EKG Exam NYU Langone

A delayed conduction of the AV node is manifested by a:

a. prolonged PR interval

b. widened QRS

c. inverted P wave

d. absence of a P wave

a. prolonged PR interval

Which of the following waveforms represent the electrical event that should initiate ventricular contraction?

QRS complex

What is the normal range of the PR interval?

0.12-0.20

What is the normal length of the QRS interval?

below 0.12

What bpm rate is Sinus Tachycardia on a strip?

101-160 bpm

Which of the following describes a cells ability to spontaneously generate an impulse?

automaticity

Which node independently conducts a rate of 40-60 in an adult patient?

AV node

Which node independently conducts a rate of 60-100 in an adult patient?

SA node 'the pacemaker of the heart'

What does the T-wave represent?

ventricle repolarization

What is the normal PQRS ratio?

1:1

What is the rate on a strip for sinus bradycardia?

less than 60 bpm

How do you calculate the rate on a strip?

multiply the number of QRS's by 10

pay attention to marks on strip to count right

How to differentiate between normal sinus rhythm and sinus arrhythmia

the distance between each R (peak in QRS wave) is different and NOT the same within a strip

the activation of BLANK system causes in a release in epinephrine which results in an increase in heart rate, blood pressure, and cardiac output

sympathetic nervous system

the QRS on an EKG corresponds to which of the following electrical events:

a. ventricular depolarization

b. ventricular repolarization

c. atrial repolarization

d. atrial depolarization

a. ventricular depolarization

Inefective atrial contractions are associated with which rhythm

a. normal sinus with PAC

b. normal sinus with PVC

c. ventricular fibrillation

d. atrial fibrillation

d. atrial fibrillation

How can you tell a strip with normal sinus rhythm with PAC (premature atrial contraction is occurring)?

The P wave comes EARLY.

P waves occur when the atria contracts followed by the QRS and T waves. You know a PAC is occurring when the PQRST segment happens too soon after the last PQRST.

Which of the following is a characteristic of atrial flutter?

tombstone pattern

When taking the pulse of a patient in atrial fibrillation the nurse would expect

a. an irregular pulse and pulse deficit

b. an irregular and bounding pulse

c. a regular pulse and pulse deficit

d. a regular and bounding pulse

a. an irregular pulse and pulse deficit

In atrial flutter the atrial rate usually ranges between:

250 and 400 bpm

Which of the following would you expect to see in a patient with SVT at a ventricular rate of 220?

a. hypotension

b. hypertension

c. headache

d. pulse deficit

a. hypotension

What will NEVER be an answer on the test?

Headache

Symptoms that may be experienced by a patient who suddenly develops atrial fibrillation with a ventricular rate of 160 include:

a. palpitations

b. dyspnea

c. hypotension

d. all of the above

d. all of the above

Which of the following is not an appropriate intervention for new onset symptomatic SVT?

a. cardioversion

b. adenosine

c. vagal maneuvers

d. av pacing

d. av pacing

Which of the following interventions is important to consider when a patient has a rhythm with ineffective atrial contractions?

a. keeping HOB above 45 degrees

b. anticoagulation

c. surgery consult

d. assessing for blurred vision

b. anticoagulation

Atrial kick accounts for how much of the total cardiac output?

25%

Which of the following assessment findings is associated with ventricular fibrillation?

a. anxiety

b. loss of consciousness

c. delirium

d. headache

b. loss of consciousness

heart rate is zero

For ANY strip that is shown, what is the FIRST response to the patient?

assess or check the patient

Which of the following is a characteristic of premature ventricular contractions (PVC's)?

a. the QRS complex is greater than 0.12 sec

b. the P-wave is inverted

c. there is a prolonged PR interval

d. the QRS complex is less than 0.12 sec

a. the QRS complex is greater than 0.12 sec

wide and bizarre!

Which of the following assessment findings are associated with this strip of V-tach?

a. hypotension

b. change in mental status

c. weak or absent pulse

d. all of the above

d. all of the above

If I show you a strip, how do you know it has ventricular bigeminy? Trigeminy?

Bigeminy

- every other beat in the strip is a PVC

Trigeminy

- every THIRD beat in the strip is a PVC

The term multifocal PVCs refers to PVCs which are:

a. frequently from the same ventricular focus

b. occur in a specific pattern

c. originate from different ventricular foci

d. occur in runs of 3 or more in a row

c. originate from different ventricular foci

Which of the following is true about V-fib?

a. it can be mimicked by artifact on the ECG

b. it is never accompanied by a peripheral pulse

c. it is treated with CPR and defibrillation

d. all of the above

d. all of the above

Which of the following is the treatment of choice for V-tach without a pulse?

defibrillation

Your patient complains of new onset chest pain (strip is shown) which is the appropriate nursing intervention?

assess your patient!!

When administering digoxin the nurse should?

a. assess for medications or conditions that affect serum digoxin levels

b. assess patient for clinical signs of toxicity

c. assess BUN and Cr prior to administration

d. all of the above

d. all of the above

IV cardizem is used to treat which of the following arrhythmias?

a. pulseless V-tach

b. sinus bradycardia with ventricular bygeminy

c. atrial fibrillation

d. missing last option??

c. atrial fibrillation

Select the statement about cardio version which is correct

a. the delivery of electrical current must be synchronized to the T-wave

b. the patient should be awake and alert to be sure of the response to cardio version

c. cardio version may be utilized for unstable rapid atrial and ventricular dysrhythmias

d. a minimum of 200 joules must be delivered to achieve cardio version

c. cardio version may be utilized for unstable rapid atrial and ventricular dysrhythmias

Which of the following is true about the R on T phenomenon

a. it may cause the atria to fibrillate

b. it may precipitate a run of ventricular tachycardia

c. it is only dangerous when the patient has a ventricular pacemaker

d. it is treated by administering a potassium supplement

b. it may precipitate a run of ventricular tachycardia

Defibrillation is the treatment of choice for which of the following rhythms?

a. Asystole

b. SVT

c. V-tach with a pulse

d. V-fib

d. V-fib

Select the true statement about cardio version

a. the patient should be awake and alert to be sure of the response

b. a minimum of 200 joules must be delivered

c. you do not need to clear the patient

d. preparing for cardioversion should include premedication with pain medication whenever possible

d. preparing for cardio version should include premedication with pain medication whenever possible

You're about to shock your patient in V-fib with a biphasic sole defibrillator, what is the starting energy for an adult sized patient?

120 joules

What occurs during atrial flutter that is unique?

There is a pulse deficit

This means that the wrist pulse will be different from what is auscultated

First Degree Heart Block

1. Looks almost normal

2. BUT the distance between P and R is above 0.20

- normal range is between 0.12 and 0.20

Treatment

- monitor

- atropine

Second Degree Heart Block Type 1

1. PR interval keeps getting longer longer longer

2. THEN will drop off and QRS will be missing

- sequence will repeat again

Treatment

- monitor

- atropine

Second Degree Heart Block Type 2

1. PR is either normal or prolonged

- but ALWAYS the same length

2. There will be random missing QRS intervals

Treatment

- pacemaker

- atropine

Third Degree Heart Block

1. ALL PR intervals are different lengths

2. BUT they are all equal distance form each other

Treatment

- pacemaker