EKG Questions

A group of nursing students are discussing atrial flutter. The students recognize that which of the following are seen with atrial flutter? Select all that apply: 1) Ventricular rate of 220-300 bpm. 2) Regular rhythm 3) Saw-tooth pattern 4) Measurable PR interval 5) Long QRS interval

2) Regular rhythm 3) Saw-tooth pattern The ATRIAL rate is 220-300 bpm. Ventricular is about 75-150. The rhythm is regular, with the P wave appearing as little flutter or a "saw tooth pattern". The PR interval is not measurable r/t this saw-tooth P wave. The QRS is normal.

The patient who has recently been experiencing runs of ventricular tachycardia suddenly loses consciousness. The patient is defibrillated, and the rate returns as ventricular fibrillation. What should the nurse do first? A) Begin compressions B) Shock the client again immediately C) Prepare for intubation D) Administer adenosine

A) Begin compressions Following defibrillation, CPR is immediately initiated if a perfusable rhythm is not initiated. The client may need to be shocked again, but chest compressions must begin first.

Which of the following delays the electrical impulse to give time for the atria to complete contraction and the ventricles to fill?

AV node

A _____ is the tracing made by an electrocardiograph

ECG

If a patient is uncomfortable lying flat on the examining table for an ECG test, he can be placed in the

Fowler's position

How is the heart rate from a regular ECG tracing determined?

Multiply the number of QRS complexes in a 6 second strip by 10

Which of the following is a small upward curve that represents the sinoatrial node impulse, wave of depolarization through the atria and resultant contraction?

P wave

The PR segment is located between the...

P wave and QRS complex

The time it takes for electrical impulses to travel from the SA node to the AV node is the?

P-R interval

Which of the following dysrhythmias is due to a heartbeat originating in the ventricles that occurs early in the cycle an dis followed by a pause before the next cycle?

PVC's

The wave or complex that represents ventricular repolarization is the...

T wave

Decreased potassium levels cause what to be visible on an EKG?

U-wave

Which precordial electrode is placed in the fourth intercostal space to the left of the sternum?

V2

Which of the following is a life threatening dysrhythmia that results in no cardiac output?

Ventricular fibrillation

A patient's electrocardiogram monitor begins to sound an alarm and shows sustained ventricular fibrillation. The patient is unconscious and without a pulse. Which of the following priority interventions should the nurse take? a) Defibrillate the patient b) Perform synchronized cardioversion c) Notify the patient's attending physician d) Administer IV push atropine

a) Defibrillate the patient Immediate defibrillation using a nonsynchronized, direct-current electrical shock is mandatory for ventricular fibrillation and for ventricular flutter that has caused loss of consciousness

The client's telemetry reading shows a P wave before each QRS complex and the rate is 78. Which action should the nurse implement? a) Document this as a normal sinus rhythm. b) Request a 12-lead electrocardiogram. c) Prepare to administer the cardiotonic digoxin PO. d) Assess the client's cardiac enzymes.

a) Document this as a normal sinus rhythm. This describes normal sinus rhythm

Which is true about sinus rhythm? a) It is regular. b) It has multiple shapes of P waves. c) It has wide QRS complexes without preceding P waves. d) It as an irregular pattern of QRS complexes.

a) It is regular.

The client is experiencing multifocal premature ventricular contractions. Which antidysrhythmic medication would the nurse expect the healthcare provider to order for this client? a) Lidocaine. b) Atropine. c) Digoxin. d) Adenosine.

a) Lidocaine.

When some sinus impulses get through to ventricles and some do not, resulting in dropped beats, it is considered to be what kind of AV block? a) Second-degree block b) Third degree block c) Complete heart block d) First-degree block

a) Second-degree block

Which statement is true regarding P waves in atrial flutter? a) There are no P waves - they're called flutter waves. b) The P waves are all tall and pointy. c) P waves change shape constantly. d) P waves have an atrial rate of about 100.

a) There are no P waves - they're called flutter waves.

Which of the following arrhythmias is considered to be the most fatal and requires immediate treatment? a) Ventricular fibrillation b) Atrial flutter c) Premature atrial contractions d) Premature ventricular contractions

a) Ventricular fibrillation

The term for slow heart is ___________________. a) bradycardia b) tachycardia c) ectopic d) fibrillation

a) bradycardia

The cardiac cycle's two phases are _________and __________. a) systole; diastole b) preload; afterload c) isovolumetric relaxation; contraction d) atrial kick; ventricular filling

a) systole; diastole

You noticed a wandering baseline on the ECG tracing. What measure(s) should you do to correct the problem? a. Apply new electrodes b. Reposition the electrodes c. Ensure that the wires are not crossed d. All of the answers are correct

a. Apply new electrodes

Which heart block dysrhythmia has regular P-P and R-R intervals with both having the same rate? a. First degree heart block b. Second degree type I c. Second degree type II d. Third degree heart block

a. First degree heart block

Which heart block rhythm is the one with the distinguishing feature of a PR interval that measures greater than 0.20 second and measures the same duration each time? a. First degree heart block b. Second degree type I c. Second degree type II d. Third degree heart block

a. First degree heart block

For placement of the electrodes, how is the ICS located? a. Locating the sternum and feeling for a dip at the edge b. Finding the ribs near the nipple line c. Locating the clavicle and feeling for a dent directly below it d. Locating the space between the clavicle and V4

a. Locating the sternum and feeling for a dip at the edge

What part of the ECG tracing is measured from the end of the S wave to the beginning of the T wave and is normally on the isoelectric line? a. ST segment b. QT segment c. U wave d. QRS complex

a. ST segment

What wave on the ECG tracing is not always seen and sometimes, when seen, can indicate an electrolyte imbalance a. U wave b. P wave c. Q wave d. R wave

a. U wave

When applying chest leads, V6 is placed a. in line with V4 on the midaxillary line b. at the fourth ICS, right sternal border c. at the fifth ICS, left midclavicular line d. at the fourth ICS, left sternal border

a. in line with V4 on the midaxillary line

You notice leads I and II have a lot of artifact while recording a 12-lead ECG. Which electrode is probably not placed appropriately? a. right arm b. left arm c. left leg d. none of the answers are correct

a. right arm

A defibrillator can be used a. to treat an abnormal heart rhythm b. without training c. to produce an electrical rhythm d. to record the patient's breathing pattern

a. to treat an abnormal heart rhythm

Dysrhythmias are...

abnormal heart rhythms

P wave represents what?

atrial depolarization (contraction)

The abbreviation AF is most commonly used for...

atrial fibrillation

The dysrhythmia in which P waves cannot be identified because of rapid multiple electrical signals that fire form areas of the atria other than SA node known as?

atrial fibrillation

This arrhythmia is ___ and is caused by rapid, multiple electrical signals that fire from areas in the atria other than the SA node.

atrial fibrillation

What cardiac condition that demonstrates a sinus rate of 250-350 bpm?

atrial flutter

A series of three or more consecutive atrial premature beats that occur at a frequency greater than 100 bpm is known as...

atrial tachycardia

The client is in a complete heart block. Which intervention should the nurse implement first? a) Prepare to insert a pacemaker. b) Administer atropine, an antidysrhythmic. c) Obtain a STAT electrocardiogram (ECG). d) Notify the health-care provider.

b) Administer atropine, an antidysrhythmic. Will decrease vagal stimulation and increase the heart rate. Therefore, it is the first intervention

The patient with a history of hypertension and diabetes has a rhythm strip indicating atrial flutter. The patient's vitals are as follows: BP 145/89, HR 90, SpO2 95%, RR 19. Which of the following does the nurse expect to do at this time? a) Prepare the client for cardioversion STAT b) Begin administering anticoagulants c) Grab the crash cart for administration of adenosine d) Teach the client about possibility of pacemaker installation

b) Begin administering anticoagulants Atrial flutter places the client at high risk for development of clot formation in the atria. Because the client is stable at this time, cardioversion or adenosine would not be performed at this time. Before cardioversion can occur in a patient, anticoagulant therapy should be begun at least 48 hours beforehand if possible.

Joining leads I, II, and III at their ends produce _____________________________. a) the triaxial diagram b) Einthoven's triangle c) the hexiaxial diagram d) the precordial leads

b) Einthoven's triangle

If a pacemaker fails to fire, what is shown on the EKG? a) Paced beats on top of intrinsic beats b) Lack of a pacemaker spike where there should be one c) Tall, pointy T waves d) Lack of a P wave or QRS complex after the pac

b) Lack of a pacemaker spike where there should be one

Ventricular relaxation occurs during ________________. a) systole b) diastole c) between the lubb and dub of the heart sound d) slow blood pressure

b) diastole

Atrial fibrillation has _______________. a) P waves of multiple shapes b) no P waves at all c) P waves with uniform shape d) sawtooth-shaped waves between the QRS complexes

b) no P waves at all

Which of the following signs and symptoms indicate pacemaker failure? a) excessive thirst b) prolonged hiccups c) flushing of the skin d) increased urine output

b) prolonged hiccups Prolonged hiccups indicate pacemaker failure. Other signs and symptoms of pacemaker failure are dysrhythmias, dizziness, faintness, chest pain, shortness of breath, increase or decrease in apical rate.

When a pacemaker fires, it creates what sign on the EKG? a) P wave b) spike c) T wave d) QRS complex

b) spike

A heart rate greater than 100 is said to be a ______________. a) bundle branch block b) tachycardia c) bradycardia d) myocardium

b) tachycardia

Which ventricular dysrhythmia has a heart rate between 20 and 40 beats per minute? a. Asystole b. Idioventricular c. Accelerated idioventricular d. Ventricular tachycardia e. Ventricular fibrillation f. Agonal

b. Idioventricular

If your patient has an amputated left lower leg, where should you place the electrodes? a. LL on left upper leg, RL on right lower leg b. LL on left lower abdomen, RL on right lower abdomen c. LL on left lower leg, RL on right upper leg d. LL on left lower abdomen, RL on right lower leg

b. LL on left lower abdomen, RL on right lower abdomen

Which of the following heart block dysrhythmias is identified by a repetitious prolonging PR interval pattern after each blocked QRS complex? a. First degree heart block b. Second degree type I c. Second degree type II d. Third degree heart block

b. Second degree type I

When applying chest leads, V1 is placed a. midway between V3 and V5 b. at the fourth ICS, right sternal border c. at the fifth ICS, left midclavicular line d. at the fourth ICS, left sternal border

b. at the fourth ICS, right sternal border

If a QRS complex measures 0.12 second or wider, it most likely indicates a. normal ventricular conduction b. delayed ventricular conduction c. increased delay at the AV node d. myocardial infarction

b. delayed ventricular conduction

When premature complexes occur in a rhythm, they interrupt the underlying rhythm, causing it to be ______ when analyzing it. a. regular b. irregular c. a wider QRS complex d. bradycardic

b. irregular

Frequent nonconducted QRS complexes are likely to cause signs of __________________. a. high cardiac output b. low cardiac output c. kidney failure d. congestive heart failure

b. low cardiac output

Wandering atrial pacemaker rhythm must have ____________ or more differently shaped P waves. a. two b. three c. four d. none of the answers are correct

b. three

What is the easiest site to obtain a pulse on an infant because of its proximity to the surface of the skin?

brachial artery

The most accurate way to determine heart rate is to count the number of _________________. a) P waves in a minute-long rhythm strip b) QRS complexes on a 6-second strip and multiply by 10 c) QRS complexes in a minute-long rhythm strip d) P waves on a 6-second strip and multiply by 10

c) QRS complexes in a minute-long rhythm strip

Lead I shows the difference in electrical voltage between which limbs? a) Right arm and left foot b) Right arm and right foot c) Right arm and left arm d) Left arm and right foot

c) Right arm and left arm

Sinus arrest resembles normal sinus rhythm except for one distinguishing characteristic, which is _________________. a) length of the PR interval b) width of the QRS complex c) absence of occasional PQRST complex d) heart rhythm

c) absence of occasional PQRST complex

If the patient's rhythm changes, you should FIRST ______________. a) look for P waves b) calculate the heart rate, rhythm, and intervals c) assess your patient for signs of decreased cardiac output d) change the lead to see if the rhythm is real or if it's artifact

c) assess your patient for signs of decreased cardiac output

When there is no cardiac electrical activity, it is called _______________. a) death b) myocardial infarction c) asystole d) P wave asystole

c) asystole

Depolarization is a(n) __________________. a) mechanical event that should result in repolarization b) mechanical event that should result in depolarization c) electrical event that should result in muscle contraction d) electrical event that should result in muscle relaxation

c) electrical event that should result in muscle contraction

An abnormal heart rhythm resulting from impulses coming from a focus of tissue in the area of the atrioventicular node is called _______________________. a) bundle branch block b) myocardial infarction c) junctional rhythm d) atrial infarct

c) junctional rhythm

The normal range for an adults pulse is a. 40-80 beats per minute b. 50-60 beats per minute c. 60-100 beats per minute d. 90-120 beats per minute

c. 60-100 beats per minute

Which ventricular dysrhythmia has a heart rate between 40 and 100 beats per minute? a. Asystole b. Idioventricular c. Accelerated idioventricular d. Ventricular tachycardia

c. Accelerated idioventricular

Which atrial dysrhythmia has lowercase "f" waves, chaotic atrial electrical activity, and irregular R-R intervals? a. PACs b. Multifocal atrial tachycardia c. Atrial fibrillation d. Atrial flutter

c. Atrial fibrillation

Which of the following are ways to correct somatic tremor? a. Unplug electrical equipment; move bed away from wall b. Apply electrodes securely; remove tension from lead wires c. Have patient place hands under his or her buttocks; remind patient not to move d. Replace loose electrodes; have the patient turn slightly to the side

c. Have patient place hands under his or her buttocks; remind patient not to move

Which heart block dysrhythmia is known as the "classical" heart block? a. First degree heart block b. Second degree type I c. Second degree type II d. Third degree heart block

c. Second degree type II

Which of the following heart block dysrhythmias is identified by missing QRS complexes and a consistent PR interval measurement? a. First degree heart block b. Second degree type I c. Second degree type II d. Third degree heart block

c. Second degree type II

What part of the ECG tracing represents the repolarization of the Purkinje fibers a. T wave b. PR interval c. U wave d. P wave

c. U wave

Marks on the ECG tracing caused by another source of activity are a. asystole b. conduction marks c. artifact d. arrhythmias

c. artifact

When applying chest leads, V4 is placed a. midway between V3 and V5 b. at the fourth ICS, right sternal border c. at the fifth ICS, left midclavicular line d. at the fourth ICS, left sternal border

c. at the fifth ICS, left midclavicular line

P-P intervals are ______________ with all heart block dysrhythmias. a. irregular b. absent c. regular d. progressively prolonged

c. regular

The horizontal reading on the ECG paper represents ________, and the vertical readings represent _________. a. voltage, time b. time, height c. time, voltage d. voltage, millivolts

c. time, voltage

The sequence of contraction and relaxation that makes up a complete heartbeat

cardiac cycle

The electrical activity of the heart is recorded on the ECG. What does the T wave on the ECG represent? a) Depolarization of the sinoatrial node b) Depolarization of the ventricular conduction system c) Repolarization of the atrium d) Repolarization of the ventricles

d) Repolarization of the ventricles The P wave represents the depolarization of the sinoatrial node. The QRS complex represents the depolarization of the ventricles. The T wave represents repolarization of the ventricles, not the atrium.

A PAC is a _________________________. a) premature beat from the sinus node b) late beat from the atria c) premature beat from the ventricle d) premature beat from the atrium

d) premature beat from the atrium

The T wave represents __________________________. a) atrial depolarization b) atrial repolarization c) ventricular depolarization d) ventricular repolarization

d) ventricular repolarization

When the QRS complex measures ____, bundle branch block must be considered. a. 0.06 to 0.10 second b. 0.04 to 0.08 second c. Less than 0.06 second d. 0.12 second or greater

d. 0.12 second or greater

Which atrial dysrhythmia has capital "F" waves and a classic sawtooth or picket fence appearance? a. PACs b. Multifocal atrial tachycardia c. Atrial fibrillation d. Atrial flutter

d. Atrial flutter

You observe a wide QRS complex while continuously monitoring a patient in lead II. Which lead placement is necessary to evaluate the location of blockage in the bundle branch system? a. Lead I b. Lead V4 c. Lead III d. Lead V1

d. Lead V1

Which of the following dysrhythmias is not considered to be a medical emergency? a. Agonal b. Asystole c. Ventricular fibrillation d. Occasional PVCs

d. Occasional PVCs

What part of the ECG tracing represents the time from the start of the atrial activity to the start of ventricular activity a. QRS complex b. J point c. QT interval d. PR interval

d. PR interval

Which of the following heart block dysrhythmias is identified by regular P-P and R-R intervals that are firing at two distinctly different rates? a. First degree heart block b. Second degree type I c. Second degree type II d. Third degree heart block

d. Third degree heart block

When applying chest leads, V2 is placed a. midway between V3 and V5 b. at the fourth ICS, right sternal border c. at the fifth ICS, left midclavicular line d. at the fourth ICS, left sternal border

d. at the fourth ICS, left sternal border

Which of the following is NOT a reason for performing an ECG? a. to evaluate heart conditions b. to check for problems with the flow of electricity through the heart c. to see how well the heart is contracting and pumping d. to evaluate the rate and rhythm of breathing

d. to evaluate the rate and rhythm of breathing

The electrical impulses responsible for the cardiac cycle that appear on an electrocardiogram as peaks and valleys are called

deflections

The discharge of electrical energy that causes contraction of the heart is called?

depolarization

Which of the following is the electrical impulse that initiates a chain reaction resulting in contraction?

depolarization

What occurs when the ventricles relax and the blood flows into the atrium from the vena cava and pulmonary vein?

diastole

A regular rhythm is one in which the R-R intervals...

do not vary at all

Which ventricular dysrhythmia has a heart rate less than 20 beats per minute? a. Idioventricular b. Accelerated idioventricular c. Ventricular tachycardia d. Ventricular fibrillation e. Agonal

e. Agonal

EKG means...

electrocardiogram

Which of the following is a record of the waves of electrical impulses responsible for the cardiac cycle?

electrocardiogram

The rapid irregular and unsynchronized contraction of the muscle fibers of the heart is...

fibrillation

What phase does the ST segment represent?

initial phase of ventricular repolarization

The QRS measurement for a premature atrial contraction is...

less than 0.12 seconds

Normal QRS complexes should have a QRS complex...

less than 0.12 seconds wide

ST segment elevation is associated with

myocardial injury

Atrial fibrillation EKG readings include...

no P wave present

Atrial tachycardia EKG reading includes...

p waves close to t waves, in which it almost looks like one whole wave

In the first degree AV block...

prolonged PR interval

A heart rate of 60-100 is considered to be...

sinus rhythm

An irregular rhythm is one in which...

the R-R intervals vary "all over the place"

A normal rhythm of the heart has P waves that are...

upright, matching, and precede the QRS complex

QRS complex represents what?

ventricular depolarization

T wave represents what?

ventricular repolarization

An upward deflection of the QRS complex is called an...

R wave

To calculate rate, you must look first at what waves...

R wave

Regularity of a rhythm is determined by measuring the...

R-R intervals

The impulse that travels through both ventricles is the

S wave

Which of the following represents the time it takes for the ventricles and recovery?

S-T segment

The _____ sends out electrical impulses to initiate depolarization?

SA node

Where does the transmission of electrical impulses in the heart begin?

SA node

The classic presentation of ischemia include

ST segment depression and T wave inversion

The ST segment is located between the...

QRS complex to T wave

Which of the following refers to the contraction of the ventricles following depolarization?

QRS complex