CCT
When explaining the Bruce protocol expectations to the patient prior to starting the exercise stress test, which statement will the health care technician make?
"At Stage VII you will be running uphill at a steep incline for 3 minutes.
Which statement will be made when educating the patient on resting EKG procedure expectations?
"To perform the 12-lead EKG, 10 electrodes are placed on various parts of your body.
What is this rhythm?
. Sinus rhythm with PVCs
The technician is performing an exercise stress test using a submaximal modified Bruce protocol for a 70-year-old patient who was admitted and diagnosed with a myocardial infarction (MI) two weeks ago. At what heart rate can the technician conclude the test, assuming the patient is asymptomatic?
105
The technician is assisting with a pharmacological stress test on a 65-year-old patient. What percentage of the patient's target heart rate will the technician consider a valid and complete test?
85%
When performing a standard EKG, what action will avoid artifact and obtain the best quality tracing?
Asking the patient to remain still.
What does the PR interval represent in the normal cardiac cycle?
Atrial depolarization and AV delay.
Which instruction will be provided to the patient when reviewing safety procedures of the exercise stress test?
Avoid eating at least four hours prior to the test to avoid nausea."
When explaining the safety procedures of the exercise stress test, which instruction should be provided to the patient?
Be sure to tell me if you have any chest pain and we will evaluate if we need to stop the test."
A health care practitioner reviews the physician's order for an exercise stress test and notes that the test will include increasing the treadmill's speed and incline every 3 minutes for a total of 21 minutes. Which exercise test protocol has the physician ordered?
Bruce protocol
What is true regarding inverted P waves found in Lead II on an EKG tracing?
Conduction occurred in a retrograde manner.
What is the key to obtaining correct EKG waveforms?
D. placement of electrodesIn the resting EKG,
A health care provider is caring for a patient who has a heart rate of 42 bpm, a prolonged PR interval, and low blood pressure. When analyzing this data, which condition is the health care provider concerned about?
Decreased cardiac output
After attaching the patient to the Holter monitor, what instruction is appropriate to provide to the patient?
Do not shower with the monitor on
Which statement is true when preparing to transport a patient on continuous EKG monitoring?After attaching the patient to the Holter monitor, what instruction is appropriate to provide to the patient?
Ensure proper adhesion of electrodes and transport as necessary.
How is a right-sided EKG performed?
Exactly like a left-sided one except the electrodes are placed on the right side of the chest instead of the left
What is true regarding electrode placement for the resting EKG?
Four electrodes are attached to the upper and lower extremities; six electrodes are attached to the upper chest.
When preparing the patient for an EKG, what action should the technician take if the electrodes do not adhere properly to the patients skin?
Gently abrade the thin upper layer of the skin.
What is the purpose of collecting patient demographics and entering them into the EKG machine?
Help ensure placement into the correct patient's chart
What supplies or equipment would the nurse gather specific for the pharmacologic stress test only?
IV start kit
When reviewing safety procedures with the patient prior to the start of the exercise stress test, which of the following instructions is the most appropriate re: stopping the test?
If you want to stop the test, I am going to first ask you why you want to stop."
Which form must the patient sign prior to the surgical placement of a permanent pacemaker?
Informed consent
Question Help What is the difference between myocardial injury and infarction, according to EKG findings
Injury causes ST segment elevation; Infarct causes significant Q waves
In order to compare ST changes before and during an exercise stress test, what is one method the nurse may use when performing a baseline EKG?
Instruct the patient to breathe rapidly.
What is the purpose of the ground electrode in a12-lead EKG?
It helps to prevent electrical shock.
Question Help Which statement is true regarding the ST segment under normal circumstances?
It is isoelectric
Question Help What is a limitation of the Holter monitor?
It is unable to record all cardiac events.
Which description best describes how a pacemaker functions?
It sends out an electrical signal.
Which description best describes a universal pacemaker?
It senses and paces both the atria and ventricles
patient's EKG tracing has four normal beats then shows a sudden, long pause with no P wave and a wide, bizarre-appearing QRS complex. Which step must the health care provider take in order to determine the rhythm?
Measure the length of the pause in seconds.
A patient's EKG reveals four premature atrial complexes (PACs) in a 1-minute strip. Which is the best course of action the health care practitioner should take?
Monitor the patient and notify the physician if PACs continue, get worse, or if the patient's condition worsens.
Question Help A patient is seen in an outpatient cardiology office after a recent permanent pacemaker placement. Which finding would indicate that the pacemaker is failing to capture?
Pacemaker spikes not followed by P waves or QRS complexes.
Prior to placing the electrodes on the patient for EKG, what is the priority action of the technician?
Performing hand hygiene.
Question Help What unique consideration should be taken when attaching a female patient to a Holter monitor?
Place the chest leads under the breast.
When identifying a patient prior to a procedure, which statement will be technician use?
Please tell me your full name and date of birth
Which EKG component represents ventricular depolarization?
QRS complex
Question Help A health care provider is analyzing a patient's EKG tracing and notes that the patient's ST segments are above baseline, there are inverted T waves as well as significant Q waves. What alteration in cardiac function does the health care provider suspect?
STEMI
The health care provider analyzes data obtained by the patient's EKG. The provider notes a heart rate of 58 bpm, regular rhythm, one P wave to each QRS complex, and a PR interval of 0.14 sec. Which rhythm is analyzed?
Sinus bradycardia
A patient attempts an exercise stress test using Bruce protocol, but cannot complete the test due to the strenuous nature of the protocol. Which action should the technician take?
Suggest a modified Bruce protocol to the prescribing physician.
What does the EKG machine record?
The movement of sodium into the cardiac cell at the same time that potassium moves out of the cell.
The health care provider obtains the patient's apical pulse and notes the pulse is irregular with a rate of 66 to 156 bpm. What will the health care provider conclude from these findings?
The patient needs an EKG to determine the nature of the arrhythmia.
When identifying proper landmarks of 12-lead EKG electrodes, where is lead V2 placed?
The space below the 4th rib where it joins with the sternum on the patient's left side
A health care provider is assisting in CPR and defibrillation for a patient who is pulseless and apneic whose cardiac monitor reveals ventricular fibrillation (VF). Which statement is true regarding the patient's cardiac function as it correlates to the EKG findings?
The ventricles are quivering and not contracting
A patient's EKG tracing reveals atrial fibrillation. What is true regarding the patient's heart function due to this cardiac rhythm?
The ventricles do not completely fill with blood
Prior to attaching the EKG electrodes, which statement should be made to the patient?
These electrodes do not cause electrical shock
Why do ischemia and injury of the myocardial tissue cause changes to the ST segments and T waves?
They both cause repolarization changes
When a health care provider suspects the patient may have a posterior MI, what is the best way to analyze the resting EKG tracing?
Turn the EKG tracing upside down and look at V1 and V2 from the back of the tracing.
Which electrode is placed just lateral to V1, at the left of the sternum, at the fourth intercostal space?
V2
Which electrode is placed on the chest over the ventricular septum?
V3
Which electrode is placed at the left midaxillary line, level with V4?
V6
Which type of rhythm is seen in the EKG tracing below?
Ventricular fibrillation
Which type of rhythm is seen in the EKG tracing below?
Ventricular tachycardia
After receiving the physicians order to conduct an exercise stress test on a recently admitted patient,what is the next action of the technician?
Verify the physicians orders.
Prior to the start of the exercise stress test, the technician is teaching a 60-year-old patient about the Bruce protocol expectations. Which statement will the technician make regarding expected heart rate during the test?
Your heart rate will need to be at least
Question Help When gathering the supplies for placing a patient on a Holter monitor, what will the tech choose for prepping the patient's ski
a mild abrasive pad
A terminally ill patient in hospice care has an EKG tracing that reveals a heart rate of 18 bpm that is irregular in nature, no P waves, and wide and bizarre-shaped QRS complexes. How will the health care provider record these findings?
agonal rhythm
Which rhythm results when these characteristics are found on an EKG tracing in a patient on chronic anticoagulant therapy? Atrial Rate: 350-600 Rhythm: Irregularly irregular P wave: Not discernible QRS interval: 0.08 PR Interval: Not discernible
atrial fibrillation
In which position(s) is/are the patient's baseline vital signs obtained prior to performing an exercise stress test?
both standing and lying down
A patient with a sustained heart rate between 110 and 125bpm begins exhibiting signs of decreased cardiac output. Which symptom will the health care provider likely note when obtaining data from the patient assessment?
decreased urine output
What is the sudden change in electrical charge within a cell that can be recorded on the EKG as indicated by the P wave and QRS complex?
depolarization
A 20-year-old black man with no cardiac complaints has mild ST elevation in leads V2 and V4 on the EKG tracing. Which condition does the health care provider suspect?
early repolarization
When using the Naughton protocol for exercise stress tests, how frequently will the technician change the settings?
every 2 minutes
A patient has sinus tachycardia with a rate of 110 bpm. Which condition is consistent with this rhythm?
fever
Where is the electrode for Lead V1 placed?
fourth intercostal space, right sternal border
To prevent macroshock, what should the technician check regarding the EKG equipment?fraying of wires
fraying of wires
When verifying and comparing the Bruce and Naughton exercise stress protocols, which statement is true?
he settings in the Naughton protocol change more quickly than in the Bruce protocol.
A technician performs an EKG on patient and notes the presence of a U wave. What is the likely cause of this?
hypokalemia
A health care practitioner notes ST elevation in Lead II after performing a resting EKG. Where is the likely infarct located?
inferior surface of the left ventricle
If a patient has an occlusion to the left anterior descending (LAD) coronary artery, which location of the heart will likely be affected?
interventricular septum and the anterior left ventricle
A health care provider notes new T wave inversions on the patient's EKG tracing. What is the likely cause of this finding?
ischemia
Where is likely occlusion in a patient diagnosed with a 'widow maker' myocardial infarction (MI)?
left main coronary artery (LMCA)
Which patient information should be entered into the EKG machine?
name, DOB, sex, height, weight
Which protocol will the technician expect to use in a patient who was discharged from the hospital earlier in the day?
naughton
Question Help Which finding would be consistent with a VVI pacemaker?
no relationship between P waves and paced QRS complexes
What rhythm results when these characteristics are found on an EKG tracing? Rate: 66 Rhythm: Regular P wave: Uniform and consistent QRS complex: 0.05 seconds PR Interval: 0.12 seconds
normal sinus rhythm
What type of rhythm is seen in the EKG tracing below?
pacemaker
What supplies or equipment may be necessary when performing a resting EKG?
patient gown
Which type of stress test is best for a 75-year-old patient with poor exercise tolerance?
pharmacological
To record electrical activity from the limb leads, where will the technician place the electrodes?
right and left arms; left leg
Inferior STEMIs (ST-elevation myocardial infarctions) are caused by the blockage of which artery?
right coronary artery (RCA
In the resting EKG, where is the ground electrode placed?
right foot or leg
What type of AV block is seen in the EKG tracing below?
second degree, type 1
The health care practitioner is monitoring a patient on a continuous EKG. The patient's heart rate appears to increase when the patient inhales and slows down upon exhalation. What rhythm does the health care practitioner suspect the patient has?
sinus arrhythmia
Which rhythm shown below is typically associated with respiration?
sinus arrhythmia
Which rhythm shown below is often found in patients receiving cardiac medications?
sinus bradycardia
What rhythm is shown below in a patient who is has a high fever due to infection?
sinus tachycardia
Which rhythm results when these characteristics are found on an EKG tracing? Rate: 108 Rhythm: Regular P wave: Uniform and consistent QRS interval: 0.05 seconds PR Interval: 0.12 seconds
sinus tachycardia
What drug or substance would be used when a physician orders a modified Bruce protocol exercise stress test with myocardial perfusion study?
thallium-201
When is a radioisotope injected during an exercise stress tests?
the last minute of exercise
What does a QRS wave on the EKG tracing indicate?
ventricular depolarization
The health care provider notes frequent PVCs on the patient's EKG tracing. What alteration in the patient's cardiac function may also exist?
ventricular irritation
When educating the patient on the resting EKG procedure, which statement should be made regarding the EKG's ability to assess the heart's electrical activity?
"The 12-lead EKG can assess the electrical activity of four surfaces of the heart."
What is considered the single most important piece of equipment for the exercise stress test?
12-lead EKG
What type of PVC is potentially dangerous to the patient, due to where it falls in the cardiac cycle?Which type of rhythm is seen in the EKG tracing below?
R-on-T phenomenon
A patient's EKG tracing reveals an AV block. The PR intervals are constant and some QRS complexes are dropped. How will the health care provider record these findings?
second-degree AV block, Mobitz II
