Cardiac EKGs on the NCLEX

I had a nurse with over 30 years of cardiac experience teach me about EKGs and how to read them. She worked in the ICU and was part of the Rapid Response Team.

I immediately loved this person’s style of teaching because she simplified everything so that we could understand. She was a teacher at heart. It was a life changing moment because I no longer dreaded taking care of a client on a heart monitor! Cardiac EKGs on the NCLEX is a big topic. And cardiac disease is a big problem. Reading an EKG is a fundamental skill every nursing student should develop before they take the NCLEX.

There is a lot to know about EKGs and even “simplified EKG” books, videos and other blog posts can be a bit overwhelming. So this is my simple, SIMPLE version of what to know about EKGs.

There are 2 main things to know about Cardiac EKGs on the NCLEX.

1. Can you recognize what the rhythm is?
2. Do you know what meds to give and other basic interventions if the client is having symptoms?

1) Normal sinus rhythm – 70 beats per minute

• No interventions

2) Sinus bradycardia – 40 beats per minute

• no interventions unless showing symptoms
• give atropine or client gets a pacemaker
  • it will speed the heart rate up

3) Sinus tachycardia – 130 beats per minute

• give meds to slow the heart rate down
• beta blockers, calcium channel blockers, ACE inhibitors, digoxin

4) Asystole – 0 beats per minute

• start CPR
• epinephrine
• NO DEFIBRILLATION

5) Ventricular fibrillation – no obvious heart rate

• CPR
• defibrillation
• epinephrine
• amiodarone (give lidocaine as an alternative)

6) Ventricular tachycardia – may or may not have a pulse

• Pulseless
  • CPR
  • defibrillation
  • epinephrine
  • amiodarone (lidocaine as an alternative)
• With a pulse
  • amiodarone (lidocaine as an alternative)

7) Myocardial infarction – ST segment elevation

• OANM
  • oxygen
  • aspirin
  • nitroglycerin
  • morphine
• thrombolytics within the first 6 hours if from a clot
  • T-PA, retepase

8) Atrial fibrillation – 90 beats per minute and irregular

• high risk for blood clots
  • anticoagulants
  • antiplatelets
• meds to decrease heart rate
  • beta blockers, calcium channel blockers, ACE inhibitors, digoxin

9) Atrial flutter – 70 beats per minute

• same care as atrial fibrillation – see above!

Heart Blocks

10) 1st degree AV block – 70 beats per minute

11) 2nd degree AV block Type 1 (Wenkebach or Mobitz I) – 50 beats per minute and irregular

12) 2nd degree AV block Type II (Mobitz II) – 60 beats per minute and irregular

13) 3rd degree AV block – 30 beats per minute

• General treatment for all heart blocks
  • give atropine or client gets a pacemaker
  • it will speed the heart rate up

14) Superventricular tachycardia – 170 beats per minute

• give adenosine: will convert to normal sinus rhythm

15) Pre-ventricular contractions – 110 beats per minute and irregular

• give meds to slow the heart down and prevent the PVCs
• beta blockers, amiodarone, flecainade

16) Torsades de Pointes – no obvious pulse

• give IV magnesium first

Like I mentioned in the beginning of this post, Cardiac EKGs on the NCLEX are a big topic. Get prepared so you can feel confident answering these types of questions!