NR 446 Collaborative Exam 2 – UPDATED Questions with 100% Verified Answers
NR 446 Collaborative Exam 2 – UPDATED
Questions with 100% Verified Answers
Section 1: Vtach, Vfib, Treatment (Q1–Q12)
Question & Answer
Q1 what is Ventricular fibrillation (VF)?
A a chaotic rhythm characterized by a quivering of the ventricles, which results in total loss of cardiac
output and pulse. VF is a life-threatening emergency, and the more immediate the treatment, the
better the survival will be. VF produces a wavy baseline without a PQRST complex (Figure 7-45, p.
126).
Because a loose lead or electrical interference can produce a waveform similar to VF, it is always
important to immediately assess the patient for pulse and consciousness.
Q2 What is Ventricular tachycardia (VT)?
A a rapid, life-threatening dysrhythmia originating from a single ectopic focus in the ventricles. It is
characterized by at least three PVCs in a row. VT occurs at a rate greater than 100 beats per
minute, but the rate is usually around 150 beats per minute and may be up to 250 beats per
minute. Depolarization of the ventricles is abnormal and produces a widened QRS complex (Figure
7-43, p.126). The patient may or may not have a pulse.
The wave of depolarization associated with ventricular tachycardia rarely reaches the atria.
Therefore P waves are usually absent. If P waves are present, they have no association with the
QRS complex. The sinus node may continue to depolarize at its normal rate, independent of the
ventricular ectopic focus. P waves may appear to be randomly scattered throughout the rhythm,
but the P waves are actually fired at a consistent rate from the sinus node. This is called AV
dissociation, another clue that the rhythm is VT. Occasionally a P wave will "capture" the ventricle
because of the timing of atrial depolarization, interrupting the VT with a single capture beat that
appears normal and narrow. Then the VT reoccurs. Capture beats are a diagnostic clue to
differentiating wide complex tachycardias.
Q3 VTach rhythm analysis
A • Rate: The heart rate is 110 to 250 beats per minute. • Regularity: The rhythm is regular unless
capture beats occur and momentarily interrupt the VT. • Interval measurements: There is no PR
interval. The QRS complex is greater than 0.12 seconds and often wider than 0.16 seconds •
Shape and sequence: QRS waves are consistent in shape but appear wide and bizarre. The polarity
of the T wave is opposite to that seen in the QRS complex. • Patient response: If enough cardiac
output is generated by the VT, a pulse and blood pressure are present. If cardiac output is impaired,
the patient has signs and symptoms of low cardiac output; the patient may experience a cardiac
arrest.
Q4 VFib rhythm analysis
A • Rate: Heart rate is not discernible. • Regularity: Heart rhythm is not discernible. • Interval
measurements: There are no waveforms. • Shape and sequence: The baseline is wavy and chaotic,
with no PQRST complexes. • Patient response: The patient is in cardiac arrest.
Page 1 of 26
,NR 446 Collaborative Exam 2 – UPDATED Questions with 100% Verified Answers
Question & Answer
Q5 VTach causes
A Hypoxemia, acid-base imbalance, exacerbation of heart failure, ischemic heart disease,
cardiomyopathy, hypokalemia, hypomagnesemia, valvular heart disease, genetic abnormalities,
and QT prolongation are all possible causes of VT.
Q6 VTach treatment
A Determine whether the patient has a pulse. 1. If no pulse is present, provide emergent basic and
advanced life support interventions, including defibrillation. *2. If a pulse is present and the blood
pressure is stable, the patient can be treated with intravenous amiodarone or lidocaine. *3.
Cardioversion is used as an emergency measure in patients who become hemodynamically
unstable but continue to have a pulse.
Q7 VFib causes
A VF can be caused by ischemic and valvular heart disease, electrolyte and acid-base imbalances,
and QT prolongation.
Q8 VFib treatment
A Immediate BLS and ACLS interventions are required. * check pulse, CPR, shock(200J), shock(300J),
epi(1mg q3-5minuutes), shock, amniodarone (300mg), shock, amniodarone (150mg), shock,
lidocaine
Q9 SVT treatment
A cardiovert, and give adenosine or vagal maneuver if stable
Q10 elective cardioversion (stable)
A aysymptomatic SVT, VTach: systolic >90, awake, no complaints
Q11 emergent cardioversion (unstable)
A symptomatic SVT, VTach: altered LOC, systolic BP <90
Q12 defibrillation
A VTach (pulseless), VFib
Section 2: Precautions, Torsades, Pointes (Q13–Q24)
Question & Answer
Q13 VTach & VFib (pulseless)
A defib (200J) defib (300J) defib (360J) epi (1mg q3-5 minutes) amniodarone (300mg) then (150mg)
lidocaine
Q14 Torsades de pointes ("twisting about the point")
A is a type of VT that is caused by a prolonged QT interval. Unlike VT, where the QRS complex
waveforms have similar shapes, torsades de pointes is characterized by the presence of both
positive and negative complexes that move above and below the isoelectric line.
Page 2 of 26
, NR 446 Collaborative Exam 2 – UPDATED Questions with 100% Verified Answers
Question & Answer
Q15 Torsades de pointes treatment
A This lethal dysrhythmia is treated as pulseless VTach (defib and CPR). magnesium levels are
monitored and corrected with MgSO4 (Mg sulfate)
Q16 Torsades de pointes causes
A Magnesium deficiency is often a cause of this dysrhythmia.
Q17 Premature ventricular contractions (PVC)
A Premature ventricular contractions (PVCs) are a common ventricular dysrhythmia. PVCs are early
beats that interrupt the underlying rhythm; they can arise from a single ectopic focus or from
multiple foci within the ventricles.
Q18 Premature ventricular contractions (PVC) causes
A Causes: Hypoxemia, ischemic heart disease, hypokalemia, hypomagnesemia, acid-base imbalances
Q19 Premature ventricular contractions (PVC) treatment
A may occur in healthy individuals and usually do not require treatment. The nurse must determine if
PVCs are increasing in number by evaluating the trend. If PVCs are increasing, the nurse should
evaluate for potential causes such as electrolyte imbalances, myocardial ischemia or injury, and
hypoxemia.
*Runs of nonsustained ventricular tachycardia (3 in a row)=ventricular tachycardia.
Q20 types of precautions
A standard, contact, droplet, airborne
Q21 standard precautions
A hand hygiene, wear glove when dealing with body fluids, sharps in sharp-container, biohazard bags
for body fluid discard, no artificial nails due to risk for infection
Q22 contact precautions
A private room, gloves and gown ex. VRE, MRSA, C. Diff, herpes simplex, scabies
Q23 droplet precautions
A private room, surgical mask or respirator required
ex. chemo pts., diptheria, rubella, streptococcal pharyngitis, pneumonia/scarlet fever in infants,
pertussis, mumps, pneumonic plague, mycoplasma or meningococcal pneumonia
Q24 airborne precautions
A private room, negative pressure, N95 mask/respiratory protection device ex. pulmonary or
laryngeal TB, measles, chickenpox (varicella) *pt should wear mask out of the room if
transferring/transporting
Page 3 of 26
NR 446 Collaborative Exam 2 – UPDATED
Questions with 100% Verified Answers
Section 1: Vtach, Vfib, Treatment (Q1–Q12)
Question & Answer
Q1 what is Ventricular fibrillation (VF)?
A a chaotic rhythm characterized by a quivering of the ventricles, which results in total loss of cardiac
output and pulse. VF is a life-threatening emergency, and the more immediate the treatment, the
better the survival will be. VF produces a wavy baseline without a PQRST complex (Figure 7-45, p.
126).
Because a loose lead or electrical interference can produce a waveform similar to VF, it is always
important to immediately assess the patient for pulse and consciousness.
Q2 What is Ventricular tachycardia (VT)?
A a rapid, life-threatening dysrhythmia originating from a single ectopic focus in the ventricles. It is
characterized by at least three PVCs in a row. VT occurs at a rate greater than 100 beats per
minute, but the rate is usually around 150 beats per minute and may be up to 250 beats per
minute. Depolarization of the ventricles is abnormal and produces a widened QRS complex (Figure
7-43, p.126). The patient may or may not have a pulse.
The wave of depolarization associated with ventricular tachycardia rarely reaches the atria.
Therefore P waves are usually absent. If P waves are present, they have no association with the
QRS complex. The sinus node may continue to depolarize at its normal rate, independent of the
ventricular ectopic focus. P waves may appear to be randomly scattered throughout the rhythm,
but the P waves are actually fired at a consistent rate from the sinus node. This is called AV
dissociation, another clue that the rhythm is VT. Occasionally a P wave will "capture" the ventricle
because of the timing of atrial depolarization, interrupting the VT with a single capture beat that
appears normal and narrow. Then the VT reoccurs. Capture beats are a diagnostic clue to
differentiating wide complex tachycardias.
Q3 VTach rhythm analysis
A • Rate: The heart rate is 110 to 250 beats per minute. • Regularity: The rhythm is regular unless
capture beats occur and momentarily interrupt the VT. • Interval measurements: There is no PR
interval. The QRS complex is greater than 0.12 seconds and often wider than 0.16 seconds •
Shape and sequence: QRS waves are consistent in shape but appear wide and bizarre. The polarity
of the T wave is opposite to that seen in the QRS complex. • Patient response: If enough cardiac
output is generated by the VT, a pulse and blood pressure are present. If cardiac output is impaired,
the patient has signs and symptoms of low cardiac output; the patient may experience a cardiac
arrest.
Q4 VFib rhythm analysis
A • Rate: Heart rate is not discernible. • Regularity: Heart rhythm is not discernible. • Interval
measurements: There are no waveforms. • Shape and sequence: The baseline is wavy and chaotic,
with no PQRST complexes. • Patient response: The patient is in cardiac arrest.
Page 1 of 26
,NR 446 Collaborative Exam 2 – UPDATED Questions with 100% Verified Answers
Question & Answer
Q5 VTach causes
A Hypoxemia, acid-base imbalance, exacerbation of heart failure, ischemic heart disease,
cardiomyopathy, hypokalemia, hypomagnesemia, valvular heart disease, genetic abnormalities,
and QT prolongation are all possible causes of VT.
Q6 VTach treatment
A Determine whether the patient has a pulse. 1. If no pulse is present, provide emergent basic and
advanced life support interventions, including defibrillation. *2. If a pulse is present and the blood
pressure is stable, the patient can be treated with intravenous amiodarone or lidocaine. *3.
Cardioversion is used as an emergency measure in patients who become hemodynamically
unstable but continue to have a pulse.
Q7 VFib causes
A VF can be caused by ischemic and valvular heart disease, electrolyte and acid-base imbalances,
and QT prolongation.
Q8 VFib treatment
A Immediate BLS and ACLS interventions are required. * check pulse, CPR, shock(200J), shock(300J),
epi(1mg q3-5minuutes), shock, amniodarone (300mg), shock, amniodarone (150mg), shock,
lidocaine
Q9 SVT treatment
A cardiovert, and give adenosine or vagal maneuver if stable
Q10 elective cardioversion (stable)
A aysymptomatic SVT, VTach: systolic >90, awake, no complaints
Q11 emergent cardioversion (unstable)
A symptomatic SVT, VTach: altered LOC, systolic BP <90
Q12 defibrillation
A VTach (pulseless), VFib
Section 2: Precautions, Torsades, Pointes (Q13–Q24)
Question & Answer
Q13 VTach & VFib (pulseless)
A defib (200J) defib (300J) defib (360J) epi (1mg q3-5 minutes) amniodarone (300mg) then (150mg)
lidocaine
Q14 Torsades de pointes ("twisting about the point")
A is a type of VT that is caused by a prolonged QT interval. Unlike VT, where the QRS complex
waveforms have similar shapes, torsades de pointes is characterized by the presence of both
positive and negative complexes that move above and below the isoelectric line.
Page 2 of 26
, NR 446 Collaborative Exam 2 – UPDATED Questions with 100% Verified Answers
Question & Answer
Q15 Torsades de pointes treatment
A This lethal dysrhythmia is treated as pulseless VTach (defib and CPR). magnesium levels are
monitored and corrected with MgSO4 (Mg sulfate)
Q16 Torsades de pointes causes
A Magnesium deficiency is often a cause of this dysrhythmia.
Q17 Premature ventricular contractions (PVC)
A Premature ventricular contractions (PVCs) are a common ventricular dysrhythmia. PVCs are early
beats that interrupt the underlying rhythm; they can arise from a single ectopic focus or from
multiple foci within the ventricles.
Q18 Premature ventricular contractions (PVC) causes
A Causes: Hypoxemia, ischemic heart disease, hypokalemia, hypomagnesemia, acid-base imbalances
Q19 Premature ventricular contractions (PVC) treatment
A may occur in healthy individuals and usually do not require treatment. The nurse must determine if
PVCs are increasing in number by evaluating the trend. If PVCs are increasing, the nurse should
evaluate for potential causes such as electrolyte imbalances, myocardial ischemia or injury, and
hypoxemia.
*Runs of nonsustained ventricular tachycardia (3 in a row)=ventricular tachycardia.
Q20 types of precautions
A standard, contact, droplet, airborne
Q21 standard precautions
A hand hygiene, wear glove when dealing with body fluids, sharps in sharp-container, biohazard bags
for body fluid discard, no artificial nails due to risk for infection
Q22 contact precautions
A private room, gloves and gown ex. VRE, MRSA, C. Diff, herpes simplex, scabies
Q23 droplet precautions
A private room, surgical mask or respirator required
ex. chemo pts., diptheria, rubella, streptococcal pharyngitis, pneumonia/scarlet fever in infants,
pertussis, mumps, pneumonic plague, mycoplasma or meningococcal pneumonia
Q24 airborne precautions
A private room, negative pressure, N95 mask/respiratory protection device ex. pulmonary or
laryngeal TB, measles, chickenpox (varicella) *pt should wear mask out of the room if
transferring/transporting
Page 3 of 26
