BTSC Staff Nurse 31 July-2025
Medical & Surgical Nursing
Easy
Torsades de Pointes is a type of which of the following arrhythmias?
Appeared in: BTSC Staff Nurse 31 July-2025
Explanation
- Torsades de Pointes (TdP) is a distinct form of polymorphic ventricular tachycardia (VT), meaning it originates in the ventricles and has QRS complexes of varying shapes.
- The defining feature on an ECG is the QRS complexes that appear to twist around the isoelectric baseline, hence the name 'twisting of the points'.
- TdP is specifically associated with a prolonged QT interval, which can be caused by medications, electrolyte imbalances (hypokalemia, hypomagnesemia), or congenital syndromes.
- Because it is a ventricular arrhythmia with a rapid rate, it is classified under the broader category of Ventricular Tachycardia.
Why Other Options Were Wrong
- Option A: Supraventricular Tachycardia (SVT) originates above the ventricles (in the atria or AV node) and typically produces a narrow QRS complex. TdP is a ventricular rhythm with a wide QRS complex.
- Option B: Atrial Flutter is an atrial arrhythmia characterized by a 'sawtooth' pattern of flutter waves on the ECG. TdP is a ventricular arrhythmia with a polymorphic, twisting QRS pattern.
- Option C: Ventricular Fibrillation (VF) is a chaotic, disorganized electrical activity in the ventricles with no discernible QRS complexes. While TdP can degenerate into VF, it is a distinct, more organized (polymorphic) rhythm itself.
Related Visual
Clinical Relevance
- Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Classification of cardiac arrhythmias, specifically Torsades de Pointes as background academic context rather than a clinical decision trigger.
- Recognizing TdP is a critical nursing skill, as it is a medical emergency that can lead to sudden cardiac death if not treated promptly.
- Nurses play a key role in preventing TdP by monitoring for QT prolongation in patients on high-risk medications (e.g., sotalol, haloperidol, erythromycin) and ensuring electrolyte imbalances like hypokalemia and hypomagnesemia are corrected.
- The immediate treatment for TdP is intravenous magnesium sulfate. Nurses must be prepared to administer this and escalate care according to ACLS protocols.
How to Approach the Question
- First, identify the core term in the question: 'Torsades de Pointes'.
- Access your knowledge about this specific arrhythmia. Recall its key features: what does it look like on an ECG? Where does it originate in the heart?
- The name 'Torsades de Pointes' and its 'twisting' ECG appearance are linked to a ventricular origin and a polymorphic QRS.
- Evaluate the options based on this knowledge. 'Ventricular Tachycardia' is a broad category. Since TdP is a tachycardia originating in the ventricles, it fits this classification.
- Eliminate the other options. SVT is supraventricular (narrow QRS). Atrial Flutter has sawtooth waves. VF is completely chaotic. TdP is a specific type of VT.
Concept Tested & Keywords
- Concept Tested: Classification of cardiac arrhythmias, specifically Torsades de Pointes.
- Stem keywords: Torsades de Pointes, arrhythmias
- Lead-in keywords: type of
Question ID
QkMGPw3Zkl1mzfk4YVxJzZ
Reference Book
E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) p. 7322-7324
E6 Medicine Harrison 22e Part 1 p. 2010-2012
E6 Medicine Davidson Principles Practice 24e p. 496-498
Practise the full BTSC Staff Nurse 31 July-2025
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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