Cardiac- Telemetry Exam 72 Questions with Verified Answers
Along what axis is time measured in an EKG paper? - CORRECT ANSWER across a horizontal
... [Show More] axis
what does each small square on an EKG strip represent? - CORRECT ANSWER 1 mm in length
0.04 seconds
what does each large square on an EKG strip represent? - CORRECT ANSWER 5 mm in length
0.2 seconds
how can a regular rhythm be calculated on an EKG strip? - CORRECT ANSWER when the rhythm is regular, the heart rate is 250 divided by the number of large squares between the QRS complexes
i.e.
3 large squares between regular QRS complexes, the heart rate is 83 (250/3=83)
how can an irregular rhythm be calculated on an EKG strip? - CORRECT ANSWER count the number of R waves in a 6 second strip and multiply the number by 10
i.e.
7 R waves in a 6 second strip, the heart rate is 70 (7x10=70)
true or false: on a typical EKG grid, 5 small squares, or 1 large square, represent 0.2 seconds of time - CORRECT ANSWER true
what does the P wave indicate? - CORRECT ANSWER atrial depolarization or contraction of the atrium
*no notching or peaking should be present*
what is the normal duration of the P wave? - CORRECT ANSWER >.20 seconds (less than 5 small squares)
what is the normal amplitude of the P wave? - CORRECT ANSWER aka height
>3 mm
what does the QRS complex indicate? - CORRECT ANSWER ventricular depolarization, or contraction of the ventricles
what is the normal duration of the QRS complex? - CORRECT ANSWER >.12 seconds
should be 3 small boxes or less
true or false: R waves are deflected positively - CORRECT ANSWER true
are the Q and S waves deflected negatively or positively? - CORRECT ANSWER negatively
what does the T wave indicate? - CORRECT ANSWER ventricular repolarization
*should be rounded and symmetrical*
what are the four basic steps to EKG interpretation? - CORRECT ANSWER 1. are normal P waves present?
2. are the QRS complexes narrow or wide?
3. what is the relationship between P waves and QRS complexes?
4. is the rhythm regular or irregular?
what can be indicated if P waves are not present before every QRS complex? - CORRECT ANSWER PVCs
PACs
Complete heart block
what are the major components of normal sinus rhythm? - CORRECT ANSWER 1. P waves normal
2. QRS complexes normal
3. there is one P wave for every QRS complex
4. the rhythm is regular
5. heart rate is WNL
what is the first step in every situation where the nurse notes an irregular telemetry reading? - CORRECT ANSWER assess the patient!
what are the major components of sinus bradycardia? - CORRECT ANSWER 1. HR is 40-59 BPM
2. normal P waves present
3. QRS complex is normal (0.6-.12)
4. PR interval can be normal or slightly prolonged
5. rhythm is regular or slightly irregular
how is symptomatic sinus bradycardia treated? - CORRECT ANSWER treatment of underlying cause
atropine as potential medication: dosage is dependent on situation
true or false: sinus bradycardia is abnormal and must be treated - CORRECT ANSWER false
what are the major components of sinus tachycardia? - CORRECT ANSWER 1. HR is 101-160 BPM
2. P waves are normal
3. QRS complexes are normal
4. conduction is normal
5. rhythm can be regular or slightly irregular`
what are some examples of underlying causes of sinus tachycardia? - CORRECT ANSWER increased circulating catecholamines
CHF
hypoxia
PE
increased temperature
stress
pain response
dehyrdation
fluid volume deficit via blood loss, etc
what is the treatment of sinus tachycardia? - CORRECT ANSWER identification of underlying causes and correction of them
what should be considered regarding the rhythm present in sinus tachycardia? - CORRECT ANSWER may be difficult to assess depending on close proximity of complexes
true or false: sinus tachycardia is a normal response to pain - CORRECT ANSWER true
where is the heart rate originating from in supraventricular tachycardia? - CORRECT ANSWER from above the ventricles and is going at a faster rate than them
what are the major components of supraventricular tachycardia? - CORRECT ANSWER 1. rhythm is regular
2. HR 150-250 typically
3. PR interval difficult to measure
4. QRS complexes at a normal rhythm and distance apart
5. often paroxysmal
what does paroxysmal mean? - CORRECT ANSWER has a sudden onset and sudden termination
how is supraventricular tachycardia different from atrial fibrillation? - CORRECT ANSWER the QRS complexes are at a regular rhythm and distance apart
what is the common treatment of supraventricular tachycardia - CORRECT ANSWER adenosine: 6 mg followed by 12 mg
administered via stop cock method through large vein: needs to be slammed in and then flushed
1-2 screens of asystole is expected: prepare patient for "feelings of impending doom"
what patient population is supraventricular tachycardia common in? - CORRECT ANSWER adolescents
ablation may be a typical intervention
what is the most common irregular heart rhythm? - CORRECT ANSWER atrial fibrillation
where does the impulse originate from in atrial fibrillation? - CORRECT ANSWER atria
what is occurring in atrial fibrillation? - CORRECT ANSWER many impulses begin and spread through the aorta and complete for a chance to travel through the AV node, causing a rapid and disorganized heartbeat
what is the typical atrial heart rate in a-fib? - CORRECT ANSWER 300-600 BPM
what node limits the number of impulses that are allowed to travel to the ventricles? - CORRECT ANSWER the AV node
in a rhythm with unidentifiable P and T waves and irregularity present, what rhythm should first be considered? - CORRECT ANSWER a-fib
what two questions should be asked when a-fib is present? - CORRECT ANSWER is it controlled or uncontrolled?
is the patient symptomatic?
what assessments should be done when a-fib is present? - CORRECT ANSWER HR
BP
electrolytes (K, Mg, Ca)
oxygenation status
dizziness
anxiety
CO low, resulting in low BP?
what is considered controlled a-fib? - CORRECT ANSWER HR under 100
what treatments are typically done for a-fib? - CORRECT ANSWER beta blockers
ca-channel blockers (most common IV cardizem if uncontrolled)
amiodarone (can do IV or PO)
what is a major concern with a-fib? - CORRECT ANSWER clots
what secondary issues can occur with cardizem? - CORRECT ANSWER it is titrated to decrease HR in emergent a-fib situations, but secondary BP hypotension can occur
what can the use of amiodarone impact? - CORRECT ANSWER liver function
a client developed atrial fibrillation, which a ventricular rate of 150 beats/min. The nurse should assess the client for which associate signs or symptoms?
A. flat neck veins
B. nausea and vomiting
C. hypotension and dizziness
D. hypertension and headache - CORRECT ANSWER C
what are the major components of atrial flutter? - CORRECT ANSWER 1. atrial rate of 250-250 BPM
2. ventricular rate typically 150-175 BPM
3. P waves not present, saw tooth pattern typically seen
4. QRS complex is normal
5. conduction is 2:1 atrial-ventricular commonly
6. rhythm: regular, but can turn irregular if AV block varies
when does atrial flutter typically occur? - CORRECT ANSWER in diseased hearts
frequently precipitates CHF
what methods are used to perform immediate rate reduction in atrial flutter? - CORRECT ANSWER cardioversion
vagal maneuvers
ca-channel blockers (verapamil, cardizem)
what medications can be used to treat atrial flutter? - CORRECT ANSWER digoxin
anti-arrhythmatic drugs
what are the major components of ventricular tachycardia? - CORRECT ANSWER 1. rate: 100-220 BPM but up to 250 BPM
2. P waves are obscured if even present and unrelated to QRS complexes
3. QRS complexes wide and bizarre
4. rhythm is three or more ventricular beats in a row that may be regular or irregular
when does ventricular tachycardia often occur? - CORRECT ANSWER in diseased hearts
what are some common causes of v-tach? - CORRECT ANSWER CAD
acute MI
digitalis toxicity
CHF
ventricular aneurysms
what can ventricular tachycardia quickly turn into? - CORRECT ANSWER ventricular fibrillation
true or false: patients with v-tach are at times asymptomatic and may convert on their own - CORRECT ANSWER true
what are the main treatments for v-tach? - CORRECT ANSWER check for pulse
defibrillation
ACLS
if responsive:
bearing down
cardioversion
ventricular tachycardia is characterized by:
A. three or more ventricular beats in a row
B. a rate of 100-220 BPM
C. wide and bizarre QRS complexes
D. all of the above - CORRECT ANSWER D
a nurse is watching the cardiac monitor and notices that the rhythm suddenly changes. there are no P waves, but the QRS complexes are wide, and the ventricular rate is regular but more than 100 beats/min. the nurse determines that the client is experiencing which of the following dysrhythmias?
A. sinus tachycardia
B. ventricular fibrillation
C. ventricular tachycardia
D. premature ventricular contraction - CORRECT ANSWER C
what are the major components of ventricular fibrillation? - CORRECT ANSWER 1. rate unattainable
2. P waves may be present but are obscured by ventricular waves
3. QRS complexes are not apparent
4. chaotic electrical activity
5. rhythm is totally irregular
what does ventricular fibrillation do to cardiac output? - CORRECT ANSWER there is no cardiac output present
when does ventricular fibrillation typically occur? - CORRECT ANSWER with serious heart disease, especially acute MI
what is the course of treatment for ventricular fibrillation? - CORRECT ANSWER immediate defibrillation
identification and treatment of underlying cause
what are the major components of aystole? - CORRECT ANSWER 1. no rate
2. P waves may be seen, but there is no ventricular response
3. no QRS complexes
4. no conduction
5. no rhythm
true or false: asystole due to an acute MI and CAD is frequently fatal - CORRECT ANSWER true
what interventions can be done for asystole? - CORRECT ANSWER CPR
ACLS
what occurs in a PVC? - CORRECT ANSWER the ventricles beat early
wide, erratic looking QRS seen
what assessments should be done for a patient with PVCs? - CORRECT ANSWER HR
BP
electrolytes (K, Mg, Ca)
oxygenation
dizziness
what is considered to be occurring when multiple PVCs occur in a row? - CORRECT ANSWER V tach
what is bigeminy? - CORRECT ANSWER when a PVC occurs every other beat
what patient type are PACs often seen in? - CORRECT ANSWER those with respiratory issues like COPD, etc
what do PACs look similar to? - CORRECT ANSWER a-fib
what assessments should be done for the patient with PACs? - CORRECT ANSWER HR
BP
electrolytes (K, Mg, Ca)
oxygenation
dizziness [Show Less]