NRNP 6566 WEEK 7 KNOWLEDGE CHECK 2026/2027 |
Advanced Care of Adults in Acute Settings I | Questions and
Verified Answers | Pass Guaranteed - A+ Graded
Dysrhythmias & Electrical Management
Q1: A 72-year-old patient presents with dizziness and syncope. Telemetry shows a
regular rhythm at 35 bpm with P waves preceding each QRS complex and normal PR
interval. What is the appropriate initial management?
A. Atropine 0.5mg IV every 3-5 minutes to a maximum of 3mg while preparing for
transcutaneous pacing if unresponsive
B. Atropine 0.5mg IV every 3-5 minutes to a maximum of 3mg while preparing for
transcutaneous pacing if unresponsive
C. Immediate transcutaneous pacing without medication trial
D. Epinephrine infusion for symptomatic bradycardia per ACLS protocol
Correct Answer: B
Rationale: This describes symptomatic sinus bradycardia. Atropine is first-line
pharmacologic therapy for symptomatic bradycardia per ACLS guidelines, starting at
0.5mg IV every 3-5 minutes to maximum 3mg. Transcutaneous pacing (Option C) is
indicated if atropine fails or for high-grade blocks, not first-line. Epinephrine (Option D)
is for pulseless arrest, not bradycardia with pulse.
,Q2: A patient with acute inferior wall MI develops complete heart block with ventricular
rate 40 bpm and hypotension (BP 78/52). What is the immediate management?
A. Atropine 1mg IV push with close monitoring
B. Atropine 1mg IV push with close monitoring
C. Transcutaneous pacing or transvenous pacing with atropine as bridge therapy
D. Immediate transcutaneous pacing or transvenous pacing with atropine as bridge
therapy
Correct Answer: C
Rationale: In the setting of acute inferior MI with complete heart block (third-degree AV
block) and hemodynamic instability, immediate pacing (transcutaneous or transvenous)
is indicated. Atropine may be used as bridge therapy but often ineffective in complete
heart block with wide escape rhythms. The isoproterenol or epinephrine infusions may
be used as bridge to pacing.
Q3: A patient with narrow-complex tachycardia at 180 bpm with visible flutter waves in
leads II, III, aVF is hemodynamically stable. Which medication is first-line?
A. Adenosine 6mg rapid IV push followed by 12mg if needed to unmask underlying
rhythm
B. Adenosine 6mg rapid IV push followed by 12mg if needed to unmask underlying
rhythm
C. Diltiazem 15-20mg IV for rate control in atrial flutter
D. Synchronized cardioversion at 50-100J due to risk of decompensation
,Correct Answer: B
Rationale: This presentation describes atrial flutter with 2:1 conduction. Adenosine is
first-line for stable narrow-complex tachycardia to unmask underlying rhythm or convert
SVT. It causes transient AV block allowing flutter wave visualization. Diltiazem (Option
C) is for rate control but does not convert rhythm. Cardioversion (Option D) is for
unstable patients.
Q4: A patient becomes pulseless and telemetry shows polymorphic ventricular
tachycardia. What is the immediate intervention?
A. Defibrillation at 200J biphasic, followed by magnesium sulfate 1-2g IV for prolonged
QT
B. Defibrillation at 200J biphasic, followed by magnesium sulfate 1-2g IV for prolonged
QT
C. Amiodarone 300mg IV push as first-line antiarrhythmic before defibrillation
D. Synchronized cardioversion at 100J for polymorphic VT
Correct Answer: B
Rationale: Pulseless polymorphic VT is treated as ventricular fibrillation with immediate
unsynchronized defibrillation at 200J biphasic. Magnesium sulfate is indicated for
Torsades de Pointes (polymorphic VT with prolonged QT). Amiodarone (Option C) is for
pulseless VT/VF after defibrillation not before. Synchronized cardioversion (Option D) is
for unstable tachycardia with pulse.
Q5: A patient with stable ventricular tachycardia (monomorphic) at rate 160 bpm has
preserved ejection fraction. What is the appropriate pharmacologic intervention?
, A. Amiodarone 150mg IV over 10 minutes, repeat as needed to maximum 2.2g in 24
hours
B. Amiodarone 150mg IV over 10 minutes, repeat as needed to maximum 2.2g in 24
hours
C. Lidocaine 1-1.5mg/kg IV push as alternative to amiodarone
D. Procainamide 20-50mg/minute to maximum 17mg/kg as first-line therapy
Correct Answer: B
Rationale: For stable monomorphic VT with preserved EF, amiodarone is preferred
first-line antiarrhythmic per ACLS. Lidocaine (Option C) is an alternative but less
effective for sustained VT. Procainamide (Option D) can be used but requires slow
infusion and hemodynamic monitoring; amiodarone is generally preferred in ischemic
heart disease.
Q6: A patient with recurrent atrial fibrillation with rapid ventricular response (RVR) at 140
bpm is hypotensive (SBP <90). What is the immediate management?
A. Immediate synchronized cardioversion at 100-200J biphasic
B. Immediate synchronized cardioversion at 100-200J biphasic
C. IV Diltiazem for rate control once hemodynamically stable
D. IV Amiodarone for chemical cardioversion in unstable patient
Correct Answer: B
Rationale: Atrial fibrillation with RVR and hemodynamic instability (hypotension, altered
mental status, signs of shock) requires immediate synchronized cardioversion.
Advanced Care of Adults in Acute Settings I | Questions and
Verified Answers | Pass Guaranteed - A+ Graded
Dysrhythmias & Electrical Management
Q1: A 72-year-old patient presents with dizziness and syncope. Telemetry shows a
regular rhythm at 35 bpm with P waves preceding each QRS complex and normal PR
interval. What is the appropriate initial management?
A. Atropine 0.5mg IV every 3-5 minutes to a maximum of 3mg while preparing for
transcutaneous pacing if unresponsive
B. Atropine 0.5mg IV every 3-5 minutes to a maximum of 3mg while preparing for
transcutaneous pacing if unresponsive
C. Immediate transcutaneous pacing without medication trial
D. Epinephrine infusion for symptomatic bradycardia per ACLS protocol
Correct Answer: B
Rationale: This describes symptomatic sinus bradycardia. Atropine is first-line
pharmacologic therapy for symptomatic bradycardia per ACLS guidelines, starting at
0.5mg IV every 3-5 minutes to maximum 3mg. Transcutaneous pacing (Option C) is
indicated if atropine fails or for high-grade blocks, not first-line. Epinephrine (Option D)
is for pulseless arrest, not bradycardia with pulse.
,Q2: A patient with acute inferior wall MI develops complete heart block with ventricular
rate 40 bpm and hypotension (BP 78/52). What is the immediate management?
A. Atropine 1mg IV push with close monitoring
B. Atropine 1mg IV push with close monitoring
C. Transcutaneous pacing or transvenous pacing with atropine as bridge therapy
D. Immediate transcutaneous pacing or transvenous pacing with atropine as bridge
therapy
Correct Answer: C
Rationale: In the setting of acute inferior MI with complete heart block (third-degree AV
block) and hemodynamic instability, immediate pacing (transcutaneous or transvenous)
is indicated. Atropine may be used as bridge therapy but often ineffective in complete
heart block with wide escape rhythms. The isoproterenol or epinephrine infusions may
be used as bridge to pacing.
Q3: A patient with narrow-complex tachycardia at 180 bpm with visible flutter waves in
leads II, III, aVF is hemodynamically stable. Which medication is first-line?
A. Adenosine 6mg rapid IV push followed by 12mg if needed to unmask underlying
rhythm
B. Adenosine 6mg rapid IV push followed by 12mg if needed to unmask underlying
rhythm
C. Diltiazem 15-20mg IV for rate control in atrial flutter
D. Synchronized cardioversion at 50-100J due to risk of decompensation
,Correct Answer: B
Rationale: This presentation describes atrial flutter with 2:1 conduction. Adenosine is
first-line for stable narrow-complex tachycardia to unmask underlying rhythm or convert
SVT. It causes transient AV block allowing flutter wave visualization. Diltiazem (Option
C) is for rate control but does not convert rhythm. Cardioversion (Option D) is for
unstable patients.
Q4: A patient becomes pulseless and telemetry shows polymorphic ventricular
tachycardia. What is the immediate intervention?
A. Defibrillation at 200J biphasic, followed by magnesium sulfate 1-2g IV for prolonged
QT
B. Defibrillation at 200J biphasic, followed by magnesium sulfate 1-2g IV for prolonged
QT
C. Amiodarone 300mg IV push as first-line antiarrhythmic before defibrillation
D. Synchronized cardioversion at 100J for polymorphic VT
Correct Answer: B
Rationale: Pulseless polymorphic VT is treated as ventricular fibrillation with immediate
unsynchronized defibrillation at 200J biphasic. Magnesium sulfate is indicated for
Torsades de Pointes (polymorphic VT with prolonged QT). Amiodarone (Option C) is for
pulseless VT/VF after defibrillation not before. Synchronized cardioversion (Option D) is
for unstable tachycardia with pulse.
Q5: A patient with stable ventricular tachycardia (monomorphic) at rate 160 bpm has
preserved ejection fraction. What is the appropriate pharmacologic intervention?
, A. Amiodarone 150mg IV over 10 minutes, repeat as needed to maximum 2.2g in 24
hours
B. Amiodarone 150mg IV over 10 minutes, repeat as needed to maximum 2.2g in 24
hours
C. Lidocaine 1-1.5mg/kg IV push as alternative to amiodarone
D. Procainamide 20-50mg/minute to maximum 17mg/kg as first-line therapy
Correct Answer: B
Rationale: For stable monomorphic VT with preserved EF, amiodarone is preferred
first-line antiarrhythmic per ACLS. Lidocaine (Option C) is an alternative but less
effective for sustained VT. Procainamide (Option D) can be used but requires slow
infusion and hemodynamic monitoring; amiodarone is generally preferred in ischemic
heart disease.
Q6: A patient with recurrent atrial fibrillation with rapid ventricular response (RVR) at 140
bpm is hypotensive (SBP <90). What is the immediate management?
A. Immediate synchronized cardioversion at 100-200J biphasic
B. Immediate synchronized cardioversion at 100-200J biphasic
C. IV Diltiazem for rate control once hemodynamically stable
D. IV Amiodarone for chemical cardioversion in unstable patient
Correct Answer: B
Rationale: Atrial fibrillation with RVR and hemodynamic instability (hypotension, altered
mental status, signs of shock) requires immediate synchronized cardioversion.
