Davis Questions CH 16

Increased PR interval duration is associated with which of the following? Couplet AV fibrillation AV block Bigeminy Ventricular fibrillation

AV block

Which conduction abnormality is associated with an increased risk for clot formation? AV block PVC Couplet AV fibrillation Trigeminy

AV fibrillation

Which of the following statements about angina are true? Select all that apply. Angina pectoris is cardiac chest pain that occurs when there is lack of blood flow to the myocardium. Increased oxygen levels and lactic acid formation may play a role in angina. Unstable angina is chest pain the patient is experiencing for the first time. Stable angina is considered a medical emergency. Unstable angina may indicate new damage to the heart.

Angina pectoris is cardiac chest pain that occurs when there is lack of blood flow to the myocardium. Unstable angina is chest pain the patient is experiencing for the first time. Unstable angina may indicate new damage to the heart.

Can you differentiate the various dysrhythmias? For each disorder, drag and drop the statements that apply to the disorder to the box. Ventricular fibrillation

Bizarre ECG waves with no discernible P, QRS, or T waves Loss of consciousness and death Defibrillation is needed Ventricular fibrillation is a life-threatening cardiac dysrhythmia. Loss of consciousness and death are possible, as the ventricular rhythm is completely destabilized. The uncoordinated electrical signaling and contraction of the ventricles leads to an ECG with no recognizable waveforms. Defibrillation is used to reestablish a normal heart rhythm.

A patient's test results reveal a significant occlusion of a coronary artery, and bypass surgery is immediately scheduled. What is another term or acronym for bypass surgery? Stent PCTA Angioplasty CABG Echo

CABG

Samuel has undergone a thallium stress test during which a nuclear scan was performed. When he steps off the treadmill, he becomes lightheaded and loses consciousness briefly. Based on this episode and his test results, the physician feels Samuel needs immediate surgical intervention for his blocked arteries. Which treatment will Samuel receive?

Coronary artery bypass graft Coronary artery bypass graft, or CABG, is a form of treatment used to "get around", or bypass, blocked coronary arteries. Atherosclerotic plaques are usually the cause of this obstruction. In the CABG procedure, a portion of a vein or artery from another part of the body is attached to the blocked coronary arteries in such a way to divert, or detour, blood flow around the blockage. This restores blood flow to the affected areas. CABG may be performed on several vessels, and may be referred to as a "double", "triple", or "quadruple" bypass depending on the number of vessels involved.

Can you differentiate the various dysrhythmias? For each disorder, drag and drop the statements that apply to the disorder to the box. Ventricular tachycardia

HR greater than 100 bpm Series of widened QRS complexes Tachycardia refers to a heart rate greater than 100 bpm. In ventricular tachycardia, the elevated rate begins in the ventricles. As signaling in the ventricles proceeds in an abnormal manner, distortion and widening of the QRS complexes is observed on ECG. Multiple, irregular P waves and increased stroke risk are associated with atrial fibrillation, not ventricular tachycardia.

Can you differentiate the various dysrhythmias? For each disorder, drag and drop the statements that apply to the disorder to the box. Premature ventricular contraction

Infrequent forms do not require treatment Sporadic, widened QRS complex without associated P and T waves As the name implies, a premature ventricular contraction (PVC) occurs when the ventricles contract out of sequence. The cells of the ventricles are electrically active, and sometimes they depolarize on their own. On an ECG, this appears as a wide, distorted QRS complex, as the signal traveling through the ventricles takes longer than normal. Infrequent, isolated PVC's do not require treatment. A PVC results in QRS abnormalities and does not affect P and T wave appearance.

As a nurse working the emergency department, which of the following signs and symptoms are you concerned may indicate a patient is experiencing angina? Select all that apply. Levine's sign Muscle weakness Pain radiating to the jaw and neck Fever Pain alleviated with nitroglycerin

Levine's sign Pain radiating to the jaw and neck Pain alleviated with nitroglycerin

Can you differentiate the various dysrhythmias? For each disorder, drag and drop the statements that apply to the disorder to the box. Atrial fibrillation

Multiple, irregular P waves Increases risk or ischemic stroke by 2 to 7 times Atrial fibrillation is one of the most common serious cardiac arrhythmias. As it affects the atria, and not the ventricles, loss of consciousness and death are not common developments. P, QRS, and T waves are discernible on ECG; however, multiple P waves will appear, often with an irregular shape. Because of the uncoordinated contraction of the atria, blood may pool in the atria, increasing the risk for clot formation and stroke.

Antonia is a 63-year old lawyer with the district attorney's office. She mentions she occasionally gets a crushing pain in her chest that radiates to her neck and jaw that usually last about 5 to 10 seconds. The doctor suspects stable angina. The physician prescribes rest in addition to which treatment?

Nitrates Nitrates, also known as "nitroglycerin", are potent vasodilators. Chest pain, such as Antonia is experiencing, often manifests as a result of poor blood flow through coronary vessels. When blood flow to tissues is reduced, anaerobic metabolism and the subsequent formation of lactic acid occurs, which results in the sensation of pain. By dilating the vessels, nitrates serve to increase blood flow to affected areas, relieving chest pain.

Can you differentiate the various dysrhythmias? For each disorder, drag and drop the statements that apply to the disorder to the box. Third-degree atrioventricular block

No association between P waves and QRS complexes Severe bradycardia, syncope A third-degree AV block may also be referred to as a "complete" heart block, as signals from the atria do not reach the ventricles. Thus, the normal progression from P wave to QRS complex does not occur. The ventricles are able to generate their own electrical impulse; however, this is slower than normal, resulting in severe bradycardia. Patients may also report dizziness and hypotension may be present.

Which of the following treatments utilizes a catheter with a balloon that is inflated to restore blood flow? Stent CABG PCTA STEMI NSTEMI

PCTA

A single, widened QRS complex is referred to as a _______________. PVC couplet bigeminy trigeminy ventricular tachycardia

PVC

Marcus thinks he has the flu, but after his physical examination and diagnostic tests the doctor suspects Marcus has myocarditis. He is given activity restrictions as well as nitrates, beta blockers, and corticosteroids. He is told if his condition is not improving at his follow-up appointment, he may need additional intervention. Which intervention might Marcus need?

Pacemaker Inflammation of the myocardium, or middle layer of the heart wall, is known as myocarditis. The heart muscle cells or the electrical conduction system of the heart may be affected. Myocarditis may present with chest pain, fatigue, light-headedness, and fever. Such symptoms may account for Marcus's belief that he has the flu. When the heart is inflamed, additional stressors on the heart, such as exercise should be avoided. Beta blockers and nitrates are prescribed to increase heart functioning, while corticosteroids are used to reduce inflammation. Disruption of the electrical conduction system may require the insertion of a pacemaker to stabilize the heart rhythm.

Damage to which of the following structures may result in a heart murmur? Pericardium Papillary muscles AV node Bundle branches

Papillary muscles

Phillip is undergoing surgery for unstable angina. The surgeons are inserting a catheter with a balloon tip through the femoral artery of Phillip's leg. The catheter will be threaded up the aorta into the obstructed coronary artery. At the point of obstruction, the balloon is inflated and pushes the plaque content against the walls of the artery. What treatment is Phillip receiving?

Percutaneous transluminal coronary angioplasty Percutaneous transluminal coronary angioplasty (PCTA) is a procedure used to open blocked coronary arteries. PCTA can be used to treat unstable angina and multi-vessel coronary artery disease. The purpose of PCTA is to expand the lumen of a vessel blocked by some type of obstruction, such as an atherosclerotic plaque. Atherosclerotic plaques are initially formed from endothelial injury resulting in the formation of foam cells, which transform into plaques lining the inner wall of the artery. They can become so large that they obstruct blood flow to tissues. Inflating a balloon catheter near the atherosclerotic plaque pushes the plaque to the side of the vessel wall, reestablishing adequate blood flow through the vessel.

Can you differentiate the various dysrhythmias? For each disorder, drag and drop the statements that apply to the disorder to the box. First-degree atrioventricular block

Prolong PR interval Often asymptomatic In a first-degree AV block, the signal from the atria to the ventricles is delayed at the AV node. This delay in signal transmission appears as a prolonged PR interval on an ECG. Eventually the signal does reach the ventricles, so QRS complexes are not dropped. Often, no symptoms are present.

Of the following characteristics, which is associated with a STEMI? Partial occlusion of coronary artery ST segment elevation Partial thickness damage of heart muscle Relatively benign condition Treatment limited to nitroglycerin tablets

ST segment elevation

Can you differentiate the various dysrhythmias? For each disorder, drag and drop the statements that apply to the disorder to the box. Second-degree atrioventricular block

Slower than normal HR Sense of "skipped" heart beat Prolonged PR interval and dropped QRS complexes In a second-degree AV block, some, but not all, impulses from the atria fail to reach the ventricles. As the ventricles are not stimulated to contract, a "skipped" heart beat may be sensed. On an ECG, a missing QRS complex will be noted. Usually, these dropped QRS complexes will be preceded by prolonged PR intervals on the previous cycles.

Can you differentiate the various dysrhythmias? For each disorder, drag and drop the statements that apply to the disorder to the box. PVC Couplet

Two successive PVCs Associated with increased mortality (compared to singular forms) PVC stands for "premature ventricular contraction". Ventricles are electrically active and may contract out of sequence, resulting in a PVC. When two PVCs appear in sequence, it is known as a "PVC couplet". A PVC couplet indicates increased frequency of abnormal signaling, and thus is associated with increased mortality. Severe bradycardia and a decreased heart rate are not observed with PVC couplets

As a nurse examining ECGs, the appearance of which of the following would be most worrisome to you? Atrial fibrillation Ventricular tachycardia Single PVC AV block Couplet

Ventricular tachycardia

Rapid, irregular P waves are known as ____________. ventricular fibrillation ventricular tachycardia AV block atrial fibrillation PVC

atrial fibrillation

A PVC that follows every other beat is called __________. ventricular tachycardia ventricular fibrillation couplet bigeminy trigeminy

bigeminy

Myocardial infarction _________________________. Select all that apply. is synonymous with myocardial ischemia. indicates death of heart tissue. results from increased oxygenation of heart tissue. may produce abnormalities on an ECG. usually resolves on its own, without any treatment.

indicates death of heart tissue may produce abnormalities on an ECG.

Stable angina _____________________. is another name for a heart attack. requires immediate surgical correction. is consistent, chronic chest pain. occurs without signs or symptoms. is chest pain experienced for the first time.

is consistent, chronic chest pain.

Factors that influence the amount of damage an MI causes include _____________. Select all that apply. location gender duration collateral circulation age

location duration collateral circulation

Angina may be relieved by ______________, which vasodilate(s) coronary arteries. glucose tablets oxygen sedatives nitroglycerin tablets morphine

nitroglycerin tablets

Vivienne's tests are showing that she has endocarditis. She has a history of heart issues and had surgery years ago to have prosthetic heart valves inserted. She is told that surgery to remove the valves may be needed, but she will first be given a 6-week round of medication. Which treatment is prescribed to Vivienne?

parenteral antibiotics Endocarditis is inflammation of the endocardium, or inner lining of the heart. The inflammation is usually due to some type of infection, and frequently, as we see in Vivienne's case, involves the heart valves. Prosthetic heart valves can be particularly susceptible to colonization by infectious agents, such as Staphylococcus and Streptococcus bacterium. The fact that Vivienne's treatment involves antibiotic therapy indicates the presence of a bacterial infection. The valves receive a limited blood supply, which makes delivery of medications to the area of infection difficult; parenteral delivery of antibiotics is used.

Inflammation of the sac surrounding the heart is known as ____________. heart failure pericarditis heart murmur AV block ventricular tachycardia

pericarditis

A block at the AV node is likely to appear as a(n) ___________________ on an ECG. prolonged PR interval inverted P wave PVC widened QRS complex couplet

prolonged PR interval

A patient is diagnosed with a STEMI in the emergency room. This means ______________. the patient is experiencing an aneurysm. the patient is experiencing complete occlusion of a coronary artery. the patient is experiencing a minor injury to the heart. the patient is presenting with a normal appearing ECG. the patient requires careful observation but no treatment at this time.

the patient is experiencing complete occlusion of a coronary artery.

A series of widened QRS complexes without associated P and T waves is known as _________. atrial fibrillation ventricular fibrillation ventricular tachycardia bigeminy premature ventricular contraction

ventricular tachycardia