A nurse leaves a coffee shop and sees a man lying on the ground. He is unresponsive and has no pulse and the nurse begins chest compressions. EMS arrives and connects the cardiac monitor displaying this rhythm. Identify the rhythm.

Sinus Rhythm

Ventricular Tachycardia

Ventricular Fibrillation

Sinus Tachycardia

Answer and Explanation

The Correct Answer is C

A. Sinus rhythm is the normal rhythm of the heart with regular P waves, QRS complexes, and T waves. The presence of a sinus rhythm would mean the heart is pumping blood effectively, so the client would not be pulseless. This is inconsistent with the clinical scenario.

B. Ventricular tachycardia (VT) is a fast, regular rhythm originating in the ventricles. VT can lead to pulselessness if not treated, but it has distinct QRS complexes that are wide and regular, unlike the chaotic waveform seen in VF.

C. Ventricular Fibrillation appears as rapid, chaotic electrical activity without identifiable P waves, QRS complexes, or T waves. This rhythm prevents the heart from pumping blood, causing the client to be pulseless and unresponsive. VF is the most common arrhythmia associated with sudden cardiac arrest and requires immediate defibrillation.

D. Sinus tachycardia is a fast heart rate (>100 bpm) with regular rhythm, identifiable P waves, and QRS complexes. This rhythm typically occurs in response to stress, fever, or hypovolemia, and the client would have a pulse, which contradicts the scenario.

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Correct Answer is B

Explanation

A. Assessing oral temperature is not a priority immediately after an electrical burn, as the focus should be on monitoring for cardiac issues and other life-threatening conditions.

B. Electrical burns can cause cardiac arrhythmias, including dysrhythmias like ventricular fibrillation, which can be life-threatening. The nurse should place the client on a cardiac monitor immediately to detect any abnormal rhythms and respond accordingly.

C. While checking potassium levels is important for assessing potential complications such as kidney damage or arrhythmias, cardiac monitoring should take precedence.

D. Assessing for pain at contact points is important, but it is secondary to ensuring cardiac stability in an electrical burn victim.

A. Low-density lipoprotein cholesterol: 160 mg/dL (4.1 mmol/L) B. Total cholesterol: 280 mg/dL (7.3 mmol/L) C. Serum albumin: 4 g/dL (5.8 mcmol/L) D. High-density lipoprotein cholesterol: 50 mg/dL (1.3 mmol/L) E. Triglycerides: 200 mg/dL (2.3 mmol/L)

Correct Answer is ["A","B","E"]

Explanation

A. LDL of 160 mg/dL is elevated, which is a risk factor for atherosclerosis.

B. Total cholesterol of 280 mg/dL is above the recommended level, increasing the risk of atherosclerosis.

C. Serum albumin is within the normal range and does not indicate atherosclerosis risk.

D. HDL cholesterol at 50 mg/dL is considered within a normal protective range and is not indicative of atherosclerosis risk.

E. Triglycerides of 200 mg/dL are also elevated, contributing to the risk for atherosclerosis.

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A nurse leaves a coffee shop and sees a man lying on the ground. He is unresponsive and has no pulse and the nurse begins chest compressions. EMS arrives and connects the cardiac monitor displaying this rhythm. Identify the rhythm.

Nursing Test Bank

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