ECG Placement Techniques, Recording, and Interpretation

A. left midclavicular line, 5th intercostal space An ECG test is an important diagnostic tool. Proper placement of the ground and leads is necessary. The V4 electrode should be placed at the left midclavicular line, 5th intercostal space. Special care should be taken to properly align the electrode by the center of the active surface area (it should align with the correct part of the patient's anatomy).

1. Where should the V4 electrode be placed on the body? A. left midclavicular line, 5th intercostal space B. right midclavicular line, 5th intercostal space C. left midclavicular line, 4th intercostal space D. right midclavicular line, 4th intercoastal space

A. atrial contraction. The P wave on an ECG represents atrial contraction. The baseline is the heart at rest. The QRS complex is ventricular contraction, whereas the T wave is ventricular relaxation

10. The P wave of an ECG indicates A. atrial contraction. B. the heart at rest. C. ventricular contraction. D. ventricular relaxation.

C. ventricular fibrillation A ventricular fibrillation is the most life threatening arrhythmia, requiring immediate shock (defibrillation) and BLS intervention to reverse. Though the other choices in this scenario can be important, the ventricular fibrillation could lead to the most dire patient outcome, hence the need for immediate notification of the physician.

12. Which of the following rhythms identified on an ECG prompts the medical assistant to notify the provider immediately? A. sinus bradycardia B. premature ventricular contraction C. ventricular fibrillation D. sinus tachycardia

C. PR interval of 0.14 second, QRS complex of 0.10 second, QT interval of 0.40 second and HR of 78 The PR interval normal range is 0.12-0.2 seconds, the QRS complex range is 0.06-0.10 seconds (greater than 0.12 is considered abnormal and you would need to consider a bundle branch block), the QT interval is approximately 40% of the heart rate. The choice in this question that meets all of these criteria is "C" (PR interval of 0.14 second, QRS complex of 0.10 second, QT interval of 0.40 second and HR of 78).

13. Which of the following indicates a normal sinus rhythm? A. PR interval of 0.22 second, QRS complex of 0.10 second, QT interval of 0.40 second and HR of 78 B. PR interval of 0.22 second, QRS complex of 0.12 second, QT interval of 0.42 second and HR of 72 C. PR interval of 0.14 second, QRS complex of 0.10 second, QT interval of 0.40 second and HR of 78 D. PR interval of 0.14 second, QRS complex of 0.16 second, QT interval of 0.42 second and HR of 72

A. normal sinus rhythm The strip shows normal sinus rhythm because the rate is normal and arrhythmia is not noted. Bradycardia would occur if the rate is slower than 60 and tachycardia is not correct because the rate would need to be faster than 100.

14. Which of the following rhythms is shown in the strip? A. normal sinus rhythm B. sinus bradycardia C. sinus tachycardia D. sinus arrhythmia

A. Avoid scars and incisions. C. Tape the lead wires to the patient's skin. D. Abrade the skin with an alcohol pad or dry 4x4. A Holter monitor is used to monitor a patient's heart during normal activity (for a period of 24-48 hours or up to 30 days). It is a small monitor that can be carried in a pouch or strapped to the waist or shoulder. The electrodes should be placed so they will stay in place for the duration of the monitoring. Avoid scars and incisions when selecting where to place electrodes. Electrodes and lead wires should be secured to the patient. Abrading the skin with a dry 4x4 is one approach to preparing the skin. Lead wires can be placed facing any direction.

2. Which of the following are appropriate actions for the ECG technician to take when placing electrodes on a patient's skin for a 24-hour Holter monitor? (Select the three (3) correct answers.) A. Avoid scars and incisions. B. Place tape directly over electrodes to help secure them to the patient's skin. C. Tape the lead wires to the patient's skin. D. Abrade the skin with an alcohol pad or dry 4x4. E. Place limb leads with tabs facing up.

A. 0.06-0.10 seconds The QRS complex should be recorded for 0.06-0.10 seconds when running an ECG. The PR interval normal range is 0.12-0.2 seconds, the QRS complex range is 0.06-0.10 seconds (greater than 0.12 is considered abnormal and you would need to consider a bundle branch block), the QT interval is approximately 40% of the heart rate.

3. What is the approximate amount of time for the QRS complex to record on an ECG? A. 0.06-0.10 seconds B. 0.04-0.08 seconds C. 0.04-0.12 seconds D. 0.04-0.06 seconds

C.Ensure that new electrodes and clean clips are used. D. Ensure good skin preparation. In this scenario, it is important to make sure good skin preparation and new electrodes and clean clips are used. The other options, though they could potentially create issues on a ECG, are not specific to an obese patient or a wandering baseline. In general, the technician should make sure the patient isn't touching the frame or side rail because this will cause artifact to be present (most exam tables will be metal and have no side rails). The examination table should not touch the wall in order to prevent alternate current interference.

4. The ECG technician is performing an ECG on a patient who is obese, and wandering baseline is present. Which of the actions should the technician take? (Select the two (2) correct answers.) A. Ensure that the examination table is not touching the wall. B. Ensure the patient is not touching the frame or side rail. C. Ensure that new electrodes and clean clips are used. D. Ensure good skin preparation. E. Ensure the patient's arms are folded over the chest.

B. Have the patient slide their hands under their buttocks. A patient with Parkinson's could cause a somatic tremor artifact. The technician should have the patient place their hands under their buttocks which would help hold the arms still so there would be less movement. Parkinson's causes involuntary movements so asking the patient to remain calm would not work. If the patient were to grasp the side of the table, they may grasp too hard and cause tension.

5. A patient with Parkinson's comes in for an ECG with noticeably severe tremors. Which of the following should the medical assistant do to ensure a proper reading? A. Ask the patient to remain calm. B. Have the patient slide their hands under their buttocks. C. Have the patient grasp the side of the table. D. Move the patient into the semi-fowlers position to ease breathing.

D. identify the patient. While all of these answers apply to the overall performance of an ECG, the technician should first establish positive patient identification by asking his/her name and DOB. Confirm the answers by looking at the identification arm band (if present) or patient chart. Then the technician would explain the procedure, provide privacy, and apply the electrodes before proceeding with the ECG.

8. After validating an ECG order, collecting all supplies, and ensuring the machine is in proper working order, the technician's next action should be to A. explain the procedure. B. provide for privacy. C. apply the electrodes. D. identify the patient.

A. Inform the patient of expectations during the testing. B. Explain the symptoms to report if experienced during testing C. Obtain the patient's medical history and current medications. D. Have a crash cart with defibrillator close at hand. An exercise stress test is an important diagnostic tool, but it is not without risk. Several things need to be addressed BEFORE beginning the test. It is important to have a crash cart with defibrillator close at hand. The patient should be informed of what to expect during the testing. The ECG tech should explain the symptoms the patient should report if experienced during stress test. As with most medical procedures, the tech should have documented the patient's medical history and current medications. DURING the stress test, the tech will observe and monitor the patient, documenting symptoms in the chart.

9. Which of the following actions by the ECG technician are likely to be performed prior to exercise stress testing? (Select the four (4) correct answers.) A. Inform the patient of expectations during the testing. B. Explain the symptoms to report if experienced during testing. C. Obtain the patient's medical history and current medications. D. Observe and monitor the patient, documenting symptoms in the chart. E. Have a crash cart with defibrillator close at hand.

B. Monitor the patient for deterioration of symptoms. This rhythm is considered a second degree AV-block due to the extra P-waves. The AV-node will select either to conduct or block the impulses from the SA node. This causes more P-wave than QRS complexes. The medical assistant needs to monitor the patient after notifying the physician. The rhythm strip is a Lead II strip, which means it is from the limb leads, therefore the technician does not need to check the precordial leads V1-6.

After notifying the physician, which of the following should the medical assistant's next action after recording this ECG rhythm on a patient? A. Check precordial (V1-V6) leads and limb placement. B. Monitor the patient for deterioration of symptoms. C. Initiate Emergency Response System or Code Blue. D. Monitor the patient's cardiac output.

A. EEG EEG is the abbreviation for electroencephalogram (a test that measures and records electrical activity in the brain utilizing electrodes). EKG and ECG are both abbreviations for electrocardiogram, and ENT is the abbreviation for ears, nose, and throat.

What is the abbreviation for electroencephalogram? A. EEG B. EKG C. ECG D. ENT

C. echocardiogram An echocardiogram uses high pitched sound waves to create visual images as blood flows through the heart. The test is noninvasive and may also be called a sonogram. An electroencephalogram looks at activity in the brain, an angiogram is a test that takes pictures of the arteries and how blood is flowing through them, and an electrocardiogram monitors how the heart is beating.

Which of the following diagnostic procedures uses ultrasound to display an image of the structure of the heart? A. electroencephalogram B. angiogram C. echocardiogram D. electrocardiogram