Chapter 13: Ambulatory Monitoring

as a health care professional, your responsibilities with the ambulatory monitor include which of the following

a. interpreting the results of the monitoring

b. purchasing the equipment

c. explaining the test results to the patient

d. applying and removing the monitor

d. applying and removing the monitor

which of the following is an instrument that records the electrical activity of the heart during a patient’s normal daily activities

a. exercise electrocardiograph

b. single-channel recorder

c. ambulatory monitor

d. pacemaker

c. ambulatory monitor

how long does a Holter monitor typically record an ECG

24-48 hours

how many leads are attached to a patient’s chest with ambulatory monitoring

3-5 leads

what is another term for loss of consciousness (fainting)

syncope

what is the term for fast, irregular heartbeat sensations felt by the patient, which may or may not be associated with complaints of chest pain

palpitations

which of the following is NOT a reason to use an ambulatory monitor

a. to evaluate artificial pacemaker functioning

b. the evaluate the effectiveness of cardiac medications

c. to evaluate the function of the heart after a recent myocardial infarction

d. to evaluate oxygen utilization by the myocardium

d. to evaluate oxygen utilization by the myocardium

why might ambulatory monitoring be used in addition to 12-lead ECG monitoring

the patient was complaining of palpitations but did not have any symptoms during the 12-lead ECG

which of the following statements about telemetry monitoring is correct

a. it sends data to a licensed practitioner automatically when a cardiac anomaly is detected

b. it consists of a small transmitting device attached to the chest with electrodes

c. it has two types: loop-memory monitor and symptom event monitor

d. the patient activates it when he or she experiences symptoms

b. it consists of a small transmitting device attached to the chest with electrodes

which monitoring device can be worn on the wrist and records a bipolar lead I ECG tracing

a. MCOT device

b. Holter monitor

c. symptom event monitor

d. loop-memory monitor

c. symptom event monitor

which type of monitoring device can be implanted under the skin with a single lead

a. MCOT device

b. Holter monitor

c. loop recorder

d. symptom event monitor

c. loop recorder

which type of ambulatory monitoring requires the patient to keep a diary of all daily activities, abnormal experiences, and symptoms

a. symptom event monitor

b. MCOT device

c. Holter device

d. loop recorder

c. Holter device

which of the following patients is not a candidate for Holter monitoring

a. Ms. Jones, who is complaining of chest pain; she is independent in care but confined to a wheelchair

b. Mr. Peters, who is complaining of palpitations but has inconclusive ECG and stress test results

c. Miss Jeffers, who is confused and living in a nursing home

d. Mr. Jackson, who is complaining of dizziness and has normal ECG and stress tests

c. Miss Jeffers, who is confused and living in a nursing home

which type of monitoring device can hold up to 96 hours of data and allows licensed practitioners to capture significant cardiac events even when the patient is not experiencing symptoms

a. Holter monitor

b. symptom event monitor

c. loop recorder

d. MCOT device

d. MCOT device

which type of ambulatory monitoring device is often used in a hospital

a. implantable loop recorder

b. telemetry monitor

c. wearable monitor with defibrillator

d. symptom event monitor

b. telemetry monitor

when would a patient use an event marker during ambulatory monitoring

to mark the ECG tracing when symptoms occur

which patient will be asked to keep a diary

a. Mr. Evans, who is on telemetry

b. Mr. Abram, who is complaining of chest discomfort and is having an ECG

c. Mrs. Jones, who is scheduled for a stress test

d. Ms. Fisher, whose physician ordered Holter monitoring this morning

d. Ms. Fisher, whose physician ordered Holter monitoring this morning

Mrs. Hansen has an ambulatory monitor in place. what instructions do you give her regarding the electrodes

if an electrode becomes loose, she should press it in the center to reapply; however, she must return to the clinic if one comes off completely

which of the following instructions would be given to a patient scheduled for ambulatory monitoring

a. you may take a tub bath as long as you do not let the monitor drop in the water

b. you should not take your heart medications during the ambulatory monitoring procedure unless instructed to do so by your physician

c. you should avoid alcohol and caffeine during ambulatory monitoring

d. wear a loose-fitting shirt, preferably one that buttons down the front, and you will be more comfortable during the procedure

d. wear a loose-fitting shirt, preferably one that buttons down the front, and you will be more comfortable during the procedure

during ambulatory monitoring, in which of the following would NOT be recorded in the patient diary

a. trimming fingernails or toenails

b. hours of sleep

c. an argument with a spouse or child

d. urination and bowel movements

a. trimming fingernails or toenails

when a Holter monitor is used, when should the patient start his or her diary

when the monitor is turned on

which of the following devices should a patient avoid while wearing an ambulatory monitor

a. computers

b. flashlights

c. electric coffeemakers

d. electric blankets

d. electric blankets

when asked by a patient or the parent of the patient whether ambulatory monitoring is painful, what would be your best response

the monitoring is not painful; however, there may be some discomfort while the electrodes are in place

when preparing a patient for ambulatory monitoring, it is important to ensure that which of the following occurs

a. the patient agrees to avoid regular physical activities during the monitoring period

b. the physician is notified immediately when the monitoring begins

c. the patient understand the physical requirements of the monitoring procedure

d. a family member is present during the entire monitoring period

c. the patient understand the physical requirements of the monitoring procedure

you need to prepare a 10/yo boy for an ambulatory monitoring procedure. which of the following should you include in your patient teaching

a. ask the parents to leave the room so the child will not be embarrassed

b. allow the child to touch the equipment before applying it

c. explain the procedure using the proper medical terminology

d. tell the child that there may be some pain initially

b. allow the child to touch the equipment before applying it

which of the following equipment will NOT be needed in preparation for applying an ambulatory monitoring device

a. electrodes

b. oxygen supplies

c. skin preparation equipment

d. patient diary

b. oxygen supplies

how can you ensure that each electrode is firmly attached

run your finger around the edge of each electrode

what is the last thing you should do before having the patient put on his or her shirt during ambulatory monitoring

run a baseline ECG tracing

you are putting a new type of ambulatory monitor on Mrs. Farmer. it uses a five-lead system that is unfamiliar to you. what should you do before placing the electrodes

consult the manufacturer’s instructions; they are the best resource for using new equipment

you are preparing an 82/yo patient for ambulatory monitoring. what precautions do you need to take when applying electrodes to this patient

manipulate the electrodes as little as possible when applying and removing them

what should be done with a Holter monitor before entering a patient’s room to begin the procedure

insert new batteries in the monitor

Mr. Benson’s Holter monitor was applied yesterday at 9:00 am. at that time, he was told to return this morning at 9:00 am to have the monitor removed. he arrives at 10:30 am but did not bring his diary. what should you do

ask him to return home to get the diary before removing the monitor

which of the following is a correct statement regarding the results received from an outside laboratory for ambulatory monitoring

a. results will be available in 1-3 days and placed on the chart for the physician to discuss with the patient

b. results will be available in 7-10 days; the patient will be called if abnormalities are found

c. results will be available in 7-10 days and placed on the chart for the physician to discuss with the patient

d. the final report will be available in 7-10 days and sent to the patient

c. results will be available in 7-10 days and placed on the chart for the physician to discuss with the patient

which of the following factors may reduce the accuracy of ambulatory monitoring

a. the patient felt ill, so he did not follow his normal routine

b. the patient did her usual 5-mile run this morning

c. the patient recorded all of her activities in the diary

d. one of the leads became loose overnight and the patient put it back in place

a. the patient felt ill, so he did not follow his normal routine

Mr. Freeman asked you about the results of his test. you saw the final report and know there were abnormalities. how do you respond

you tell him he needs to discuss the results with his physician

which of the following cardiac conditions CANNOT be confirmed by performing an ambulatory monitoring test

a. rhythm abnormalities

b. heart valve defects

c. premature ventricular complexes

d. premature atrial complexes

b. heart valve defects

what additional test is NOT likely to be ordered if the ambulatory monitor results are abnormal

pulmonary function test

what is the first step in reducing a patient’s fear of ambulatory monitoring

help the patient understand the procedure

which of the following activities is NOT allowed during ambulatory monitoring

a. taking a tub bath

b. lifting heavy objects

c. exercising with friends

d. drinking alcohol

a. taking a tub bath

for ambulatory monitoring, why is it recommended that chest hair should be clipped, not shaved

clipping reduces the chance that the patient will scratch at the skin, causing an artifact on the tracing

what is the proper procedure for connecting electrodes for ambulatory monitoring to reduce tugging and pulling during patient movement

tape the electrodes in place

while you are preparing Mrs. Trevor for ambulatory monitoring, she asks you a question that you cannot answer. what should you do

ask your supervisor or the licensed practitioner

what does the term ambulating mean

walking

what is another name for a stress ECG

exercise electrocardiography

what is the purpose of antidysrhythmic medications

to prevent cardiac rhythm abnormalities

in which type of monitoring is a continuous tracing of the heart always sent directly to a monitoring station to be viewed in real time

telemetry monitoring

which type of monitoring device activates itself when its electrode feet are pressed onto the patient’s chest

symptom event monitor

which type of monitor saves and transmits an ECG tracing for up to 5 minutes before a patient experiences symptoms

loop memory monitor

what is the first thing you should of after removing a patient’s ambulatory monitor

document and label the report, diary, and disk

which of the following tests is not typically ordered to follow up on results of ambulatory monitoring

a. exercise electrocardiography

b. positron emission tomography

c. echocardiogram

d. magnetic resonance imaging

a. exercise electrocardiography

once the patient turns in the ambulatory monitor and diary, who is the person that typically provides the final interpretation of the ambulatory monitoring data

physician

the term ___ is often used to mean any type of ambulatory monitor

Holter

memory on the monitor can hold up to 5 minutes of the EKG tracing

loop memory monitor

automatically sends data when cardiac anomaly is detected; holds up to 96 hours of data

MCOT

white lead

R sternal border, 1st rib

red lead

R sternal border, 3rd rib

black lead

L side, anterior axillary line, 5th rib

brown lead

L sternal border, 1st rib directly opposite the white lead

green lead

R lower thoracic area anywhere on the rib cage

additional testing after abnormal results

echocardiogram, coronary angiogram, CT scan, MRI, PET