Chapter 49

When the ECG paper is moving at a standard rate of 25 mm per second, what does the distance across 2 large squares on the paper represent?

0.4 second

The sensitivity level when obtaining an ECG should be set to ______ unless instructed otherwise.

1

Smoking or eating within ______ of spirometry may affect the results.

1 hour

Each small square on ECG paper measures

1 mm by 1 mm.

Viral infections or acute illness within the previous ______ days may affect spirometry results.

14 to 21

How many peak flow zones are there?

3

How many readings should you take when you are measuring a patient's peak expiratory flow rate?

3

If the peaks on an ECG tracing are too close together, the paper speed should be increased to ______ mm per second to separate the peaks.

50

Green

80-100% of highest peak flow; good asthma control

Which of the following would make a spirometry maneuver unacceptable?

A cough during the first second

In which direction should the electrode tabs point for a 12-lead ECG?

Arm electrodes down, leg electrodes up, precordial electrodes down

When should you insert a fresh battery in the Holter monitor?

Before placing the unit on the patient

Which of the following waves is an upward curve that represents recovery?

T

AV node

Delays the electrical impulse to allow the atria to complete their contraction and the ventricles to fill before the next contraction

How can you avoid placing tension on the wires, cable, and electrodes when the patient moves?

Tape them with extra lengths to permit movement.

Spirometry

Test used to measure breathing capacity

What is a patient's peak expiratory flow rate?

The greatest rate of flow during forced expiration

Which of the following is the most accurate description of forced vital capacity (FVC)?

The greatest volume of air that can be expelled when a person performs rapid, forced expirations

Where do PVCs originate from?

The heart's ventricles

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

PVCs

What instrument is used to measure a patient's peak expiratory flow rate?

Peak flow meter

Red

Peak flow rates are less than 50%; medical emergency

Deflection

Peaks and valleys observed in an ECG tracing

Stylus

Penlike instrument on an ECG machine

Which precordial electrode is located by counting to the fourth intercostal space to the right of the sternum?

V1

______ is placed in the fourth intercostal space, to the right of the sternum.

V1

______ is placed in the fourth intercostal space, to the left of the sternum.

V2

Which type of electrodes come with an electrolyte preparation in place?

Disposable

Purkinje fibers

Distribute the electrical impulses through the right and left ventricles

When obtaining a peak-flow rate, you should ____ the ____ readings.

Document, highest

Which of the following represents the time it takes for the ventricles to contract and recover, or repolarize?

Q-T interval

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

QRS complex

If a lead does not appear on an ECG tracing, what step should be taken before repeating the tracing?

Reconnect the wire.

To what portion of the limbs should electrodes be applied?

Fleshy

The greatest volume of air that can be expelled when a person performs rapid, forced expiration is

Forced vital capacity

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

Fowler's position

Forced vital capacity

Greatest volume of air that can be expelled during rapid, forced expiration

The physician assesses a patient's rhythm by viewing the rhythm strip obtained from which lead?

II

The standard limb leads appear on the ECG tracing as

III. II. I.

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

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

What must the patient wear to ensure that he or she does not breathe through the nose during spirometry testing?

Nose clip

The deflections that occur on an ECG are labeled with the letters __________.

P, Q, R, S, T, and U

The __________ send(s) out electrical impulses to initiate depolarization.

SA node

Which of the following initiates the heartbeat?

SA node

Ventricular fibrillation

Saw-tooth image

Cardiac cycle

Sequence of contraction and relaxation of the heart

Before patients are connected to a Holter monitor, they must sign a(n)

consent form.

In a regularly spaced complex, the distance between 1 P wave and the next P wave is

consistent.

Lead

View of the electrical activity of the heart

Acceptable maneuvers for successfully obtaining spirometry results include

a quick/forceful start. no coughing. a fast, consistent flow. an adequate length of time.

Each lead provides an image of the heart's electrical activity from a different

angle.

To obtain a good-quality tracing, medical assistants must be able to recognize a(n).........or a generally defective ECG tracing.

artifact

Which of the following is an erroneous mark or defect that may appear on an ECG strip?

artifact

Erroneous marks or defects on a strip are called

artifacts.

During exercise electrocardiography, the patient may be at risk of suffering

cardiac arrest. cardiac distress. a myocardial infarction.

Exercise electrocardiography is also known as a(n) _______ test.

cardiac stress

The instrument that measures and displays the electrical impulses responsible for the cardiac cycle is a(n) __________.

electrocardiograph

Stress echo-echocardiography is usually performed along with ______ to assess the heart's response to increased demand.

electrocardiography

Which of the following is the process by which a graphic pattern is created from the electrical impulses generated in the heart as it pumps?

electrocardiography

A basic understanding of the conduction system and how it appears on an ECG tracing is essential when performing

electrocardiography.

Each heartbeat produces an electrical ______, which can be measured with an electrocardiograph.

impulse current

Limb electrodes are most commonly placed on the inside of the fleshy part of the calf muscle and on the outside of the

upper arm.

When performing an electrocardiograph, it is important to explain the ______ to the patient.

procedure

The peak flow zone that requires immediate medical treatment is the __________.

red zone

A ______ ECG machine prints the record on a long, thin strip of ECG paper.

single-channel

Which of these is a component of an acceptable maneuver for spirometry?

minimum of 6 seconds

ECG accuracy can sometimes be affected by electrical currents emitted from

nearby machines.

A stress test assesses the heart's conduction system during exercise, when the patient's demand for ______ increases.

oxygen

While running an ECG, it is very important that the ______ remain still.

patient

Polarity is having either ______ poles.

positive or negative

On an ECG tracing, heart rate can be determined by counting the number of QRS complexes in a 6-second strip and then multiplying by

10.

If very low peaks appear on the ECG tracing, the sensitivity level should be set to ______ to increase the height of the peaks.

2

Patients usually wear a Holter monitor for ______ hours.

24 - 48

ECG paper is normally run at a rate of ______ mm per second for adults.

25

ECG paper speed is usually set to ______ mm per second unless instructed otherwise.

25

How many valid maneuvers must you obtain during a test for forced vital capacity?

3

Holter monitors have either ______ electrodes.

3 or 5

Each large square on ECG paper measures

5 mm by 5 mm.

Yellow

50-80% of highest peak flow; lungs airways are beginning to constrict

During spirometry, the patient must blow hard and fast for at least ______ seconds.

6

Premature ventricular contractions

A beat that occurs early in the cycle followed by a pause before the next cycle

Which of the following is a correct statement about the stylus temperature control?

A higher temperature produces a heavier line.

For which of the following patients is a Holter monitor most likely to be ordered?

A patient that has intermittent chest pain and a normal resting ECG

Turning off unnecessary electrical equipment in the room when performing an ECG is helpful in reducing which type of artifact?

AC artifact

Which of the following delays the electrical impulse for muscle contraction, giving the atria time to contract completely and fill the ventricles with blood?

AV node

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

AV node

You are performing an ECG on Mr. Nielsen, but his heart rate is so fast that the electronic deflections on the ECG paper are too close together to be seen clearly. What should you do?

Adjust the speed selector to 50 mm per second.

When should medical assistants wash their hands when obtaining a peak expiratory flow rate?

After the procedure Before the procedure

How should you instruct the patient to blow into the mouthpiece of the peak flow meter?

As fast and hard as possible

PFTs are used to monitor which of the following conditions?

COPD Asthma Cystic fibrosis

Bundle of His

Conducts electrical impulses from the atria to the ventricles

Which of the following should you instruct the patient to do while wearing a Holter monitor?

Continue normal activities

Which type of ECG machines standardize the wave output height automatically?

Digital

Which of the following is performed to evaluate the signs and symptoms of heart disease, to detect abnormal heart rhythms, to evaluate progress after an MI, or to check the effectiveness or side effects of certain medications?

ECG

Holter monitor

ECG device that includes a small recorder and is worn by the patient over a period of time to record the electrical activities of the heart

Which of the following uses ultrasound to view the heart in motion?

Echocardiography

Electrode

Electrical impulse sensor

Depolarization

Electrical impulse that initiates a chain reaction, resulting in contraction

Which of the following are attached to the patient's skin during electrocardiography?

Electrodes

Which communication would alleviate a patient's anxiety about having an electrocardiography?

Encourage the patient to ask questions and verbalize her concerns.

Pulmonary function test

Measures and evaluates lung capacity and volume

Which type of ECG units record more than 1 lead at a time?

Multichannel

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

P

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 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 measures and evaluates lung capacity and volume?

PFTs

If a flat line occurs on more than one lead, what probably happened?

Two of the wires may be switched

How do you calculate the peak expiratory flow rate from the three readings?

Use the highest reading as the peak expiratory flow rate.

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

V2

Which precordial electrode is placed in the fifth intercostal space, where it intersects an imaginary line drawn straight down the middle of the clavicle?

V4

Which of the following are precordial leads?

V6 V3 V4

You are performing an ECG on Ms. Donovan, and you notice artifacts on the tracing. The room is cold, and the patient is shivering in spite of the blanket you provided. What type of artifact are you most likely encountering?

Wandering baseline

When should the patient be disconnected from the ECG machine?

When the quality of the ECG tracing is acceptable

The augmented limb leads appear on the ECG tracing as

aVR. aVF. aVL.

Patients should be advised to record all ______, emotional upsets, physical symptoms, and medications taken while wearing a Holter monitor.

activities

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

atrial fibrillation

Of the 6 limb leads, 3 are standard and the other 3 are

augmented.

Precordial leads are also referred to as ______ leads.

chest

Pulmonary function tests are useful in monitoring which condition?

chronic obstructive pulmonary disease

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

deflections

An electrical impulse that initiates a chain reaction leading to contraction is

depolarization.

Which of the following results in a flat line on the ECG tracing?

detached/loose wire

Peak flow meters are used to

determine asthma triggers determine the effectiveness of asthma treatment plan know when to seek medical care

Often times, a series of ECGs is performed before a doctor can make a(n)

diagnosis. assessment. treatment plan.

Artifacts on an ECG tracing may make it difficult for the physician to make a(n)

diagnosis. plan of care. assessment.

The most common type of electrode is

disposable.

The most commonly used electrodes are

disposable.

Heart rate irregularities may result from conduction abnormalities or reactions to certain

drugs.

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

electrocardiogram

Disposable electrodes come with _______ gel pre-applied.

electrolyte

A substance that enhances the transmission of electrical currents is called a(n)

electrolyte.

Some Holter monitors include a(n) ______ button to mark an area on the recording.

event

A(n) ______ on an ECG tracing is usually caused by a loose or disconnected wire.

flat line artifact

Electrodes for limb leads should be attached to __________.

fleshy portions of the limbs

The greatest volume of air that can be expelled when a person performs a rapid, forced expiration is the __________.

forced vital capacity

The greatest amount of air that can be expelled when a person performs rapid, forced expiration is called

forced vital capacity.

If the patient has good control of her asthma, her peak flow rate is in the __________,

green zone

Stress echo-echocardiography is performed before and after exercise or the injection of a drug that makes the heart work

harder and faster.

ECG paper is

heat- and pressure-sensitive.

A(n) ______ is an electrocardiography device that records the heart's electrical activity over a period of time.

holter monitor

Before an electrocardiograph is used, the date of its last ______ should be checked.

inspection

Before using an electrocardiograph, it is important to check the date of its last....., to ensure the safety of both patient and practitioner.

inspection

Some multichannel ECGs provide a(n) ________ of the electrocardiogram.

interpretation diagnosis

To make the patient feel comfortable prior to an electrocardiogram, medical assistants should

introduce themselves. explain the procedure. answer any questions.

All ECG machines have a ______ selector that allows each lead to run individually.

lead

The different views recorded on an electrocardiogram that are produced by the electrical activity of the heart are __________.

leads

The impulses received through various combinations of electrodes constitute different ______, which are recorded on an ECG.

leads

The images obtained from all leads together provide the doctor with a full picture of the electrical activity moving

left and right. up and down. forward and backward.

Leads I and III obtain tracings from the ______ electrode.

left arm

Leads II and III obtain tracings from the ______ electrode.

left leg

During Holter monitoring, the patient's clothing should be

loose-fitting.

AC interference can be prevented by __________.

making sure lead wires are not crossed and following the contour of the body

An inadequately warmed stylus, an inadequate electrolyte, and improper application of electrodes are ______ problems that can cause a wandering baseline.

mechanical

The causes of a wandering baseline include a variety of ______ problems.

mechanical

The parts of a spirometer include a ______ with or without a tube to carry air to the machine, a mechanism to measure the volume or flow of air, and a means of calculating and printing the results.

mouthpiece

Artifacts can be caused by

poor conduction. interference. improper technique.

Possible causes for a wandering baseline are __________.

poor skin preparation, dangling wire, or improper application of electrodes

Which of the following measures and evaluates a patient's lung capacity and volume?

pulmonary function test

PFT is an acronym for

pulmonary function test.

The Holter monitor includes a small ______ worn around the patient's waist.

recorder

The resting period of the heart occurs during

repolarization

Before attempting to perform spirometry and peak flow testing, medical assistants should have a good understanding of __________ anatomy and physiology.

respiratory

The most common single-channel units allow the attachment of all electrodes at the same time and obtain a manual or automatic printout of individual leads, which is also referred to as a(n)

rhythm strip.

The image of the heart is clearer in transesophageal echocardiography because the transducer is closer to the heart and the sound waves do not have to penetrate the

ribs.

PFTs may be ordered on a patient who suffers from

shortness of breath.

If a patient has had an arm amputated, both electrodes should be placed at ______ level.

shoulder

An instrument used to measure the air taken in by and expelled from the lungs is the __________.

spirometer

To obtain FVC, the patient must take as deep a breath as possible and exhale into the ______ as quickly and completely as possible.

spirometer

An instrument used to measure the air taken in and expelled from the lungs is called a(n)

spirometer.

Of the 6 limb leads, 3 are ______ and the other 3 are augmented.

standard

When pressed, which of the following should cause the stylus to move up 10mm (10 small squares) and remain there for 0.08 second (2 small squares or 2 mm)?

standardization control

An exercise ECG is also referred to as a(n) ______ test.

stress

Which test is utilized to measure the heart's conduction system during exercise, when the demand for oxygen is increased?

stress testing

A penlike instrument, called a(n) ______, records movement on ECG paper.

stylus

The heated ______ on the electrocardiograph acts as a pen and records the ECG pattern on the paper.

stylus

Which of the following is a pen-like instrument that records impulse movement on the ECG paper?

stylus

Before running an ECG, remind the patient to be still and not to

talk.

In addition to the upper arm and calf muscle, limb electrodes may also be placed

thigh. above the wrist. on the abdomen.

If a patient has had a leg amputated, both leg electrodes should be placed on the

thighs. abdomen.

Transthoracic echocardiography involves moving an ultrasound ______ around on the chest and/or abdomen to create heart images.

transducer

During ______ echocardiography, the transducer is passed through the esophagus to produce a clearer image of the heart.

transesophageal

During ______ echocardiography, the ultrasound transducer is moved around on the chest and/or abdomen to produce heart images.

transthoracic

An echocardiogram can be performed ______.

while the patient is at rest

Which peak flow zone indicates that large airways are beginning to narrow?

yellow zone

A device used to monitor the heart's electrical activity over a 24-hour period is called a(n)

Holter monitor.

Which type of spirometer measure air volume and airflow, perform various calculations, and print a graphic representation of the information?

Computerized

Polarity

Condition of having 2 poles, 1 of which is positive and the other negative

Bundle branches

Conduct impulses down both sides of the interventricular septum

Which of the following should a patient do when wearing a Holter monitor?

Inform the office if the monitor is not working properly

Which of the following may affect the accuracy of spirometry?

Recent heart attack

You have obtained the correct number of acceptable maneuvers from Mr. Jackson. What should you ask him to do next?

Remain until the physician has reviewed the results

Which of the following is the primary pacemaker of the heart?

SA node

The parts of the conduction system are the

SA node. Purkinje fibers. bundle of His.

Which of the following is appropriate when preparing the room and equipment for an electrocardiogram?

Select a room away from all other electrical equipment.

What is used to adjust the height of the standardization mark and the tracings if the peaks are too high or too low?

Sensitivity control

Which of the following is not a correct step in preparing the electrode sites on the patient's skin?

Shave the entire area closely.

Atrial fibrillation

Small, irregular, uncoordinated complex that are difficult to interpret

Which of the following are basic respiratory procedures performed by medical assistants?

Spirometry Peak flow

A peak expiratory flow rate is taken to determine the amount of ______ that can be quickly forced from the lungs.

air

Electrical currents from equipment, such as ______, may interfere with obtaining a good-quality ECG tracing.

air conditioners refrigerators fans

Which of the following is used to assess the electrical activity of a patient's heart over a 24-hour period of normal activity?

ambulatory monitoring

How many electrodes are needed to produce a 12-lead ECG?

10

Which of the following features are assessed by an ECG?

Heart rate Wave changes Heart rhythm

An ECG evaluates the __________ and a PFT evaluates the __________.

Heart; lungs

Which of the following should you ask a patient to do before measuring forced vital capacity using spirometry?

Loosen tight clothing

Which of the following is the condition of having 2 separate poles, 1 positive and 1 negative?

Polarity

The impulse that travels through both ventricles is the __________.

S wave

Which of the following is a test used to measure breathing capacity?

Spirometry

Which of the following are reasons for conducting an ECG?

To evaluate the signs and symptoms of heart disease To evaluate progress after an MI

How do you prepare patients for spirometry?

have them wear a nose clip

The sensitivity control is normally set on

1.

SA node

Initiates heartbeat with an electrical impulse that causes depolarization

Electrocardiograph

Instrument that measures and displays the electrical impulses of the heart

Repolarization

Period of electrical recovery

What will help you obtain the best-quality ECG tracing?

Proper technique