Branching Exercise: Cardiac Case 1: 63 Year Old Female

Branching Exercise: Cardiac Case 1: 63 Year Old Female

Week 2: 12-lead EKG Interpretation and Diagnostic Evaluation of Arrhythmias

Much like problems with a home’s heating and cooling system, arrhythmias begin with symptoms that often require expertise to diagnose. The symptoms of arrhythmias are routinely among the leading reasons for emergency room visits. Palpitations, racing hearts, anxiety, irregular heartbeats, and chest pain often alert sufferers to the potential for bigger problems. This puts cardiology squarely in the spotlight as the branch of medicine responsible for addressing not only arrythmias but the many cardiac and circulatory disorders that afflict so many each year.

As an advanced practice nurse, you must be prepared to effectively recognize, respond, diagnose, and treat these symptoms. Hence, it is important for nurses at every level of care to demonstrate expertise in heart arrhythmias as a component of cardiovascular care.

This week, you examine issues pertinent to arrhythmias. You examine diagnosis and management approaches to heart rhythm issues and the health problems that may trigger them. You also examine the tools used to help recognize and respond to these issues. 

Learning Objectives

Students will:

  • Interpret 12-lead EKGs
  • Discern arrhythmias within 12-lead EKGs
  • Develop appropriate treatment plans, including diagnostics and laboratory orders for patients with identified arrhythmias

Learning Resources – Branching Exercise: Cardiac Case 1: 63 Year Old Female

Required Readings (click to expand/reduce)

Barkley, T. W., Jr., & Myers, C. M. (2020). Practice considerations for the adult-gerontology acute care nurse practitioner (3rd ed.). Barkley & Associates.

  • Chapter 21, “Arrhythmias” (pp. 263–290)

Document: Admission Orders Template (Word document)

Required Media (click to expand/reduce)

MedCram. (2019, June 9). ECG interpretation explained clearly and succinctly – arrhythmias, blocks, hypertrophy [Video file]. Retrieved from

MedCram. (2018, July 15). ST elevation – EKG/ECG interpretation case 12 (STEMI, MI, ACS) [Video file]. Retrieved from

MedCram. (2017, July 23). EKG/ECG practice strip interpretation explained clearly – case 10 [Video file]. Retrieved from

Walden University (Producer). (2019a). Branching exercise: Cardiac case 1 [Interactive media file]. Minneapolis, MN: Author.

Antiarrhythmic Drugs for the AGACNP

Dr. Tony Anno, core faculty for the AGACNP program at Walden University reviews that cardiac cycle and arrythmia pathophysiology. A review and discussion on the use of antiarrhythmic drugs that the AGACNP may encounter in practice is also provided. (18m)


ECG Review for the AGACNP

Dr. Tony Anno reviews important concepts and skills needed in understanding and interpreting ECGs for the AGACNP in practice. This review will also build upon you previous knowledge and expertise in diagnosing and treating cardiac disorders. (14m)


Assignment: Branching Exercise: Cardiac Case 1

For this Assignment, you will review the interactive media piece/branching exercise provided in the Learning Resources. As you examine the patient case, consider how you might assess and treat patients with the symptoms and conditions presented.

Branching Exercise: Cardiac Case 1: 63 Year Old Female

Photo Credit: [IMAGEMORE Co., Ltd.]/[none]/Getty Images

To prepare:

  • Review the interactive media piece/branching exercise provided in the Learning Resources.
  • Reflect on the patient’s symptoms and aspects of disorders that may be present in the interactive media piece/branching exercise.
  • Consider how you might assess, perform diagnostic tests, and recommend medications to treat patients presenting with the symptoms in the interactive media piece/branching exercise.
  • You will be asked to develop a set of admission orders based on the patient in the branching exercise.

The Assignment

Using the Required Admission Orders Template, write a full set of admission orders for the patient in the branching exercise.

  • Be sure to address each aspect of the order template
  • Write the orders as you would in the patient’s chart
  • Make sure the order is complete and applicable to the patient
  • Any rationale you feel the need to supply should be done at the end of the order set – not included with the order
  • Please do not write per protocol. We do not know what your protocol is and you need to demonstrate what is appropriate standard of care for this patient.
  • A minimum of three current, evidenced based references are required.
By Day 7 of Week 2

Submit your completed Assignment by Day 7 of Week 2 in Module 2.

Scenario #1 63 year old female (Branching Exercise: Cardiac Case 1: 63 Year Old Female)

63 year old female

Decision Point One

Atrial Fibrillation with Rapid Ventricular Response


  • Correct!

Decision Point Two

12 lead EKG, TSH, CBC CMP


  •  Correct!
  • These tests are all indicated to evaluate this rhythm and the potential pathophysiology related to this rhythm.

Decision Point Three

Metoprolol tartrate 2.5 mg IV bolus over 2 minutes

Guidance to Student


Rate control in this patient is the first priority in order to enable ventricular filling and cardiac output. This would treat the initial symptoms and then medications for rhythm control can be considered.