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NUR 2006: ECG: EXAM TEST QUESTIONS WITH
CORRECT ANSWERS
The smallest box on an ECG strip is ___ seconds. -- Answer โโ 0. The large box on an ECG strip is ___ seconds. -- Answer โโ 0. A six second strip is ___ large boxes. -- Answer โโ 30 What does the P wave represent? -- Answer โโ atrial depolarization (contraction) How long should a normal PR internal last? -- Answer โโ 0.12-0.20 seconds (3-5 small boxes) What does the PR interval represent? -- Answer โโ The time of transmission of the electrical impulse from the atria to the ventricles How long is a normal QRS complex? -- Answer โโ 0.06 to 0.12 seconds (1.5 to 3 small boxes)
What does the QRS complex represent? -- Answer โโ The spread of the electrical impulse through the bundle of HIS and bundle branches to the purkinje fibers resulting in ventricular depolarization What does the ST segment represent? -- Answer โโ Early phase of repolarization of the ventricles What is the J point? -- Answer โโ Where the QRS complex ends and the ST segment begins The ST segment is measured from the end of the QRS (J point) to the ____ of the T wave. -- Answer โโ Beginning What does isoelectric mean? -- Answer โโ Flat/baseline. No positive or negative charge ST segment is usually ____. -- Answer โโ Isoelectric What does the QT interval represent? -- Answer โโ Total time from the onset of ventricular depolarization to the completion of repolarization. The QT interval is measured from ....? -- Answer โโ The beginning of QRS to the end of the T wave
If the electrical impulse of the heart is going away from the positive electrode the ECG pattern will be inverted or _____. -- Answer โโ Negative Steps to ECG interpretation: -- Answer โโ 1. Count the rate (atrial and ventricular).
- Is it regular or irregular?
- Is there a p-wave for each QRS?
- Is the PR interval normal?
- Is the QRS normal?
- What is the rhythm? Identify the following rhythm: -- Answer โโ Normal sinus rhythm Identify the following rhythm:
-- Answer โโ Sinus bradycardia What are the causes of bradycardia? -- Answer โโ Caused by slow firing of SA node, increased vagal tone. Can be caused by drugs such as beta blockers, Ca channel blockers, Dioxin. Can be caused by hypothermia or hypothyroidism. True or false: Sinus bradycardia is normal in athletes. -- Answer โโ True What are the signs and symptoms of sinus bradycardia? -- Answer โโ Usually asymptomatic. If pronounced it can lead to fatigue, syncope, SOB, dizziness, hypotension, symptoms of HF What is the treatment for sinus bradycardia? -- Answer โโ Correct underlying cause. Acutely give atropine, dopamine or epinephrine. Chronically may need a pacemaker if symptomatic. Identify the following rhythm:
-- Answer โโ Supraventricular tachycardia (SVT) What is atrial tachycardia? -- Answer โโ A type of SVT In supraventricular tachycardia (SVT), the heart rate is usually around ________ bpm. -
- Answer โโ 140 - 250 What are the causes of SVT? -- Answer โโ Caffeine, alcohol, excitement, anxiety. What is the treatment for supraventricular tachycardia? -- Answer โโ Vagal maneuvers first, then drugs adenosine first then beta blockers and Ca channel blockers. Finally cardioversion if unstable Examples of vagal maneuvers: -- Answer โโ Valsalva, carotid massage, ice! What is cardioversion? -- Answer โโ Low-energy shocks to convert an arrhythmia back to sinus rhythm How is defibrillation different than cardioversion? -- Answer โโ Defibrillation is a more powerful shock whereas cardioversion is less powerful. Defibrillation shocks are
delivered unsynchronized and immediate where as cardioversion shocks are synchronized with QRS What is adenosine used for? -- Answer โโ Antiarrhythmic used to treat SVT Identify the following rhythm: -- Answer โโ Atrial fibrillation (A-Fib) Identify the following rhythm: -- Answer โโ Atrial fibrillation (A-fib) What is the heart rate in atrial fibrillation? -- Answer โโ Atria - 350 - 650, ventricles - slow to rapid Atrial fibrillation is an _______ rhythm. -- Answer โโ Irregular
What is the left atrial appendage -- Answer โโ Small saclike structure in the left atrium. In A fib and A flutter, this is a common spot where blood can pool and thrombus can form. What is a Watchman procedure? -- Answer โโ A type of implant that blocks off the left atrial appendage and decreases the risk of traveling blood clots. What is the heart rate typically in atrial flutter? -- Answer โโ Atria - 220 - 430, Ventricles < Identify the following rhythm: -- Answer โโ Atrial flutter What is the rhythm in atrial flutter? -- Answer โโ Regular or variable What is the defining characteristic of atrial flutter? -- Answer โโ Sawtooth appearance between QRS complex What is the pathophysiology of atrial flutter? -- Answer โโ One singular ectopic spot in the walls of the atria is causing the atria to contract
What are the causes of atrial flutter? -- Answer โโ MI, valvular heart disease, cardiac surgery, organic heart disease What are the symptoms of atrial flutter? -- Answer โโ May have SOB or dizziness if ventricular rate is rapid What is the treatment of atrial flutter? -- Answer โโ Control rate (digoxin, verapamil, beta blockers), anticoagulation, cardioversion once fully anticoagulated, catheter ablation Identify the following rhythm: -- Answer โโ Atrial flutter Identify the following rhythm: -- Answer โโ Atrial flutter What is the pathophysiology of a first degree AV block? -- Answer โโ Impulse originates in the SA node but has a delayed conduction through the AV node resulting in a prolonged PR interval.
What is the characteristic feature of second degree AV block type 1 "Wenckebach"? -- Answer โโ The PR interval increases until a beat is dropped What are the causes of second degree AV block type 1 "Wenckebach"? -- Answer โโ MI, digoxin toxicity, CABG What is the treatment for a second degree AV block type 1 "Wenckebach"? -- Answer โโ Observation, if symptomatic may need atropine, pacing, dopamine Identify the following rhythm: -- Answer โโ Second degree AV block type 1 - Wenckebach Identify the following rhythm: -- Answer โโ Second degree AV block type 1 - Wenckebach
What is the rhythm seen in second degree AV block Mobitz type II -- Answer โโ Atrial regular rhythm, ventricular irregular (atrial > ventricular) IN second degree AV block Mobitz type II, there are more ___ than ____. -- Answer โโ More P's than QRS's True or false: For each QRS conducted, the PR interval is identical and normal in second degree AV block Mobitz type II. -- Answer โโ True What are the causes of second degree AV block Mobitz type II? -- Answer โโ MI, digoxin toxicity What is the treatment for second degree AV block Mobitz type II? -- Answer โโ Pacemaker if symptomatic, external pacing pads on stand-by mode, atropine/dopamine/epi if symptomatic Identify the following rhythm: -- Answer โโ second degree AV block Mobitz type II. Identify the following rhythm:
Identify the following rhythm: -- Answer โโ Third degree heart block What are premature ventricular contractions (PVCs)? -- Answer โโ Originates outside the normal conduction pathway from a ventricular foci. Causes a wide QRS with no p waves. What are the causes of PVCs? -- Answer โโ Acute MI, ischemia, electrolyte imbalances (K, Mg), acidosis, hypoxemia, stress, stimulants, drugs True or false: Premature ventricular contractions (PVCs) are associated with many full body symptoms. -- Answer โโ False (usually asymptomatic) What are the nursing interventions for PVCs? -- Answer โโ Check O2 sat, check and replace electrolytes, monitor pt and document occurrence, amiodarone Identify the abnormality in the following rhythm:
-- Answer โโ PVCs Identify the abnormality in the following rhythm: -- Answer โโ PVCs Identify the following rhythm: -- Answer โโ V tach Identify the following rhythm: -- Answer โโ V tach
Identify the following rhythm: -- Answer โโ V fib What are the characteristics of ventricular fibrillation? -- Answer โโ Chaotic, irregular electrical activity. Quivering ventricle from multiple foci True or false: Ventricular fibrillation will never have a pulse. -- Answer โโ True What are the causes of ventricular fibrillation? -- Answer โโ Ischemic heart disease, CHF, CAD, MI, hypoxia, acidosis, electrolytes What is the treatment for ventricular fibrillation? -- Answer โโ Code blueโ start cpr, shock, epi Identify the following rhythm: -- Answer โโ V fib What is the cause of torsade de pointes? -- Answer โโ Low mag
What is the treatment for torsade de pointes? -- Answer โโ Code blue - magnesium as first line drug. CPR, defib, epi Identify the following rhythm: -- Answer โโ Torsade de pointes What are the five H's (Causes of lethal rhythms)? -- Answer โโ Hypoxia, hypothermia, hypovolemia, hypo/hyperkalemia, hydrogen ion acidosis What are the five T's (Causes of lethal rhythms)? -- Answer โโ Tension pneumothorax, tamonade, tablet OB, thrombus - MI, thrombus - PE What are the nursing responsibilities related to ECGs that we discussed in lecture? -- Answer โโ Print, measure, interpret and post a rhythm strip at the beginning of your shift. Get a 12 lead ECG and do vitals for any rhythm changes. Know your unit stands/when to notify md What are the first steps you should take if something looks wrong on an ECG? -- Answer โโ Check the patient, check the leads and connection, check battery
