Telemetry exam 1|153 Questions with Verified Answers
Right atrium: oxygenated or deoxygenated? - CORRECT ANSWER deoxygenated
right ventricle:
... [Show More] oxygenated or deoxygenated? - CORRECT ANSWER deoxygenated
Left atrium: oxygenated or deoxygenated? - CORRECT ANSWER oxygenated
left ventricle: oxygenated or deoxygenated? - CORRECT ANSWER oxygenated
pulmonary artery: oxygenated or deoxygenated? - CORRECT ANSWER deoxygenated
aortic arch: oxygenated or deoxygenated? - CORRECT ANSWER oxygenated
superior vena cava: oxygenated or deoxygenated? - CORRECT ANSWER oxygenated
inferior vena cava: oxygenated or deoxygenated? - CORRECT ANSWER deoxygenated
pulmonary vein: oxygenated or deoxygenated? - CORRECT ANSWER oxygenated
atrioventricular valves - CORRECT ANSWER mitral and tricuspid
what heart sound do the atrioventricular valves produce? - CORRECT ANSWER makes S1 or "lub"
semi-lunar valves - CORRECT ANSWER pulmonary and aortic
what heart sounds do the semi-lunar valves produce? - CORRECT ANSWER S2 or "DUB"
automaticity - CORRECT ANSWER ability to make an impulse
excitability - CORRECT ANSWER ability to respond to an impulse
conductivity - CORRECT ANSWER ability to transmit energy from one cell to another
what sets the rate for the heart and what is normal rate? - CORRECT ANSWER determined by the fastest firing node
SA node: 60-100
what node fires at a rate of 40-60? - CORRECT ANSWER AV node
what "pacemaker" fires the slowest? what are the norms for this node? - CORRECT ANSWER ventricular: 30-40
identify 5 stage of action potential - CORRECT ANSWER 1. rapid depolarization
2. early repolarization
3. plateau phase
4. rapid repolarization
5. resting phase
1. rapid depolarization - CORRECT ANSWER sodium moves RAPIDLY into cells, calcium moves SLOWLY into cells
2. early repolarization - CORRECT ANSWER sodium channels close
3. plateau phase - CORRECT ANSWER calcium continues to flow in, potassium flows out of cell
4. rapid repolarization - CORRECT ANSWER calcium channels close, potassium flows out RAPIDLY
5. resting phase - CORRECT ANSWER active transport through sodium-potassium pump- restores potassium in cell and sodium to outside of cell, cell membrane becomes impermeable to sodium, potassium may move out of cell
what EKG wave is reflective of atrial depolarization? - CORRECT ANSWER p
what EKG wave is reflective of ventricular depolarization? - CORRECT ANSWER QRS
what is the significance of the ST segment? - CORRECT ANSWER represents the interval between ventricular depolarization and repolarization
what is the significance of the QT wave? - CORRECT ANSWER measurement that represents the total time from ventricular depolarization to complete repolarization
cardiac ouput - CORRECT ANSWER amount of blood ejected from a ventricular in liters/minutes
cardiac output norms - CORRECT ANSWER 4-6 liters
3 factors that influence cardiac ouput - CORRECT ANSWER heart rate
stroke volume
autonomic NS
preload - CORRECT ANSWER amount of blood in ventricles at end of diastole
what factors increase preload? - CORRECT ANSWER hypertension
fluid replacement
what factors decrease preload? - CORRECT ANSWER bleeding
diuretics
vasodilators
dehydration
afterload - CORRECT ANSWER resistance to ejection of blood from ventricle
frank-starling law - CORRECT ANSWER The greater the stretch, the stronger is the heart's contraction. This increased contractility results in an increased volume of blood ejected (Increased SV)
ejection fraction - CORRECT ANSWER percent of end diastolic volume ejected with each heartbeat
ejection fraction norms - CORRECT ANSWER left ventricle 55-65%
ejection fraction points of concern - CORRECT ANSWER less than 40% means ventricular function
should begin treatment for heart failure
mean arterial pressure - CORRECT ANSWER average pressure with arterial system felt by organs
what is required to perfuse organs - CORRECT ANSWER MAP 60 needed to perfuse vital organs
age-related changes atria - CORRECT ANSWER increased atria/thickens
age related changes: left ventricle - CORRECT ANSWER fibrosis/hypertrophy/fat
age related changes: valves - CORRECT ANSWER thick/rigid/calcify
age related changes: conduction - CORRECT ANSWER decreased conduction cells
age related changes: sympathetic nervous system - CORRECT ANSWER decreased responses
age related changes: aorta/arteries - CORRECT ANSWER stiffens/decreased elasticity
age related changes: baroreceptor response - CORRECT ANSWER decreased receptors
increased atria/thickens functional change - CORRECT ANSWER increased irritability
fibrosis/hypertrophy/fat left ventricle functional change - CORRECT ANSWER decreased output
prolonged systole
less compliant
thick/rigid/calcify valves functional changes - CORRECT ANSWER altered blood flow
decreased conductance cells functional changes - CORRECT ANSWER decreased impulses
decreased responses functional change - CORRECT ANSWER decreased contractility/heart rate
decreased response oxygen
stiffens/decreases elasticity aorta/arteries functional changes - CORRECT ANSWER left ventricular hypertrophy
decreased receptors baroreceptor response functional change - CORRECT ANSWER poor regulation of heart rate/vascular tone
angina triggers - CORRECT ANSWER exertion
emotion
meals
angina remedy - CORRECT ANSWER rest/nitroglycerine
ACS: reperfusion
pericarditis triggers - CORRECT ANSWER sudden onset pain with inspiration, swallowing, rotating
pericarditis remedy - CORRECT ANSWER sit upright
anti-inflammatory
medications
pulmonary triggers - CORRECT ANSWER increases with inspirations, coughing, movement
occurs with lung infections
pulmonary remedy - CORRECT ANSWER treat underlying cause
esophageal triggers - CORRECT ANSWER laying down
cold liquid
exercise
esophageal remedy - CORRECT ANSWER antacids
nitroglycerine
anxiety triggers - CORRECT ANSWER anytime
triggers
anxiety remedy - CORRECT ANSWER relaxation
remove stimuli
treat anxiety
musculoskeletal triggers - CORRECT ANSWER respiratory infection
idiopathic
musculoskeletal remedy - CORRECT ANSWER rest
ice
heat
anti-inflammatory medications
non-modifiable cardiovascular risk factors - CORRECT ANSWER ethnicity
age
gender
family history
modifiable risk factors - CORRECT ANSWER abdominal obesity
high blood pressure
diabetes
high cholesterol
psychosocial factors
smoking
Gordan's functional patterns - CORRECT ANSWER elimination
activity and exercise
sleep and rest
self-perception and self-concept
roles and relationships
sexuality and reproduction
coping and stress
assessment findings for atrial/ventricular problems - CORRECT ANSWER jugular venous distention
peripheral edema
ascites
crackles
postural hypotension
assessment findings for cardiac ouput - CORRECT ANSWER clubbing
cold/cool skin and diaphoresis
cool/pale/painful fingers/toes
cyanosis
ecchymosis/bruising
edema
pallor
red-blue discoloration of legs
ulcers
xanthelasma
assessment findings for acute arterial obstruction - CORRECT ANSWER pain
pallor
pulselessness
parethesia
poliothermia
paralysis
what values are significant for BMI - CORRECT ANSWER BMI over 30
what values are significant for waist circumference - CORRECT ANSWER male waist circumference over 40
female waist circumference over 35 inches
cause of clubbing - CORRECT ANSWER chronic desaturation
what disease processes might you suspect in clients displaying jugular vein distention? - CORRECT ANSWER right sided heart failure
hypervolemia
pulmonary hypertension
pulmonary stenosis
shock
hypovolemia
mitral regurgitation
mitral/aortic stenosis
how are preload and cardiac output being impacted with change in position? - CORRECT ANSWER since cardiac output is equal to the product of stroke volume and heart rate, with increased preload the cardiac output is increased die to the increase in stroke volume
pulse pressure - CORRECT ANSWER the difference between systolic and diastolic blood pressure
Increases stroke volume - CORRECT ANSWER An increased preload
decreased stroke volume - CORRECT ANSWER decreased cardiac output
S1 - CORRECT ANSWER closure of AV valves
S2 - CORRECT ANSWER closure of semi-lunar valves
S3 - CORRECT ANSWER associated with heart failure
1. tricuspid area: left sided heart failure
2. apical/left lateral: left sided heart failure
S4 - CORRECT ANSWER gallops are best heart with bell lightly against the chest
1. atria forcing blood into the left ventricle
lungs impact the heart - CORRECT ANSWER hemoptysis
cough
crackles
wheeze
1. may be compression on vessels or narrowing from beta-blockers
liver impact the heart - CORRECT ANSWER fluid accumulation or enlarged, tender liver may indicate right-sided heart failure, pulsating may indicate-aaa
kidney impact the heart - CORRECT ANSWER check for edema in bedridden cleints
what cardiac biomarker is most indicate of a myocardial infarction? - CORRECT ANSWER creatine kinase (CK)
CK isoensymes (CK-MB)
proteins (Troponin T)
what is the value of BUN and creatine to cardiac assessment - CORRECT ANSWER elevated BUN and creatine=renal impairment
normal creatine and increased BUN= intravascular fluid volume deficit
magnesium - CORRECT ANSWER 1.8-3.0
magnesium significance - CORRECT ANSWER helps absorb calcium, maintain potassium, metabolism ATP
potassium - CORRECT ANSWER 3.5-5.5.
potassium significance - CORRECT ANSWER cardiac electrophysiology
sodium - CORRECT ANSWER 135-145
Sodium Significance - CORRECT ANSWER impacts fluid levels
PTT - CORRECT ANSWER 60-70 seconds
PTT significance - CORRECT ANSWER goal: adjust heparin 1.5-2.5 times baseline
adjust less than 50 or more than 1000
PT - CORRECT ANSWER 9.5-12 seconds
PT significance - CORRECT ANSWER monitor anticoagulation
INR - CORRECT ANSWER 1
INR significance - CORRECT ANSWER monitor warfarin therapeutics with PT goal 2-3.5
VDL - CORRECT ANSWER View Definition Language - Specifies user views/mappings to conceptual schema
LDL - CORRECT ANSWER low density lipoprotein (bad cholesterol)
HDL - CORRECT ANSWER high density lipoproteins (healthy type of cholesterol)
what are patient considerations specific to cardiac stress testing? - CORRECT ANSWER 48 hours post MI
uncontrolled dysthymias with hemodynamic compromise
severe aortic stenosis
myocarditis/pericarditis
decompensating heart failure
3-5 leads what is monitored - CORRECT ANSWER give up a quick simple view and basic understanding of heart rhythm
12 leads what is monitored - CORRECT ANSWER picture in picture view of the heart
15 leads what is monitored - CORRECT ANSWER additional leads are added to the right side of the chest
indicate right ventricular/left posterior ventricular infarction
18 lead what is monitored - CORRECT ANSWER three posterior leads
reflect myocardial ischemia/injury
why do we use holter monitors? - CORRECT ANSWER cardiac events recorders
indicate sensations in the movement
what are the benefits of telehealth with recorders and implantable devices? - CORRECT ANSWER use from home or that doctors use to improve or support health care services
implantable devices
1. web portal
2. implantable loop recorder
what steps are important prior to/during lead placement why? - CORRECT ANSWER debride
clip hair
connect leads to wires
peel backing of leads
1. it is sticky
consider anatomic position
1. change every 24 hours
5 lead monitor placement - CORRECT ANSWER white-right upper chest
black- left upper arm
green- right lower chest
red-left lower chest
brown-middle
snow over grass
smoke over fire
earth in the middle
12 lead EKG placement - CORRECT ANSWER • Limb (extremity) electrodes and placement
o RA right arm (aVr)- anywhere between the right shoulder and wrist
o LA left arm (aVL)- anywhere between the left shoulder and wrist
o LL left leg (aVF)- anywhere between the left lower torso to left ankle
o RL right leg- anywhere between the right lower torso and right ankle
• Chest (precordial) electrodes and placement
o V1- fourth intercostal space right sternum
o V2- fourth intercostal space left sternum
o V4- fifth intercostal space midclavicular line
o V3- place between V2 and V4
o V6- mid axillary line at 5th intercostal space
o V5- place in line between V4 and V6
ekg leads should not be placed over what 3 areas - CORRECT ANSWER bones
scars
high muscle areas
what considerations should be in place to eliminate artifact? - CORRECT ANSWER explain the process
settle the patient
eliminate
1. artifact
2. interference
3. environmental concerns
how many big boxes make a 3 second strip? - CORRECT ANSWER 15 boxes
how many big boxes make a 6 second strip? - CORRECT ANSWER 30 boxes
a 1 second strip can be measured by how many big boxes? - CORRECT ANSWER 5 boxes
one large box is reflective of how much time? - CORRECT ANSWER 0.2
each tiny is reflective of how much time? - CORRECT ANSWER 0.04
how is a PR interval measured? - CORRECT ANSWER count the boxes
what range does a normal PR interval fall into? - CORRECT ANSWER 0.12-0.2
atrial depolarization
how is a QRS measured and what range does a normal? - CORRECT ANSWER 0.08-0.12
how is a QT interval measured and what values are considered normal? - CORRECT ANSWER 0.325-0.43
what causes tall P waves? - CORRECT ANSWER increased left atrial pressure or atrial dilation
what conditions may cause notched or wide P waves? - CORRECT ANSWER increased left atrial pressure or atrial dilation
what two conditions may cause individuals to experience longer PR interval? - CORRECT ANSWER heart block
digoxin toxicity
what are causes for wide QRS? - CORRECT ANSWER severe hyperkalemia
drug toxicity
what conditions result from missing QRS complexes? - CORRECT ANSWER sinus arrest
a client with ST segment depression should be evaluated for what condition - CORRECT ANSWER injury
your EKG indicated ST segment elevation. what should you do - CORRECT ANSWER stemi
what variables may alter QT length? - CORRECT ANSWER prolonged:
1. torsades de pointe
2. class 1a antiarrhythmics
shortend:
1. digoxin toxicity
2. hypercalcemia
what five step process should be applied when dissecting EKG strips? - CORRECT ANSWER determine a rhythm
is the rhythm regular/irregular
identify the P wave
measure PR interval
evaluate QRS
what are 3 variable which impact the SA node? - CORRECT ANSWER vagus nerve
sympathetic nerve
parasympathetic nerve
how do respirations impact sinus arrhythmia? - CORRECT ANSWER inspiration
1. increases blood flow, decreased tone, increased heart rate
expiration
1. decrease venous return, increased vagal tone, slower heart rate
what medical conditions may result in sinus arrhythmia? - CORRECT ANSWER inferior wall MI
advanced age
digoxin/morphine
conditions with increased intracranial pressure
what 5 conditions and 2 medications which may cause sinus brady cardia? - CORRECT ANSWER electrolyte disorders
SA nodal disease
Sleep
MI
Valsalva maneuver
beta blockers
calcium channel blockers
what conditions may cause tachycardia? - CORRECT ANSWER pain
hypovolemia
myocardial infarction
hemorrhage
what assessment findings might you anticipate seeing in clients with tachycardia? - CORRECT ANSWER anxiety
chest pain/palpitation
hypotension/syncope
crackles/heart failure
as a general rule of protection and erroring on the safe side, what interventions should be in place or close by if needed? - CORRECT ANSWER assess patient-are they symptomatic? are they stable?
give oxygen and monitor saturation
monitor blood pressure and heart rate
start IV if not already established
notify MD
why do we use synchronized cardioversion? - CORRECT ANSWER if the patient if possible or defibrilation
how should we administer adenosine? - CORRECT ANSWER first dose: 6 mg rapid Iv push; follow with NS flush. second dose: 12 mg if required
what are non-invasive methods to attempt to slow down the heart rate? how would you perform them? - CORRECT ANSWER vagal maneuvers
-Valsalva maneuver: hold nose, close mouth, try to blow air out
-cough
-gag
-hold knees against chest
-carotid sinus massage: lie down and stick out chin. put pressure on carotid sinus.
adenosine
beta blockers/calcium channel blockers
what is the difference between sinus pause and sinus arrest? - CORRECT ANSWER sinus pause: 1-2 beats missing
sinus arrest: more than 3 beats missing
you are notified your patient has experienced severe sinus arrests. what physical sinus arrests. what physicals assessment findings might you see? - CORRECT ANSWER asymptomatic
low cardiac output
dizzy/syncope
cool/clammy skin
your patient is symptomatic sinus arrest. what interventions will you take to care for the patient? - CORRECT ANSWER lower head of bead
administer atropine/epinephrine
consider digoxin or betablocker toxicity/electrolyte imbalance
what physicals findings may be present in clients with sick sinus? - CORRECT ANSWER crackles
S3 heart sounds
lightheaded/syncope
what are least invasive and most invasive treatment options for clients with sick sinus? - CORRECT ANSWER atropine/epinephrine
pacemaker
what are signs and symptoms of emboli? - CORRECT ANSWER pain
shortness of breath
tachypnea
tachycardia
confusion
visual disturbances
clients susceptible for an embolus should receive what treatment? - CORRECT ANSWER anticoagulation [Show Less]