exam 12 lead

Which of the following patients would MOST likely present with atypical signs and symptoms of an acute myocardial infarction? 49-year-old obese man 58-year-old diabetic woman 60-year-old man with anxiety 71-year-old woman with hypertension

58-year-old diabetic woman

Which of the following medications would be the MOST acceptable alternative to morphine for analgesia in patients with an acute coronary syndrome? Versed Fentanyl Diazepam Ibuprofen

Fentanyl

Which of the following statements is correct? Lead I is contiguous with lead II. Lead II is contiguous with leads V6 and aVL. Lead V6 is contiguous with leads V4 and V5. Lead III is contiguous with leads II and aVF.

Lead III is contiguous with leads II and aVF.

Which of the following MOST accurately describes an acute myocardial infarction? Death of the myocardium secondary to spasm of a major coronary artery Injury to a portion of the heart muscle secondary to atherosclerotic disease Damage to the left ventricle following occlusion of the left coronary artery Necrosis of a portion of the myocardium due to a prolonged lack of oxygen

Necrosis of a portion of the myocardium due to a prolonged lack of oxygen

A right ventricular infarction is characterized by: ST-segment elevation greater than 1 mm in lead V5R and ST-segment depression in leads II, III, and aVF. ST-segment elevation greater than 1 mm in lead V4R and ST-segment elevation in leads II, III, and aVF. ST-segment depression greater than 2 mm in lead V4R and ST-segment elevation in leads II, III, and aVF. ST-segment elevation greater than 2 mm in lead V5R and ST-segment elevation in leads II, III, and aVF.

ST-segment elevation greater than 1 mm in lead V4R and ST-segment elevation in leads II, III, and aVF.

Injury to the inferior wall of the myocardium would present with: T-wave inversion in leads V1 through V4. ST-segment elevation in leads II, III, and aVF. pathologic Q waves in leads V4 and V5. ST-segment depression in leads V5, V6, and aVL.

ST-segment elevation in leads II, III, and aVF.

Ischemia to the anterior wall of the myocardium would present with: T-wave inversion in leads V3 and V4. ST-segment depression in leads I and aVL. T-wave inversion in leads II, III, and aVF. ST-segment elevation in leads V3 and V4.

T-wave inversion in leads V3 and V4.

Which of the following statements regarding oxygen administration for a patient experiencing an acute myocardial infarction is correct? Evidence has shown that high (greater than 90%) concentrations of oxygen reduce mortality. In order to prevent hypoxic injury, do not give any patient with an acute myocardial infarction more than 2 L/min of oxygen. Treatment with oxygen should be individualized and titrated to maintain the SpO2 level above 94%. Any patient experiencing an acute myocardial infarction should receive high-flow oxygen.

Treatment with oxygen should be individualized and titrated to maintain the SpO2 level above 94%.

Which of the following leads provides the BEST view of the anterolateral wall of the left ventricle? V2 to V3 V4 to V6 V4 to V5 V5 to V6

V4 to V6

On the 12-lead ECG, extreme right axis deviation is characterized by: a positive QRS in lead I and a negative QRS in lead aVF. a negative QRS in lead I and a negative QRS in lead aVF. a negative QRS in lead I and a positive QRS in lead aVF. a positive QRS in lead I and a positive QRS in lead aVF.

a negative QRS in lead I and a negative QRS in lead aVF.

The Levine sign is defined as: pushing on the sternum with the fingertips. rubbing the arm to which pain is radiating. a subconsciously clenched fist over the chest. a state of denial in patients with an acute myocardial infarction.

a subconsciously clenched fist over the chest.

If the ECG leads are applied correctly, the PQRST configuration should be inverted in lead: I. II. aVR. aVL.

aVR

When viewing leads V3 and V4, you are looking at the _________ wall of the _________. septal, heart. lateral, left ventricle. anterior, left ventricle. inferior, right ventricle.

anterior, left ventricle.

Leads V1 to V3 allow you to view the ________ wall of the left ventricle. septal lateral anterior anteroseptal

anteroseptal

Acute coronary syndrome is a term used to describe: acute chest pressure or discomfort that subsides with rest or nitroglycerin. a clinical condition in which patients experience chest pain during exertion. any group of clinical symptoms consistent with acute myocardial ischemia. a sudden cardiac rhythm disturbance that causes a decrease in cardiac output.

any group of clinical symptoms consistent with acute myocardial ischemia.

A diagnosis of acute myocardial infarction is made if ST-segment __________ of ___ mm or more is seen in ___ or more contiguous leads. elevation, 1, two depression, 2, one elevation, 2, one depression, 1, two

elevation, 1, two

When applying the precordial leads, lead V1 should be placed in the: fourth intercostal space at the right sternal border. fourth intercostal space at the left sternal border. fifth intercostal space at the left midclavicular line. fourth intercostal space at the left midclavicular border.

fourth intercostal space at the right sternal border.

You receive a call to a residence for a 44-year-old man who is "ill." The patient, who receives dialysis treatments three times a week, tells you that he has missed his last two treatments because he was not feeling well. As your partner takes the patient's vital signs, you apply the ECG, which reveals a sinus rhythm with tall T waves. The 12-lead ECG reveals a sinus rhythm with inverted complexes in lead aVR. On the basis of your clinical findings, you should be MOST suspicious that the patient is: hypocalcemic. hypernatremic. hyperkalemic. having an acute myocardial infarction.

hyperkalemic

Common signs of left-sided heart failure include all of the following, EXCEPT: confusion. tachycardia. hypotension. hypertension.

hypotension

The presence of a J wave (Osborn wave) on the ECG is an indicator of: a delta wave. hyponatremia. hypercalcemia. hypothermia.

hypothermia

In a patient with left heart failure and pulmonary edema: the right atrium and ventricle pump against lower pressures, resulting in the systemic pooling of venous blood. diffusely collapsed alveoli cause blood from the right side of the heart to bypass the alveoli and return to the left side of the heart. increased pressure in the left atrium and pulmonary veins forces serum out of the pulmonary capillaries and into the alveoli. an acute myocardial infarction or chronic hypertension causes the left ventricle to pump against decreased afterload, resulting in hypoperfusion.

increased pressure in the left atrium and pulmonary veins forces serum out of the pulmonary capillaries and into the alveoli.

The precordial leads do NOT view the __________ wall of the heart. septal inferior anterior lateral

inferior

The pain associated with an acute myocardial infarction: radiates to the left or right arm in the majority of cases. is not influenced by deep breathing or body movement. is most often described as a sharp sensation in the chest. is often relieved by two or three doses of sublingual nitroglycerin.

is not influenced by deep breathing or body movement.

A pathologic Q wave: generally indicates that an acute myocardial infarction has occurred within the past hour. is deeper than one quarter of the height of the R wave and indicates injury. is wider than 0.04 seconds and indicates that a myocardial infarction occurred in the past. can only be substantiated by viewing at least two previous 12-lead ECGs.

is wider than 0.04 seconds and indicates that a myocardial infarction occurred in the past.

The circumflex branch of the left coronary artery supplies the _________ wall of the left ventricle. septal lateral anterior inferior

lateral

Lead I views the ________ wall of the heart, while lead aVF views the _________ wall of the heart. lateral, inferior septal, anterior posterior, septal anterior, inferior

lateral, inferior

Patients experiencing a right ventricular infarction: may present with hypotension. should not be given baby aspirin. often require higher doses of morphine. usually have anterior myocardial damage.

may present with hypotension.

Patients who are experiencing an infarction of the right ventricle: should not be given IV fluid boluses. often require high doses of nitroglycerin. are usually hypertensive and tachycardic. may present with significant hypotension

may present with significant hypotension.

Infarctions of the inferior myocardial wall are MOST often caused by: blockage of the left coronary artery. acute spasm of the circumflex artery. occlusion of the right coronary artery. a blocked left anterior descending artery

occlusion of the right coronary artery.

Stable angina: typically subsides within 10 to 15 minutes. occurs after a predictable amount of exertion. usually requires both rest and nitroglycerin to subside. is characterized by sharp chest pain rather than pressure.

occurs after a predictable amount of exertion.

In contrast to stable angina, unstable angina: occurs following periods of strenuous exertion. often awakens the patient from his or her sleep. indicates that myocardial necrosis has occurred. is less frequent but is associated with more pain.

often awakens the patient from his or her sleep.

The inferior wall of the left ventricle is supplied by the: right coronary artery. left coronary artery. circumflex artery. left anterior descending artery.

right coronary artery.

Cardiac arrhythmias following an acute myocardial infarction: tend to originate from ischemic areas around the infarction. typically manifest as atrial fibrillation or atrial tachycardia. generally originate from the center of the infarcted tissues. are uncommon within the first 24 hours after the infarction

tend to originate from ischemic areas around the infarction.

When monitoring a patient's cardiac rhythm, it is MOST important to remember that: a heart rate below 60 beats per minute must be treated immediately. many patients with acute myocardial infarction experience asystole. the ECG does not provide data regarding the patient's cardiac output. the presence of a QRS complex correlates with the patient's pulse.

the ECG does not provide data regarding the patient's cardiac output.

Anatomically contiguous leads view: opposite walls of the heart. only the lateral wall of the heart. the same general area of the heart. only the anterior wall of the heart

the same general area of the heart.

Death in the prehospital setting following an acute myocardial infarction is MOST often the result of: asystole. myocardial rupture. cardiogenic shock. ventricular fibrillation

ventricular fibrillation.

Most patients with an ST-elevation myocardial infarction: will develop Q waves. heal without treatment. experience cardiac arrest. present without chest pain.

will develop Q waves.