EKG Ch 13 Ambulatory Monitoring v2

Which of the following is an abnormal symptom that should be recorded during ambulatory monitoring? 

Responses

• A

  Chest pain

• B

  Indigestion

• C

  Dizziness

• D

  All of the above

D

All of the above

As a healthcare professional, your responsibilities with the ambulatory monitor may include: 

Responses

• A

  Applying and removing the monitor

  Providing patient education

• C

  Placing the results in the patient's chart

  given

• D

  All of the above

D

All of the above

An instrument that records the electrical activity of the heart during a patient's normal daily activities is called: 

Responses

• A

  Pacemaker

  Single-channel recorder

• C

  Oscilloscope

• D

  Ambulatory monitor

D

Ambulatory monitor

How long does an ambulatory monitor record an ECG? 

Responses

• A

  12 hours

  12 hours - no response given

• B

  24 to 48 hours

  24 to 48 hours - correct

• C

  21 days

  21 days - no response given

• D

  30 days

B

24 to 48 hours

How many leads are attached to the patient's chest with ambulatory monitoring? 

Responses

• A

  2 leads

• B

  12 leads

• C

  10 leads

• D

  3 to 5 leads

D

3 to 5 leads

Another term for loss of consciousness (fainting) is: 

Responses

• A

  Apnea

• B

  Asystole

• C

  Syncope

• D

  Cyanosis

C

Syncope

Fast, irregular heartbeat sensations felt by the patient, which may or may not be associated with complaints of chest pain, are known as: 

Responses

• A

  Precordial

• B

  Palpitations

• C

  PVCs

• D

  Polarization

B

Palpitations

Which one of the following is NOT a reason to use an ambulatory monitor? 

Responses

• A

  To evaluate artificial pacemaker functioning

• B

  To 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

Ambulatory monitoring may be used in addition to 12-lead ECG monitoring because: 

Responses

• A

  The patient may not experience any symptoms during the 12-lead ECG testing

  B

  No abnormalities were observed during the 12-lead ECG to correlate with the patient's symptoms of syncope

  n

• C

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

• D

  All of the above

D

All of the above

The two most common types of ambulatory monitoring are: 

Responses

• A

  Continuous and 12-lead ECG

• B

  12-lead ECG and exercise electrocardiography

  C

  Ambulatory and 12-lead ECG

• D

  Continuous and intermittent

D

Continuous and intermittent

Patients with permanent pacemakers may require monitoring for 30 days or more. The type of ambulatory monitoring most often used is: 

Responses

• A

  Transtelephonic monitoring

• B

  Multichannel recorder

• C

  Telemetry monitoring

• D

  24-hour ambulatory monitoring

A

Transtelephonic monitoring

Which type of monitoring requires the patient to activate the monitor while the patient is experiencing symptoms? 

Responses

• A

  Transtelephonic postsymptom event monitor

• B

  Telemetry monitor

  C

  Transtelephonic loop-memory monitor

• D

  24-hour ambulatory monitoring

A

Transtelephonic postsymptom event monitor

Postsymptom event monitors are used primarily to document what type of dysrhythmias? 

Responses

• A

  Atrial fibrillation

• B

  Atrial flutter

• C

  Supraventricular tachycardia

• D

  All of the above

D

All of the above

Which of the following patients is NOT a candidate for ambulatory monitoring? 

Responses

• A

  Ms. Jones is complaining of chest pain. She is independent in care but confined to a wheelchair.

• B

  Mr. Jackson complains of dizziness. His ECG and stress tests were normal.

• C

  Mr. Peters complains of palpitations but ECG and stress test were inconclusive.

  D

  Miss Jeffers is confused and living in a nursing home.

• 
  

  D

  Miss Jeffers is confused and living in a nursing home.

What is the advantage of continuous monitoring over intermittent monitoring? 

Responses

• A

  All of the above

• B

  Continuous monitoring provides a complete tracing and records before, during, and after the patient activates the event marker

• C

  Continuous monitoring is shorter and more quickly evaluated

  Continuous monitoring is shorter and more quickly evaluated - no response given

• D

  Continuous monitoring is activated when the patient pushes the event marker

B

Continuous monitoring provides a complete tracing and records before, during, and after the patient activates the event marker

Which type of ambulatory monitoring is performed in a hospital? 

Responses

• A

  Telemetry

• B

  Transtelephonic

• C

  Holter monitoring

• D

  All of these

A

Telemetry

Why would a patient use an "event marker" during ambulatory monitoring? 

Responses

• A

  To mark the beginning and ending of ambulatory monitoring

• B

  To mark the ECG tracing after any symptoms occur

• C

  To mark the ECG tracing when symptoms occur

• D

  To identify the type of event or symptom when it occurs

C

To mark the ECG tracing when symptoms occur

Which patient will be asked to keep a diary? 

Responses

• A

  Mr. Fisher, whose physician ordered ambulatory monitoring for him this morning

• B

  Mr. Jones, who is scheduled for a stress test

• C

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

  D

  Mr. Evans, who is on telemetry

A

Mr. Fisher, whose physician ordered ambulatory monitoring for him this morning

Mr. Hansen has an ambulatory monitor in place. What instructions do you give him regarding the electrodes? 

Responses

• A

  If an electrode becomes loose, he should press the event marker

• B

  If an electrode comes off, he should just document it in his diary and not worry about it

• C

  If an electrode comes off, he should replace it with one of the extras that you provided

• D

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

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

Which of the following is a correct statement regarding patient education for ambulatory monitoring? 

Responses

• A

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

• B

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

  You should avoid alcohol and caffeine during ambulatory monitoring

  You should avoid alcohol and caffeine during ambulatory monitoring - no response given

• D

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

A

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

Which of the following should be recorded in the patient diary during ambulatory monitoring? 

Responses

• A

  Urination and bowel movements

• B

  Sleeping

• C

  An argument with a spouse or child

• D

  All of the above

D

All of the above

When an ambulatory monitor is used, when should the patient start his or her diary? 

Responses

• A

  At the time the monitor is turned on

• B

  At the time the patient first experiences chest pain during monitoring

• C

  After the patient leaves the clinic

• D

  Prior to coming to the clinic for monitor placement

A

At the time the monitor is turned on

What devices should a patient avoid while wearing an ambulatory monitor? 

Responses

• A

  Magnets and metal detectors

• B

  High-voltage areas

• C

  Electric blankets

• D

  All of the above

D

All of the above

When asked by a patient or the parent of a patient whether ambulatory monitoring is painful, what would be your BEST response? 

Responses

• A

  The only pain you will feel is from the electrodes that are placed on the chest

  B

  It is uncomfortable when the hair on the chest is shaved

• C

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

  Ambulatory monitoring is completely pain-free

C

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

When preparing the patient for ambulatory monitoring, it is important to ensure that: 

Responses

• A

  The patient understands the procedure

• B

  The patient is allowed to ask questions

  The patient is allowed to ask questions - no response given

• C

  The patient understands the physical requirements of the monitoring procedure

• D

  All of the above

D

All of the above

How do you decrease a child's fears and anxieties for the ambulatory monitoring procedure? 

Responses

• A

  Explain in terms the child can understand

• B

  Allow the child to touch the equipment

• C

  Instruct the parent

• D

  All of the above

D

All of the above

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

Responses

• A

  Skin preparation equipment

• B

  Electrodes

• C

  Oxygen supplies

• D

  Patient diary

C

Oxygen supplies

How are lead wires coded to ensure proper placement for ambulatory monitoring? 

Responses

• A

  Numbers

• B

  Letters

  n

• C

  Symbols

• D

  Colors

D

Colors

How can you ensure that each electrode is firmly attached? 

Responses

• A

  Use a large quantity of electrode gel in the center of each electrode

  Press firmly in the center of each electrode

• C

  Warm the electrode in your hands to increase the power of the adhesive

• D

  Run your finger around the edge of each electrode

D

Run your finger around the edge of each electrode

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

Responses

• A

  Tape each of the electrodes in place

  Tape each of the electrodes in place - no response given

• B

  Run a baseline ECG tracing

  Run a baseline ECG tracing - not selected, this is the correct answer

• C

  Double-check the lead wires and electrodes to ensure there is no pulling on them

  Double-check the lead wires and electrodes to ensure there is no pulling on them - incorrect

• D

  Place the monitor in its carrying case

B

Run a baseline ECG tracing

You are putting a new type of ambulatory monitor on Mr. Farmer. It uses a five-lead system with which you are not familiar. What should you do before placing the electrodes? 

Responses

• A

  Check the facility's policy on lead placement

• B

  Get an ambulatory monitor with which you are familiar

• C

  Ask a co-worker about the unit

• D

  Consult the manufacturer's instructions; they are the best resource for using new equipment

D

Consult the manufacturer's instructions; they are the best resource for using new equipment

What precautions do you need to take when applying electrodes to an elderly patient? 

Responses

• A

  All of the above

• B

  Pull them off quickly to prevent pain

• C

  
   

  Use less pressure to abrade the skin and manipulate them as little as possible   - correct

• D

  Use more pressure to apply the electrodes

C

Use less pressure to abrade the skin and manipulate them as little as possible

What should be done with the monitor prior to entering the patient room to begin the procedure? 

Responses

• A

  Insert a new blank tape or disk if required

• B

  Insert new batteries

• C

  Review the manufacturer's instructions

• D

  All of the above

D

All of the above

Which of the following steps is out of order for removing an ambulatory monitor? 
 

Responses

• A

  Remove the tape and electrodes from the patient and clean the sites

• B

  Turn off the monitor and detach it from the lead wires

• C

  Remove the wires and cables from the patient

• D

  Review the diary with the patient

C

Remove the wires and cables from the patient

What should you do if the patient returns after ambulatory monitoring and does not have the diary with him or her? This is a multiple choice question.

Responses

• A

  Remove the monitor and ask the patient to return home and bring it to you

• B

  Ask the patient to return home to get the diary before removing the monitor

• C

  Leave the monitor in place and ask the patient to return the next day with the diary

• D

  Have the patient fax or bring the diary to you later or the next day

B

Ask the patient 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 lab for ambulatory monitoring? 

Responses

• A

  Results will be available in 7 to 10 days and the patient will be called if abnormalities are found

• B

  Results will be available in 7 to 10 days and placed on the chart for the physician to discuss with the patient

• C

  Results will be available in 1 to 3 days and placed on the chart for the physician to discuss with the patient

• D

  The final report is available in 7 to 10 days and is sent to the patient

B

Results will be available in 7 to 10 days and placed on the chart for the physician to discuss with the patient

What factors can affect the results of ambulatory monitoring? 

Responses

• A

  Improper lead attachment

• B

  Incomplete patient diary

• C

  Failure of the patient to maintain a normal routine

  D

  All of the above

D

All of the above

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

Responses

• A

  You ignore the question and ask about his week

• B

  To avoid upsetting him, you tell him the test results were okay

• C

  You tell him the results and encourage him to discuss them with his physician

• D

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

D

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

Abnormal ambulatory monitor results could indicate what cardiac condition? 

Responses

• A

  Electrical-conduction defects in the heart's rate and rhythm-controlling system

  B

  Rhythm abnormalities

• C

  Premature atrial or ventricular contractions

• D

  All of the above

D

All of the above

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

Responses

• A

  Coronary angiogram

• B

  Pulmonary function test

• C

  Echocardiogram

• D

  CT scan

B

Pulmonary function test

Patients may take a tub bath during ambulatory monitoring as long as they do not let the monitor drop in the water. 

Responses

• True

• False

False

The patient should avoid alcohol and caffeine during the ambulatory monitoring. 

Responses

• True

• False

• 
  

  True

For telemetry monitoring, it is recommended that chest hair be clipped, not shaved. 

Responses

• True

• False

• 
  

  True

It is important to document and label the report, diary, and tape or digital disk with all the required patient and facility information. 

Responses

• True

• False

True

Ambulatory monitoring can be used to evaluate the effectiveness of cardiac medications such as anti-arrhythmic drugs. 

Responses

• True

• False

• 
  

  True

All ambulatory monitors are voice-activated when the patient speaks into the recorder to describe each event. 

Responses

• True

• False

False

Telemetry monitoring is the transmission of an electrical signal to a monitoring station, similar to a transmitter radio. 

Responses

• True

• False

True

After applying the electrodes in their proper sites and attaching lead wires to the electrodes, it is necessary to tape the electrodes in place to reduce tugging, pulling, and disconnection of the electrodes. 

Responses

• True

• False

True

You should instruct the patient to restrict physical activity during the monitoring period. 

Responses

• True

• False

• 
  

  False

If you do not know the answer to a patient's question, ask a licensed practitioner or your supervisor. 

Responses

• True

• False

True