NUR-255 Test 1 Review

When computing a heart rate on a patient's electrocardiogram (ECG) tracing, the nurse counts 15 small blocks in an R-R interval. The rhythm is regular. Which heart rate in beats/min would the nurse document?

A) 60

B) 75

C) 100

D) 150

C) 100

Rationale

Because each small block on the ECG paper represents 0.04 second, 1500 of these blocks represent 1 minute. By dividing the number of small blocks (15 in this case) into 1500, the nurse can calculate the heart rate in a patient whose rhythm is regular (in this case, 100 beats/min). Heart rates of 60 beats/min, 75 beats/min, and 150 beats/min are incorrect answers.

p. 887

Which phrase describes the electrical activity represented by the PR interval on an electrocardiogram (ECG)?

A) The length of time it takes to depolarize the atrium

B) The length of time it takes for the atria to depolarize and repolarize

C) The length of time for the electrical impulse to travel from the sinoatrial (SA) node to the Purkinje fibers

D) The length of time it takes for the electrical impulse to travel from the SA node to the atrioventricular (AV) node

C) The length of time for the electrical impulse to travel from the sinoatrial (SA) node to the Purkinje fibers

Rationale

The electrical impulse in the heart must travel from the SA node through the AV node and into the Purkinje fibers for synchronous atrial and ventricular contraction to occur. When measuring the PR interval (the time from the beginning of the P wave to the beginning of the QRS), the nurse is identifying the length of time it takes for the electrical impulse to travel from the SA node to the Purkinje fibers. The P wave represents the length of time it takes for the impulse to travel from the SA node through the atrium, causing depolarization of the atria (atrial contraction). Atrial repolarization occurs during ventricular depolarization and is hidden by the QRS complex. The length of time it takes for the electrical impulse to travel from the SA node to the AV node is the flat line between the end of the P wave and the beginning of the Q wave on the ECG and is not usually measured.

p. 888

Which electrocardiogram (ECG) characteristic will be present if a patient is experiencing unifocal premature ventricular contractions (PVCs)? Select all that apply. One, some, or all responses may be correct.

1) Normal T wave

2) Normal P wave

3) PR interval that is not measurable

4) Wide and distorted QRS complex

5) PVCs that have the same shape

A) 1,3,4,5

B) 2,3,4,5

C) 3,4,5

D) 1,2,3

E) All

F) None

A) 1,3,4,5

Rationale

A PVC is a contraction that results from an ectopic focus in the ventricles. In other words, the QRS complex occurs prematurely. The T wave is generally normal. The PR interval is not measurable. The QRS complex is wide and distorted in shape compared with a QRS complex coming down a normal conduction pathway. PVCs that arise from the same foci appear the same in shape and are called unifocal PVCs. The P wave is rarely visible and is usually hidden in the PVC.

p. 897

A patient's electrocardiogram (ECG) shows a heart rate of 150 beats/min and a normal P wave preceding each QRS complex. Which interpretation would the nurse make of these findings?

A) Atrial fibrillation

B) Sinus tachycardia

C) Ventricular fibrillation

D) Premature atrial contractions

B) Sinus tachycardia

Rationale

Sinus tachycardia includes a heart rate of 101 beats to 180 beats per minute. The electrocardiographic study of sinus tachycardia shows a normal P wave preceding each QRS complex with normal time and duration. In atrial fibrillation, the P waves are chaotic and fibrillatory and the QRS complex is normal. The electrocardiographic study of ventricular fibrillation elicits the absence of P waves, and the PR interval and QRS interval cannot be measured. In premature atrial contraction, there are distorted P waves in the ECG.

pp. 891-892

A patient's electrocardiogram (ECG) shows prolonged PR interval, normal P waves, and normal QRS complexes. The patient is asymptomatic and has a normal heart rate and a regular rhythm. Which type of atrioventricular (AV) block is present?

A) First-degree AV block

B) Third-degree AV block

C) Type I second-degree AV block

D) Type II second-degree AV block

A) First-degree AV block

Rationale

First-degree AV block conducts every impulse to the ventricles with prolonged AV conduction time. In first-degree AV block, the heart rate is normal and the heart rhythm is regular. The ECG of a patient with first-degree AV block shows normal P wave, prolonged PR interval, and the normal shaped QRS complex. Third-degree AV block is suspected if no impulses are conducted from atria to ventricles. Type I second-degree AV block is suspected if the rhythm on the ECG appears as grouped beats. Type II second-degree AV block is suspected if the ventricular rhythm is irregular.

pp. 891,896

A patient's electrocardiogram (ECG) tracing shows occasional wide and distorted QRS complexes. Which rhythm does this finding indicate?

A) Sinus tachycardia

B) Ventricular fibrillation

C) Junctional dysrhythmias

D) Premature ventricular contractions

D) Premature ventricular contractions

Rationale

Premature ventricular contractions are caused by premature impulses originating from the ventricles of the heart and not from the sinoatrial node. This causes the QRS complex to be wide and distorted. The QRS wave appears normal in patients with sinus tachycardia. The QRS wave is not measurable in the ECG of a patient with ventricular fibrillation. The QRS complex will be normal in the ECG of patient with junctional dysrhythmias.

pp. 897,891

Which time period does the T wave in an electrocardiogram (ECG) represent?

A) Ventricular repolarization

B) Depolarization of both ventricles

C) Passage of the electrical impulse through the atrium

D) Time between ventricular depolarization and repolarization

A) Ventricular repolarization

Rationale

The ECG is commonly used to detect abnormal heart rhythms and to investigate the cause of chest pains. The T wave in the ECG should be upright; it represents time for ventricular repolarization. Time taken for depolarization of both ventricles is represented by QRS interval. Time for the passage of the electrical impulse through the atrium is represented by P wave. Time between ventricular depolarization and repolarization is represented by ST segment.

p. 888

In which order do electrical impulses travel through the heart?

1. Bundle of His

2. Sinoatrial node

3. Purkinje fibers

4. Internodal pathways

5. Atrioventricular node

A) 1,3,4,5,2

B) 2,4,5,1,3

C) 3,4,5,2,1

D) 4,1,2,3,5

E) 5,,4,2,1,3

F) 3,2,5,1,4

B) 2,4,5,1,3

Rationale

The conduction system of the heart consists of specialized neuromuscular tissue. The electrical impulse of the heart begins at the sinoatrial node in the upper right atrium. This impulse travels through the intermodal fibers and spreads over the atrial musculature. This causes atrial contraction. The impulse then reaches the atrioventricular (AV) node. From the AV node, the impulse moves down through the bundle of His and ends at the Purkinje fibers. Impulses from the Purkinje fibers cause ventricular contractions.

p. 884

The electrocardiogram (ECG) of a patient indicates P waves that are hidden in the preceding T waves and normal QRS complexes. Which condition is the patient experiencing?

A) Ventricular fibrillation

B) Junctional dysrhythmia

C) Premature atrial contractions

D) Premature ventricular contractions

C) Premature atrial contractions

Rationale

A premature atrial contraction occurs at the atrium and before the next sinus beat. A premature atrial contraction occurs in either the left atrium or right atrium and travels along the atria. The ECG of a premature atrial contraction usually shows hidden P waves in preceding T waves with prolonged PR interval. The QRS complex remains normal. The electrocardiogram of ventricular fibrillation has absent P waves and an undetectable PR interval and QRS complex. The ECG of junctional dysrhythmia shows a distorted P wave and reduced PR interval. The QRS complex remains normal. The ECG of premature ventricular contractions shows a rare occurrence of P waves. The PR interval cannot be measured with a disturbed and elongated QRS complex and T wave.

p. 892

Which term is used for the property of heart cells to initiate an impulse spontaneously and continuously?

A) Excitability

B) Automaticity

C) Conductivity

D) Contractibility

B) Automaticity

Rationale

Automaticity is the heart’s ability to initiate an impulse spontaneously and continuously. Excitability is the ability to be electrically stimulated. Conductivity is the ability to transmit an impulse along a membrane in an orderly manner. Contractility is the ability to respond mechanically to an impulse.

p. 888

Which term is used for the ability to be electrically stimulated?

A) Excitability

B) Automaticity

C) Conductivity

D) Contractibility

A) Excitability

Rationale

Automaticity is the heart’s ability to initiate an impulse spontaneously and continuously. Excitability is the ability to be electrically stimulated. Conductivity is the ability to transmit an impulse along a membrane in an orderly manner. Contractility is the ability to respond mechanically to an impulse.

p. 888

Which term is used for the ability to transmit an impulse along a membrane in an orderly manner?

A) Excitability

B) Automaticity

C) Conductivity

D) Contractibility

C) Conductivity

Rationale

Automaticity is the heart’s ability to initiate an impulse spontaneously and continuously. Excitability is the ability to be electrically stimulated. Conductivity is the ability to transmit an impulse along a membrane in an orderly manner. Contractility is the ability to respond mechanically to an impulse.

p. 888

Which term is used for the ability to respond mechanically to an impulse?

A) Excitability

B) Automaticity

C) Conductivity

D) Contractibility

D) Contractibility

Rationale

Automaticity is the heart’s ability to initiate an impulse spontaneously and continuously. Excitability is the ability to be electrically stimulated. Conductivity is the ability to transmit an impulse along a membrane in an orderly manner. Contractility is the ability to respond mechanically to an impulse.

p. 888

Which condition is a possible cause of the artifact in a patient’s electrocardiogram (ECG) tracing? Select all that apply. One, some, or all responses may be correct.

1. The patient is shivering.

2. The patient has dry skin.

3. The conductive gel is moist.

4. Electrical interference is present.

5. The leads and electrodes are not secure.

A) 1,5

B) 2,4,5

C) 1,4,5

D) 1,2,3

E) All

F) None

C) 1,4,5

Rationale

Muscle activity caused by shivering of the patient, electrical interference, or loose leads and electrodes can cause distorted baseline and waveforms called an artifact on the ECG. Oily skin is wiped dry with alcohol to prepare the patient for ECG. Electrodes may have to be replaced if conductive gel has dried out.

pp. 887-888

Which electrolyte plays a key role in polarization of the heart cells?

A) Sodium

B) Calcium

C) Glucose

D) Magnesium

A) Sodium

Rationale

The electrolytes sodium and potassium are partners in cardiac function. A higher sodium level outside the cell allows for a high potassium and low sodium level inside the cell. Potassium inside the cell is required for the conduction of impulses to achieve a polarized state.

What are manifestations of acute coronary syndrome (ACS)? Select all that apply

1. Dysrhythmia

2. Stable angina

3. Unstable angina

4. ST segment elevation myocardial infarction (STEMI)

5. Non-ST-segment elevation myocardial infarction (NSTEMI)

6. Atrial Fibrillation

A) 1,5

B) 2,4,5

C) 3,4,5

D) 1,2,3,6

E) All

F) None

C) 3,4,5

During assessment, the nurse identifies crackles in the lungs. Which complication of MI should the nurse suspect?

A) Pericarditis

B) Ventricular aneurysm

C) Heart Failure

D) Papillary muscle dysfunction

E) Dilated cardiomyopathy

C) Heart Failure

Rationale

Heart failure is one of the complications that can arise from MI, as the muscle tissues are damaged. Monitor for signs of heart failure (both left & right)- crackles in lungs, SOB, swelling/edema, JVD- and monitoring kidney function (urine output) and fluid volume (daily weights, monitoring I & O, IVFs they are getting), especially with patients with low EF%.

Which treatment is used 1st for the patient with confirmed MI to open the blocked artery within 90 minutes of arrival?

A) Transmyocardial laser revascularization

B) Pericardiocentesis

C) Coronary Artery Bypass Graft

D) Percutaneous Coronary Intervention (PCI)

E) Administration of thrombolytic drug

D) Percutaneous Coronary Intervention (PCI)

Rationale

PCI is considered the preferred, 1st line treatment for MI. If the facility it not equipped to perform such a procedure, then thrombolytic drugs given within 30mins is our 2nd option. The goal is to restore perfusion as quickly as possible.

A patient is being treated for heart failure. Which laboratory test result will the nurse review to determine the effects of the treatment?

A) Troponins

B) Homocysteine

C) Myoglobin

D) B-type natriuretic peptide (BNP)

D) B-type natriuretic peptide (BNP)

Rationale

Levels of BNP are a marker for heart failure. The other laboratory results would assess for myocardial infarction (troponin) or the risk for coronary artery disease (Hcy and LDL).

A patient who developed chest pain 4 hours ago may be having a myocardial infarction.Which laboratory test result would be most helpful in indicating myocardial damage?

A) Troponins

B) Myoglobin

C) Homocysteine

D) Creatinine Kinase-MB (CK-MB)

A) Troponins

Rationale

Cardiac troponins start to elevate 4 to 6 hours after myocardial injury and are highly specific to myocardium. They are the preferred diagnostic marker for myocardial infarction as they are highly sensitive and last longer in comparison to ck-mb.. High-sensitivity troponin (hs-cTnT, hs-cTnI) assays provide even earlier detection of a heart event, within 1-3 hours. Myoglobin rises in response to myocardial injury within 30 to 60 minutes but is nonspecific and rapidly cleared from the body, limiting its use in the diagnosis of myocardial infarction. Creatine kinase (CK-MB) increases 4 to 6 hours after myocardial injury but is rarely used now for diagnosis of acute MI. Homocysteine (Hcy) is an amino acid that is made during protein catabolism. Elevated levels of Hcy are linked to a higher risk of CVD, peripheral vascular disease, and stroke.

A patient recovering from a myocardial infarction (MI) develops chest pain on day 3 that increases when taking a deep breath in and is relieved by leaning forward. Which action would the nurse take as a focused follow-up on this symptom?

A) Assess both feet for pedal edema.

B) Palpate the radial pulses bilaterally.

C) Auscultate for a pericardial friction rub

D) Check the heart monitor for dysrhythmias

C) Auscultate for a pericardial friction rub

Rationale

The patient's symptoms are consistent with the development of pericarditis, a possible complication of MI. The other assessments listed are not consistent with the description of the patient's symptoms. Acute pericarditis, can happen 2-3 days after an MI, or 1-8 weeks post MI, which is known as Dressler Syndrome.

The nurse is evaluating the effectiveness of preoperative teaching with a patient scheduled for coronary artery bypass graft (CABG) surgery using the internal mammary artery. Which patient statement indicates that additional teaching is needed?

A) “They will circulate my blood with a machine during surgery.”

B) “I will have incisions in my leg where they will remove the vein.”

C) “They will use an artery near my heart to go around the area that is blocked.”

D) “I will need to take aspirin every day after the surgery to keep the graft open.”

B) "I will have incisions in my leg where they will remove the vein."

Rationale

When the internal mammary artery is used, there is no need to have a saphenous vein removed from the leg, as it is located in the chest. The other statements by the patient are accurate and indicate that the teaching has been effective.

The nurse suspects cardiac tamponade in a patient who has acute pericarditis. How would the nurse assess for the presence of pulsus paradoxus?

A) Subtract the diastolic blood pressure from the systolic blood pressure.

B) Check the electrocardiogram (ECG) for variations in rate during the respiratory cycle.

C) Note when Korotkoff sounds for SBP are heard during both inspiration and expiration

D) Listen for a pericardial friction rub that persists when the patient is instructed to stop breathing.

C) Note when Korotkoff sounds for SBP are heard during both inspiration and expiration

Rationale

Pulsus paradoxus refers to an exaggerated fall in a patient's blood pressure during inspiration by greater than 10 mm Hg.

Following an acute myocardial infarction, a previously healthy 63-yr-old develops heart failure. Which medication topic would the nurse anticipate including in discharge teaching?

A) Calcium channel blocker

B) Selective SA node inhibitor

C) Digoxin and potassium therapy regimen

D) Angiotensin-converting enzyme (ACE) inhibitor

D) Angiotensin-converting enzyme (ACE) inhibitor

Rationale

ACE inhibitor therapy is currently recommended to prevent the development of heart failure in patients who have had a myocardial infarction and as a first-line therapy for patients with chronic heart failure. Digoxin therapy for heart failure is no longer considered a first-line measure, and digoxin is added to the treatment protocol when therapy with other drugs such as ACE-inhibitors, diuretics, and B-adrenergic blockers is insufficient. Calcium channel blockers are not generally used in the treatment of heart failure

When treating a patient with dilated cardiomyopathy with the goal of decreasing preload & afterload, which medications would be administered to help achieve this goal? Select all that apply

1. Nitrates

2. Diuretics

3. Beta Blockers

4. Antiplatelet

5. Large volume IVFs

A) 1,5

B) 2,4,5

C) 3,4,5

D) 1,2,3

E) All

F) None

D) 1,2,3

Rationale

Nitrates help with vasodilation, while diuretic help decrease fluid volume- both helping to reduce cardiac preload (decreasing that volume pressure/stretch in the ventricle)

Beta blockers help to decrease the afterload, and the force the ventricle is having to pump against

When treating a patient with dilated cardiomyopathy which medications can be given to help improve cardiac contractility? Select all that apply

1. Pos. Inotropes - Digitalis (Digoxin)

2. Diuretics- Furosemide (Lasix)

3. Beta Blockers – Lopressor (Metoprolol)

4. Calcium Channel Blockers –Cardizem (Diltiazem)

5. Aldosterone Antagonist- Aldactone (Spironolactone)

A) 1,5

B) 2,4,5

C) 3,4,5

D) 1,2,3

E) All

F) None

A) 1,5

Rationale

Remember, the ventricle stretches in dilated CM- so medication are needed to help the ventricle contract properly. Positive inotropes, like Dig and Aldosterone Antagonist, like Aldactone that work in the RAAS, both help to improve contractility.

A 21 year old, presumably healthy, college football player collapses during practice, and is rushed to the ER. During his cardiovascular work up, the nurse knows he is most likely suffering from which type of cardiomyopathy?

A) Hypertrophic

B) Dilated

C) Takotsubo

D) Pericardial

E) Constrictive

A) Hypertrophic

Rationale

Hypertrophic cardiomyopathy is most common in "young" healthy adults, and accounts for 3% of death in athletes. Patient with Hypertrophic CM, have decreased CO, due to shrinking ventricle space due to the enlarged ventricular walls. These patients are also much high risk for developing fatal dysrhythmias.

Which diagnostic test can be used to distinguish between an MI and a patient experiencing Takotsubo Cardiomyopathy?

A) EKG/ECG

B) Cardiac Biomarkers

C) Heart Catheterization

D) Assessment of signs & symptoms

C) Heart Catheterization

Rationale

Patient's experiencing takotsubo CM, will present just as if they are having a STEMI. They can experience all the "classic" symptoms of an MI (chest pain), and will also have ST segment elevation on the EKG readings and elevated cardiac biomarkers. A heart cath, will show that there is no disease/damaged tissue that would be seen normally with a STEMI.

Match the artery with the correct MI classification.

Inferior MI

A) Posterior descending artery

B) Circumflex Artery

C) Right Coronary Artery

D) Left Anterior Descending Artery

C) Right Coronary Artery

Match the artery with the correct MI classification.

Anterior MI

A) Posterior descending artery

B) Circumflex Artery

C) Right Coronary Artery

D) Left Anterior Descending Artery

D) Left Anterior Descending Artery

Match the artery with the correct MI classification.

Lateral MI

A) Posterior descending artery

B) Circumflex Artery

C) Right Coronary Artery

D) Left Anterior Descending Artery

B) Circumflex Artery

Match the artery with the correct MI classification.

Posterior MI

A) Posterior descending artery

B) Circumflex Artery

C) Right Coronary Artery

D) Left Anterior Descending Artery

A) Posterior descending artery

A patient received a drug eluting stent (DES) during a PCI procedure after presenting to the ER with a MI. The patient will be discharged home on dual antiplatelet therapy of Plavix and Aspirin for how long?

A) 1 month

B) 3 month

C) 6 month

D) 12 months

E) Indefinitely

D) 12 months

Rationale

Patients who get a DES will need to be on DAPT for 12months, due to endothelialization of the vessel taking longer compared to a bare metal stent (BMS)

____________ is the resistance against which the left ventricle must pump.

A) Afterload

B) Stroke Volume

C) Preload

D) Percentage

E) Heart Rate

A) Afterload

The _____________ is the amount of blood put out with each beat.

A) Afterload

B) Stroke Volume

C) Preload

D) Percentage

E) Heart Rate

B) Stroke Volume

The volume pressure/stretch of the ventricle at the end of diastole is called the _______________.

A) Afterload

B) Stroke Volume

C) Preload

D) Percentage

E) Heart Rate

C) Preload

Ejection fraction is measured as a ____________ of blood pumped out with each beat.

A) Afterload

B) Stroke Volume

C) Preload

D) Percentage

E) Heart Rate

D) Percentage

_______________ and Heart Rate determine Cardiac output, which is normally 4-8L/min.

A) Afterload

B) Stroke Volume

C) Preload

D) Percentage

E) Heart Rate

B) Stroke Volume

Stroke Volume and _____________ determine Cardiac output, which is normally 4-8L/min.

A) Afterload

B) Stroke Volume

C) Preload

D) Percentage

E) Heart Rate

E) Heart Rate

If a patient's blood pressure is 130/90, the mean arterial pressure (MAP) would be____________.

A) 103

B) 95

C) 70

D) 85

A) 103

If a patient's blood pressure is 109/88, the mean arterial pressure (MAP) would be____________.

A) 103

B) 95

C) 70

D) 85

B) 95

If a patient's blood pressure is 110/50, the mean arterial pressure (MAP) would be____________.

A) 103

B) 95

C) 70

D) 85

C) 70

If a patient's blood pressure is 120/68, the mean arterial pressure (MAP) would be____________.

A) 103

B) 95

C) 70

D) 85

What would the nurse measure to determine whether there is a delay in electrical impulse conduction through the patient‘s ventricles?

A) P wave

B) Q wave

C) QRS complex

D) PRI interval

C) QRS complex

Rationale

The QRS complex represents ventricular depolarization. The P wave represents the depolarization of the atria. The PR interval represents depolarization of the atria, atrioventricular node, bundle of His, bundle branches, and the Purkinje fibers. The PR segment is the Period between atrial and ventricular depolarization where no electrical activity is happening

A patient's heart monitor shows that every other beat is earlier than expected, has no visible P wave, and has a QRS complex that is wide and bizarre in shape. How will the nurse document the rhythm?

A) Ventricular couplets

B) Ventricular bigeminy

C) Ventricular R-on-T phenomenon

D) Multifocal premature ventricular contractions

B) Ventricular bigeminy

Rationale

Ventricular bigeminy describes a rhythm in which every other QRS complex is wide and bizarre looking. Pairs of wide QRS complexes are described as ventricular couplets. There is no indication that the premature ventricular contractions are multifocal or that the R-on-T phenomenon is occurring.

A patient has a sinus rhythm and a heart rate of 72 beats/min. The nurse determines that the PR interval is 0.24 seconds. Which action would the nurse take?

A) Notify the health care provider on call immediately.

B) Give atropine per agency dysrhythmia protocol.

C) Prepare the patient for temporary pacemaker insertion.

D) Document the finding and monitor the patient.

D) Document the finding and monitor the patient.

Rationale

First-degree atrioventricular block is asymptomatic and usually not serious. There is no treatment for first-degree AV block; treatment of associated conditions may be considered. Monitor patients for changes in heart rhythm (e.g., more serious AV block). The rate is normal, so there is no indication that atropine is needed. Immediate notification of the health care provider about an asymptomatic rhythm is not necessary.