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NURS 403 EXAM 2 QUESTIONS WITH CORRECT
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What does the QRS complex represent? - ANS ✓Ventricular depolarization, or contraction of the ventricles. What does the ST segment identify? - ANS ✓End of ventricular depolarization and the beginning of ventricular repolarization. Should remain flat. What does the T wave identify? - ANS ✓Ventricular repolarization (relaxing and filling with blood - diastole) How do you determine heart rate with the 10 times method? - ANS ✓Count the R waves and multiply by 10 Ex. 6 R waves in a 6 second strip would be 60 bpm 6 x 10 How do you determine heart rate with the rule of 300 method? - ANS ✓Count the large boxes between R waves and divide into 300 How do you determine heart rate with the rule of 1500 method? - ANS ✓Count the small boxes between R waves and divide into 1500 When assessing a P wave, how should it look? - ANS ✓It should come before the QRS complex
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It should leave the isoelectric line and return Should be 0.10 seconds or less Should be rounded Deflection should be positive All P waves should appear the same, should have one per QRS complex How long should a P wave be? - ANS ✓Less than 0.10 seconds (2.5 boxes) When assessing a PR interval, how should it look? - ANS ✓It should start at the beginning of the P wave, ends at the QRS complex Should last 0.12 - 0.2 seconds (3-5 boxes) Should be similar from beat to beat, if not, that's an arrythmia How long should a PR interval be? - ANS ✓0.12 - 0.20 seconds (3-5 boxes) How long should a QRS complex be? - ANS ✓0.10 seconds or less (2.5 boxes) When assessing a QRS complex, how should it look? - ANS ✓It should follow the PR Interval Lasts 10 second or less (2.5 blocks)
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What would a shorted QT Interval indicate? - ANS ✓associated with digoxin toxicity A nurse is examining the ECG of a client having an acute MI. The nurse would be correct to identify an elevated ST segment as most likely indicating which alteration. A.Necrosis B.Hypokalemia C.Hypomagnesemia D.Insufficiency - ANS ✓A. Necrosis ST segment is the end of ventricular contraction (depolarization), and beginning of repolarization. If this cannot occur, negative/positive deflection can occur and that would indicate heart muscle damage/necrosis What is Sinus Bradycardia? - ANS ✓Regular heart rhythm, BUT it is less than 60 bpm What symptoms may be present with sinus bradycardia? - ANS ✓Patient may be/have; Hypotensive Chest Pain Diaphoretic Confused Lightheaded Restless AMS Syncope
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Pale Fatigued What can cause sinus bradycardia? - ANS ✓Patient sleeping (demand isn't there, HR will be lower) Athletes Medications (beta-blockers, digoxin, CCB) duh Vagal stimulation (holding breath and bearing down, coughing, vomiting, etc) Injury to heart Electrolytes (K+) Hypoxia (may be tachy initially, but eventually will be bradycardic) Hypothermia (d/t decreased depolarization) What is the drug of choice for Sinus Bradycardia? - ANS ✓Atropine ( 1 mg q 3- 5 minutes) Goal is to increase HR May decrease secretions
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What can cause Sinus Tachycardia? - ANS ✓Acute MI Caffeine / Nicotine Dehydration /Hypovolemia (r/t compensation Drugs (Epinephrine, Ritalin, Atropine) Pain / Fear/ Anxiety Infection / Fever HF / Hypoxia What's the treatment for Sinus Tachycardia? - ANS ✓Treat the underlying cause Pain? Give pain meds Anxiety? Give a benzo or somethin' Dehydrated? Give em' fluids MI w Sinus Tach? Vagal maneuvers, Betablockers (metoprolol), CCB (diltiazem)
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What's the pathophysiology of a Premature Atrial Contraction (PAC)? - ANS ✓An impulse is originating from an irritated spot, which sends that impulse to the AV before the SA node can. How does a PAC appear on an ECG? - ANS ✓It's a premature and abnormally shaped P wave What signs / symptoms are present with Premature Atrial Contractions (PACs)? - ANS ✓Normally asymptomatic What causes PACs? - ANS ✓Stress Fatigue Anxiety Inflammation Infection Caffeine, nicotine or alcohol Hypoxia Digoxin toxicity What's the treatment for PACs? - ANS ✓No tx, esp. if no symptoms If you know the cause, treat it. What's a "Pair of PACs"? - ANS ✓Two premature beats/row in a row What's a "run/bursts of PACs"? - ANS ✓three or more beats/PACs in a row What's a Bigeminy of PACs? - ANS ✓PACs every other beat
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is the PR interval measurable in A-fib? - ANS ✓no What's controlled a-fib? - ANS ✓HR less than 100 bpm What's uncontrolled a-fib? - ANS ✓HR 100- 150 What's a-fib with rapid ventricular rate (RVR)? - ANS ✓HR over 150 What signs / symptoms are present with A-fib? - ANS ✓May be asymptomatic with controlled a-fib. Will show signs of decreased perfusion with an uncontrolled or RVR Dizziness Decreased CO Lower BP Tachycardia Hyperthermia Chest Discomfort Fatigue, Dyspnea AMS, Anxiety What causes a-fib? - ANS ✓Most often associated with an underlying disease (HF, cardiomyopathy, valve issues, cardiac surgery) Usually doesn't happen to healthy people
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What's the treatment for a-fib? - ANS ✓Medications (beta-blockers, anti- arrhythmic, calcium channel blockers, anticoagulants) Cardioversion Cardiac ablation Watchman device A patient comes to the ER with chest discomfort. After seeing the ECG, the patient is diagnosed with A-Fib. What medications would you anticipate giving? A. Atenolol B. Epinephrine C. Amiodarone D. Diltiazem E. Amlodipine F. Apixaban G. Atropine H. Colchicine I. Heparin - ANS ✓A. C D E F I What medications are used to treat Atrial Fibrillation? - ANS ✓Beta blockers (Atenolol, propranolol)
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Can only cardiovert rhythms that have a QRS complex What is the R on T phenomenon? - ANS ✓A premature ventricular complex (PVC) that occurs when the ventricles are not fully repolarized. Sends the patient into a worse rhythm when they are shocked on the T wave instead of the R wave. What should be done prior to cardioverting someone? - ANS ✓Synchronizing the machine How long from the start of Atrial Fibrillation are you able to cardiovert them and why? - ANS ✓Only successful within 48 hours of the start of the dysrhythmia Cardioversion afterwards may result in throwing a clot (A-Fib) What medication would you anticipate for someone that now has A-Fib, but is beyond the first 48 hours of treatment - ANS ✓They will receive anti- coagulates for a period of time before converting them (to prevent them from throwing a clot) May do a TEE prior to ensure there are no clots What diagnostic procedure can identify clots prior to cardioversion? - ANS ✓Transesophageal echocardiogram (Tee) What would indicate cardioversion is needed? - ANS ✓A cardiac rhythm with a QRS complex Atrial fibrillation (A-Fib) Atrial Flutter (AFL)
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SVT
Stable V-Tach w/ pulse Nursing care for cardioversion - ANS ✓Get consent Sedate them (midazolam) Get crash cart, have suction & oxygen, end tidaled CO2 on standby Placed leads appropriately Document (sedation used, how many jules, rhythm before & after, how patient responded, when their LOC came back) Steps for synchronized cardioversion - ANS ✓Turn the machine on Attach pads to client Press the "sync" button Select the energy level (jules) "Charge" device, inform everyone to clear to prevent shock from transmitting to them When synchronization takes place, what will you see on the monitor? - ANS ✓Upside down triangles on each R wave after button is pushed
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What causes Atrial Flutter? - ANS ✓Cardiac Surgeries COPD, CAD, valve issues Hypoxia list goes on and on What's the pathophysiology of Supraventricular Tachycardia (SVT)? - ANS ✓Impulses originating from above the ventricles resulting in a HR from 150- 250+ BPM What's the usual HR for someone in SVT? - ANS ✓ 150 - 250 BPM What are the ECG characteristics for SVT? - ANS ✓Appears as a regular, narrow QRS complex P waves are usually not seen T waves are often unidentifiable What is PSVT? - ANS ✓paroxysmal supraventricular tachycardia (coming on quickly and ending quickly) SVT with a rate of 180 bpm - ANS ✓
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What clinical manifestations would you expect with SVT? - ANS ✓signs of decreased perfusion What can cause / trigger SVT/PSVT - ANS ✓Caffeine Decongestants (phenylephrine, pseudoephedrine) Stress, lack of sleep Hyperthyroidism (don't know exact patho) Digoxin toxicity Heroin, cocaine, ecstacy Or it can just happen What's the treatment for SVT/ PSVT? - ANS ✓Vagal stimulation (hold breath, vomit, cough, submerge face in ice cold H2O, carotid sinus massage) - excess stimulation of vagus nerve will decrease HR Medications - ADENOSINE. Others could be beta blockers, CCB, amiodarone. Cardioversion (will sometimes do this right away if above 250 BPM) What's the main medication used to treat SVT? - ANS ✓Adenosine Give 6mg followed by NS bolus "fast as humanly possible"
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What's a retrograde impulse? - ANS ✓When the AV node has to send a signal UPWARDS back to the atrias for contraction as well as downwards for ventricular contraction. Hallmark sign being an inverted P wave So what's the different between a PAC and PJC? - ANS ✓a PJC has an inverted p-wave Where can PJC's occur? - ANS ✓Before, during, or after the QRS complex What are Atrioventricular Blocks (AV Blocks)? - ANS ✓They're a problem w/ the AV node, either delaying or completely blocking the signal coming from the atriums to the ventricles - causes an interruption in the impulse from atrium to ventricles. Will see alterations in the PRI What causes Heart Blocks? - ANS ✓Acute coronary syndrome (ACS): umbrella term that describes stable and unstable angina, MI, or any cardiac death Electrolyte imbalances (K+) Drug toxicity (Digoxin, Beta Blockers, CCB) Cardiac Surgery What's the pathophysiology of a 1st degree Heart Block? - ANS ✓Impulse from atriums to ventricles is constantly delayed (it's not blocked, just takes longer to get through)
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Husband (p-wave) is always late home to his wife (qrs complex) What does an ECG look like with a 1st degree heart block? - ANS ✓P wave - normal PRI - prolonged QRS - normal What clinical manifestations appear with a 1st degree heart block? - ANS ✓Usually asymptomatic - least dangerous of all heart blocks Hallmark sign / *prolonged PRI which is greater than 0.20 seconds & will be consistent w/ each beat) Ex. if one PRI is 0.24 seconds, then they will all be 0.24 seconds. What's the treatment for a 1st degree heart block? - ANS ✓Usually no tx d/t being asymptomatic. Frequently monitored though d/t risk of HB progression 1st degree heart block - ANS ✓(greater than 0.20 seconds) If the R is far from the P.... - ANS ✓then you have a 1st degree (HB) What's the pathophysiology of a 2nd degree AV block, type 1 (wenckebach)
- ANS ✓Impulse delayed slightly longer w/ each beat until AV node stops transmitting (no QRS with that beat)
