that apply

Mr. James Anderson, a 62-year-old male with a history of coronary artery disease and hypertension, is admitted for chest pain and shortness of breath. He is currently being monitored on telemetry, and the nurse observes this peculiar trace on his EKG.

EKG STRIP

Mr. Anderson denies any palpitations or dizziness.

Under which circumstances should the nurse report this condition to the physician? Select all that apply

A 72-year-old patient presents to the emergency department with complaints of weakness and palpitations for the past 24 hours. 

Based on the patient's presentation, which interventions should the nurse anticipate?  Select all that apply

A 65-year-old male, two days post-operative from a cholecystectomy, suddenly becomes unresponsive in the ward. The nurse, after ensuring he's not responding to verbal stimuli, quickly checks the telemetry monitor.
The rhythm displayed shows fast, wide, and regular QRS complexes without any discernable associated P waves.
The nurse also cannot palpate a pulse in the patient.

What immediate nursing interventions should be considered based on the observed findings? Select all that apply

A 63-year-old patient was admitted to the emergency department at 9:00 PM.
During the initial assessment, the nurse gathers various pieces of information from the patient's history, current medications, and preliminary diagnostic tests.

Which of the following findings is most critical to relay to the health care provider who is considering the use of fibrinolytic therapy with tissue plasminogen activator for this patient?

The nurse is caring for the client admitted to the ED.

Patient Name: Mr. John Edwards

Age: 58 years

Gender: Male

Chief Complaint:
Mr. Edwards presents to the emergency department with a chief complaint of severe chest pain that began approximately 2 hours ago.

History of Present Illness:
Mr. Edwards reports that the chest pain started suddenly while he was watching television at home. He describes the pain as a heavy, crushing sensation located in the center of his chest, radiating to his left arm and jaw. He rates the pain as 9 out of 10 in intensity. The pain is continuous and is associated with diaphoresis (excessive sweating) and shortness of breath. Mr. Edwards states that he has never experienced anything like this before. He also feels nauseated and has had one episode of vomiting since the onset of the pain. Resting and taking deep breaths do not alleviate the pain.

Past Medical History:

• Hypertension (diagnosed 10 years ago; poorly controlled with occasional medication adherence)
• Hyperlipidemia (diagnosed 5 years ago; on simvastatin)
• Type 2 Diabetes Mellitus (diagnosed 8 years ago; on metformin)
• Former smoker (quit 5 years ago; 20-pack-year history)
• Family history of coronary artery disease (father died of a myocardial infarction at age 60)

Medications:

• Simvastatin 20 mg daily
• Metformin 500 mg BID
• Lisinopril 10 mg daily (reports missing doses occasionally)
• Aspirin 81 mg daily (reports not taking it consistently)

Allergies:

• No known drug allergies.

Social History:

• Mr. Edwards is a retired electrician. He lives with his wife and has two grown children. He admits to occasional alcohol consumption but denies drug use. He leads a sedentary lifestyle and has not been consistent with following dietary recommendations for his diabetes and hypertension.

A 55-year-old patient is brought into the emergency department following episodes of palpitations and lightheadedness. On the monitor, the nurse identifies a wide complex tachycardia. The patient appears alert but is symptomatic with a blood pressure slightly on the lower side.

Given the patient's presentation, which intervention involving lidocaine might the nurse anticipate?

A 68-year-old patient with a known history of chronic kidney disease presents to the emergency department after experiencing episodes of dizziness. On telemetry, the nurse observes a polymorphic ventricular tachycardia with a characteristic twisting pattern around the baseline. The rhythm is sporadic and self-terminating but recurs intermittently.
Based on the patient's presentation, which interventions should the nurse anticipate?   Select all that apply

Patient B is a 45-year-old male who presents to the emergency department with sudden onset of chest pain, shortness of breath, and palpitations. He has a history of hypertension and alcohol abuse. The following strip is obtained.

Which of the following 3 factors determines whether defibrillation or cardioversion should be used in the management of this condition?

Mrs. Sandra Miller, a 68-year-old female, was admitted to the hospital with complaints of dizziness, fatigue, and palpitations. She has a history of hypertension, hyperlipidemia, and a recent diagnosis of sick sinus syndrome.
Her blood pressure is 110/70 mmHg, and her heart rate is 45 beats per minute.
The EKG shows sinus bradycardia with occasional pauses. The cardiologist recommends the placement of a permanent pacemaker.
What is the most appropriate explanation for the patient regarding the purpose of the pacemaker?

Clinical Case: Mr. William Thompson, a 78-year-old male, arrives at the clinic for a follow-up visit. He has a history of chronic atrial fibrillation (AF) diagnosed 5 years ago with multiple hospitalizations, hypertension, and type 2 diabetes.  
His blood pressure is 140/85 mmHg, heart rate is 96 beats per minute, and his EKG shows atrial fibrillation with a ventricular rate of 95 beats per minute.

What is the most appropriate next step in managing Mr. Thompson's chronic atrial fibrillation?

Mr. Robert Lee, a 72-year-old male, presents to the clinic with a recent diagnosis of atrial fibrillation. He has a history of hypertension and diabetes. He is currently not on any anticoagulation therapy. His CHADS2 score is calculated to be 3, indicating an increased risk of stroke.

Based on Mr. Lee’s clinical presentation and risk factors, should he be started on Coumadin?