Basic ECG Interpretation

Question 11 of 14 A patient calls the health care provider's office reporting dizziness and fatigue. The patient started taking a beta blocker one week ago. The patient's radial pulse is 52 bpm. Which instruction should the nurse give the patient? "Consult your health care provider about stopping the beta blocker." "Continue taking the beta blocker. Your symptoms will resolve in a week or so." "You will need to make an appointment to have a permanent pacemaker implanted." "Ask your health care provider about doubling up on your beta blocker. You need a higher dose to treat your symptoms."

"Consult your health care provider about stopping the beta blocker." Sinus bradycardia may occur in response to certain drugs, including β-blockers. If bradycardia is due to drugs, these may have to be held, discontinued, or reduced. The patient should consult the primary health care provider.

Question 13 of 14 A patient presents with sinus tachycardia with a heart rate of 122. The patient also has pneumonia. Which assessment question should the nurse ask the patient first to identify the cause of the patient's symptoms? "Are you coughing up any secretions?" "What have you eaten in the last 24 hours?" "Do you find yourself sleeping in a chair at night?" "Have you taken any over-the-counter medications since you became sick?"

"Have you taken any over-the-counter medications since you became sick?" Many over-the-counter cold remedies have active ingredients (e.g., pseudoephedrine [Sudafed]) that can cause tachycardia.

Question 14 of 14 A patient presents during a normal well-visit with a heart rate of 58 beats per minute. The patient is an avid runner and is currently training for a triathlon. All other vital signs are normal. Which statement indicates to the nurse the patient teaching is understood? "I need to return in 48 hours. If my heart rate is still low, I need a pacemaker." "I am sad that I have to stop running. My heart does not tolerate it anymore." "I should stop drinking coffee in the morning. This will help my heart rate increase." "I do not need to take any medications. My heart rate is expected because of my triathlon training."

"I do not need to take any medications. My heart rate is expected because of my triathlon training." Sinus bradycardia may be a normal sinus rhythm in aerobically trained athletes and in some people during sleep.

Question 9 of 14 The nurse is providing patient education regarding bradycardia and its management. Further teaching is required if the patient makes which statement? "If I strain with a bowel movement my heart rate may go down." "Bradycardia means my heart rate is routinely <60 beats per minute." "My heart rate may be slower if I discontinue my calcium channel blockers." "I can continue my marathon training, even if my heart rate is 50 beats per minute."

"My heart rate may be slower if I discontinue my calcium channel blockers." Bradycardia may occur with calcium channel blockers and would not be expected to occur in response to discontinuing calcium channel blockers.

Question 4 of 4 The nurse is assessing heart rate from a patient's ECG and counts 8 R-R intervals in a 6-second stretch. The patient's heart rate is __________ beats per minute. Use numbers only.

80 Heart rate can be calculated by counting the number of R-R intervals in a 6 second strip and multiplying by 10. In this instance a 6-second strip has 8 R-R intervals meaning the heart rate is 80 beats per minute.

Question 6 of 14 Using the R-R interval formula, the heart rate in the strip shown measures __ beats per minute.

80 Heart rate using the R-R method includes counting the number of R waves in a 6-second strip and multiplying the result by 10. In this strip there are 8 R-R intervals within the 6-second interval. 8 multiplied by 10 = 80 beats per minute.

Questerm- 5 of 14 A nursing student is discussing a rhythm strip with the faculty member. Which rationale explains a shortened QT interval? A faster heart rate A slower heart rate Atrial Repolarization Firing of the sinoatrial (SA) node

A faster heart rate The QT represents the total time required for ventricular depolarization and repolarization. A shortened QT interval is associated with a quicker time for depolarization and repolarization, i.e. a faster heart rate.

Question 12 of 14 A patient reports dizziness and dyspnea. On assessment, the patient's heart rate is 130 bpm. An ECG indicates normal P-wave, PR interval, and QRS complex. The patient reports that the symptoms began shortly after an injury causing acute back pain. What is the priority intervention for this patient? Repeat the ECG. Administer pain medications as prescribed. Encourage the patient to listen to the radio to help with relaxation. Obtain cardiac enzymes for evaluation of a myocardial infarction (MI).

Administer pain medications as prescribed. The ECG indicates normal findings. Sinus tachycardia is associated with physiologic and psychologic stressors such as pain. The first step is to treat the cause (medicate the patient for pain).

Question 2 of 4 A nurse is gathering the history for a patient with sinus tachycardia. Which information should be expected based on the patient's condition? Fatigue Anemia Hypothyroidism Increased intraocular pressure

Anemia Sinus tachycardia is associated with anemia.

Question 1 of 4 Which wave on the ECG tracing will provide the nurse more information about atrial depolarization? A B C D

B The P wave demonstrates the initial firing of the SA node. The P wave can display as positive (upright), negative (inverted), or biphasic (both positive and negative).

Question 2 of 4 A patient asks the nurse, "Why do I need a 12-lead ECG if my heart rate is within normal limits?" The nurse responds by explaining that which heart conditions may be identified by the 12-lead ECG? Select all that apply. Cardiotoxicity Cardiac murmur Irregular rhythm Myocardial infarction Heart valve deformation

Cardiotoxicity The 12-lead ECG may show changes indicative of drug toxicity. Irregular rhythm Obtaining 12-lead ECG views of the heart is helpful in the assessment of dysrhythmias, or irregular heart rhythms. Myocardial infarction The 12-lead ECG may show changes suggesting damage to the heart including ischemia and myocardial infarction.

Question 1 of 14 Which statement describes the role of the Purkinje fibers in the pathway of the normal cardiac cycle? Origination of normal impulses Conduction of impulses from the atria to the ventricles Transmits electrical impulses from the AV node to the ventricles Conduction of impulses through the ventricles leading to ventricular muscle contraction

Conduction of impulses through the ventricles leading to ventricular muscle contraction The Purkinje fibers conduct impulses through the ventricles resulting in ventricular contraction.

Question 2 of 14 Which action results in the atria after firing of the sinoatrial (SA) node? Repolarization of cardiac muscle Depolarization of cardiac muscle Contraction of the atria to move blood to the ventricles Contraction of the ventricle moving blood out to the body

Contraction of the atria to move blood to the ventricles The SA node initiates the normal cardiac cycle. The end result is the contraction of the right and left atrium as they push blood into the ventricles.

Question 3 of 4 Which ECG component would the nurse measure to identify the total time needed for ventricular depolarization and repolarization of a patient's heart? A B C D

D The QT interval is the time it takes for ventricular depolarization and then repolarization. It is calculated by measuring the distance between the QRS complex and the T wave.

Question 4 of 14 The nurse is reviewing a patient's ECG reading and notices artifact on the monitor. Which action should the nurse perform to identify the cause of the artifact? Ask the patient about any medications taken prior to the ECG Ensure that the patient's cell phone is turned off during the ECG Ask the patient about the amount of caffeine ingested prior to the ECG Determine the condition of the conductive gel on the electrodes

Determine the condition of the conductive gel on the electrodes Accurate interpretation of heart rhythm is difficult when artifact is present. If artifact occurs, check the connections in the equipment. Replace the electrodes if the conductive gel has dried out.

Question 8 of 14 The nurse is caring for a patient with chest tightness and shortness of breath. The ECG tracing reports sinus tachycardia. Which additional finding should be expected? QRS duration 0.07 seconds Heart rate is 50 beats per minute Heart rate is 114 beats per minute Two P waves for each QRS complex

Heart rate is 114 beats per minute Characteristics of sinus tachycardia include a heart rate >100 beats per minute.

Question 1 of 4 A review of a patient's 12-lead ECG reveals sinus bradycardia. Which information should the nurse expect to find in the patient history? Select all that apply. Hypoglycemia Hyperthyroidism Marathon training Excessive caffeine intake Increased intracranial pressure Prolonged exposure to extreme cold

Marathon training Sinus bradycardia may be a normal sinus rhythm in aerobically trained athletes, such as those training for a marathon. Increased intracranial pressure Sinus bradycardia may be caused by increased intracranial pressure. Prolonged exposure to extreme cold Sinus bradycardia may be caused by hypothermia, as may result from prolonged exposure to extreme cold.

Question 3 of 14 Which physiologic process is responsible for repolarization of heart cells? Movement of sodium into the cell Movement of sodium out of the cell Movement of potassium into the cell Movement of magnesium out of the cell

Movement of sodium out of the cell When a cell or groups of cells is stimulated, the cell membrane changes its permeability. This allows sodium to move rapidly into the cell, making the inside of the cell positive compared with the outside (depolarization). A slower movement of sodium ions across the membrane restores the cell to the polarized state, called repolarization.

Question 3 of 4 A patient presents with fatigue, dizziness and chest pain. On assessment, the patient's heart rate is 55 beats per minute and blood pressure is 85/60. A dopamine infusion is ineffective at reducing symptoms and returning vital signs to normal. The nurse should expect the health care provider to schedule the patient for which procedure? Echocardiogram IV atropine administration Synchronized cardioversion Placement of a permanent pacemaker

Placement of a permanent pacemaker Permanent pacemaker therapy may be necessary for a patient who does not respond to atropine or dopamine.

Question 4 of 4 A patient presents with a sinus rate of 150 beats per minute and body temperature of 103 °F; the patient is otherwise clinically stable. How should the nurse prepare to manage the patient's sinus tachycardia? Prepare to administer antipyretics. Prepare to administer IV atropine. Provide the patient information on epinephrine infusion. Provide the patient information on synchronized cardioversion.

Prepare to administer antipyretics. The underlying cause of tachycardia guides the treatment. Sinus tachycardia may be caused by a high fever. Treating the patient's fever would be the first step to treating the tachycardia.

Question 7 of 14 The nurse obtains an ECG for a 53-year-old patient with chest pain. The nurse palpates a heart rate of 106. Which alteration in waveform should the nurse expect to see on the ECG tracing? Inverted T wave Flattened P wave Short QT interval Narrow QRS complex

Short QT interval The nurse would expect a shortened QT interval for tachycardic patients.

Question 4 of 4 Which electrolytes play key roles in polarization of the heart cells? Sodium and potassium Potassium and calcium Potassium and glucose Sodium and magnesium

Sodium and potassium The electrolytes sodium and potassium are partners in cardiac function. A higher sodium level outside the cell allows for a high potassium and low sodium level inside the cell. Potassium inside the cell is required for the conduction of impulses to achieve a polarized state.

Question 3 of 4 An increase in the rate of cardiac impulse initiation is linked to stimulation of which component? Purkinje system Electrolyte system Sympathetic nervous system Parasympathetic nervous system

Sympathetic nervous system The sympathetic nervous system is responsible for increasing the rate of cardiac impulse initiation at the SA node. It also assists with node impulse conduction and cardiac contractility.