Telemetry Exam 87 Questions with Verified Answers,100% CORRECT

Telemetry Exam 87 Questions with Verified Answers Right side of the heart supplies - CORRECT ANSWER Pulmonary circulation (circuit through lungs where blood is oxygenated) Left side of the heart supplies - CORRECT ANSWER Systemic circulation (tissues of the body) Arteries take blood - CORRECT ANSWER AWAY from the heart Veins take blood - CORRECT ANSWER TO the heart Automaticity - CORRECT ANSWER Ability to initiate and maintain an electrical rhythm Exictability - CORRECT ANSWER Ability to respond to the electrical stimulus Conductivity - CORRECT ANSWER Ability to transfer electrical stimulus to neighboring cells Contractility - CORRECT ANSWER The ability of myocardial cells to shorten and contract in response to an electrical stimulus Cardiac output formula - CORRECT ANSWER CO = SV x HR Cardiac output - CORRECT ANSWER the amount of blood pumped by each ventricle in L/min Stroke volume - CORRECT ANSWER The amount of blood ejected with each heart beat Preload - CORRECT ANSWER Volume of blood in the ventricles at the end of diastole (ventricular filling) Afterload - CORRECT ANSWER The amount of resistance the ventricle must overcome to eject blood out of the heart SA node - CORRECT ANSWER Primary pacemaker of the heart that sets the rate 60-100 BPM AV node - CORRECT ANSWER Synchronizes atrial and ventricle activity; if SA node fails, will maintain the heart at 40-60 BPM Purkinje fibers - CORRECT ANSWER Finally stimulation for ventricles to contract; if SA node and then AV node fail, will maintain heart at 30-40 BPM Depolarization (Stimulation) - CORRECT ANSWER Cardiac cell is normally negatively charged. During depolarization cells become positive and heart contracts Electrolyte movement during depolarization - CORRECT ANSWER Na+ and Ca+ enter the cell, K+ leaves the cell Repolarization (Relaxation) - CORRECT ANSWER Restoration of the negative charge of cardiac cells in order to relax the heart Electrolyte movement during repolarization - CORRECT ANSWER K+ still leaves cell, Na+ flows into cell with Cl- Arrhythmias/dysrhytmias - CORRECT ANSWER Disorders of the electrical impulse within the heart that causes disturbances How are arrhythmias named? - CORRECT ANSWER According to site of origin of impulse & mechanism of conduction How to place continuous telemetry monitoring - CORRECT ANSWER Left side of the body: Smoke over fire Right side of body: snow over grass Middle: poop Time value of a small box on an EKG strip - CORRECT ANSWER 0.04 seconds Problem with P wave indicates - CORRECT ANSWER Atria issue Problem with QRS complex indicates - CORRECT ANSWER Ventricular issue Atrial depolarization is indicated by - CORRECT ANSWER P wave Ventricular contraction is indicated by - CORRECT ANSWER QRS complex Ventricular repolarization is indicated by - CORRECT ANSWER T wave Isoelectric line - CORRECT ANSWER The flat line that occurs when no electrical activity is taking place Positive deflection on an EKG - CORRECT ANSWER A wave moves towards the top of the paper Negative deflection on an EKG - CORRECT ANSWER A wave moves towards the bottom of the paper/down How to analyze a heart rhythm - CORRECT ANSWER Calculate HR, analyze the regularity, analyze the P wave and measure PR interval, analyze the QRS and measure the interval, analyze the QT and measure the interval, interpret the rhythm How to calculate HR on ekg? - CORRECT ANSWER Count the number of QRS complexes and multiply by 10 Normal P wave length - CORRECT ANSWER 0.12 seconds or less, or 3 small boxes normal P wave - CORRECT ANSWER Upright, round, symmetrical PR interval length - CORRECT ANSWER .12-.20 seconds (3-5 small boxes) PR interval measured from - CORRECT ANSWER Beginning of P wave to beginning of QRS; time for impulse to travel from SA node through the AV node QRS complex - CORRECT ANSWER Ventricular depolarization, measured from start of the Q to the J point Normal length for QRS complex - CORRECT ANSWER 0.04-0.1 seconds, or about 1-2 small boxes J point - CORRECT ANSWER Where the wave moves back to the isoelectric line QT interval - CORRECT ANSWER Total time for ventricular depolarization and repolarization QT interval indicated by - CORRECT ANSWER Beginning of QRS complex to end of T wave Normal time for QT interval - CORRECT ANSWER 0.35-0.45 seconds, or about 20 small boxes St segment - CORRECT ANSWER Early ventricular repolarization U wave indicates - CORRECT ANSWER Old ischemia or necrosis T wave represents - CORRECT ANSWER Ventricular repolarization (recovery) or the relative refractory period ST elevation - CORRECT ANSWER J point is above isoelectric line ST depression - CORRECT ANSWER J point is below isoelectric line What are the 3 lethal rhythms? - CORRECT ANSWER Vfib, asystole, Vtach Sinus bradycardia - CORRECT ANSWER Rate under 60 BPM Causes of sinus bradycardia - CORRECT ANSWER SA node firing too slowly, athletic, vagal stimulation, increased ICP, inferior wall MI, hypothermia, hypothyroidism Treatment for sinus bradycardia - CORRECT ANSWER Indicated by SOB, altered mental status, chest pain; can treat with atropine, dopamine, epinephrine Steps to treating adult bradycardia - CORRECT ANSWER Get a 12 lead EKG, identify underlying cause, give atropine, start infusion, transcutaneous pacing Sinus tachycardia - CORRECT ANSWER Rate over 100 BPM, P waves may not be rounded Causes of sinus tachycardia - CORRECT ANSWER SA node firing too fast, stress, infection, shock, illicit drugs Nursing care for sinus tachycardia - CORRECT ANSWER Check pt, treat underlying cause, ABCs Meds for Sinus Tachycardia - CORRECT ANSWER Beta blockers, Calcium channel blockers, fluids Atrial flutter - CORRECT ANSWER Originates in the atrium; caused by pulmonary embolism, hyperthyroidism, mitral/tricuspid valve disease EKG appearance of atrial flutter - CORRECT ANSWER Variable and sawtooth pwaves, normal QRS Treatment for atrial flutter - CORRECT ANSWER Cardioversion, anticoagulation, beta blockers Atrial fibrillation - CORRECT ANSWER Rapid and disorganized activity in the atria, no defined P wave, variable rhythm overall Afib what is happening in the heart - CORRECT ANSWER Atria muscles quivering, ineffective contraction so blood pools in the atria Causes of Afib - CORRECT ANSWER Coronary artery disease, HTN, CHF, diabetes, obesity, cardiomyopathy, old age; this is the most common dysrhythmia Pt with Afib is at high risk for - CORRECT ANSWER Stroke and embolism. Rate controlled would be a pt is taking meds and their HR is stable Management of Afib - CORRECT ANSWER Check pt! Control the rate, ANTICOAGULATION, beta blockers, calcium channel blockers, digoxin, amiodarone Synchronized Cardioversion - CORRECT ANSWER Controlled shocking, pt receiving shock at specific time during cardiac cycle. The pt will have a pulse and just needs a shock Nursing considerations for synchronized cardioversion - CORRECT ANSWER Conscious sedation, connected to central monitor, oxygen is flammable, "ALL CLEAR" Supraventricular Tachycardia (SVT) - CORRECT ANSWER Occurs "above ventricles", commonly in bundle of His. Rate is over 150 BPM EKG appearance for SVT - CORRECT ANSWER Equal rate, non-visible P waves, normal or narrow QRS complex Symptoms of SVT - CORRECT ANSWER Palpitations, SOB, dizzy, syncope, panic, chest pain Management SVT - CORRECT ANSWER Vagal maneuver, 12 lead EKG, check pt first!, adenosine, synchronized cardioversion Sinus pause - CORRECT ANSWER Failure to generate an impulse for a period of time PAC - CORRECT ANSWER Premature atrial complex where the P wave is upright in front of QRS PJC - CORRECT ANSWER Premature junctional complex where P wave is inverted or absent PVC - CORRECT ANSWER Premature ventricular complex where there is no P wave and wide QRS Causes of PVCs - CORRECT ANSWER Stimulant, medications, acid-base imbalances, hypoxia, ischemia PVCs are concerning when there are - CORRECT ANSWER 6 or more per minute Junctional rhythm - CORRECT ANSWER AV node becomes pacemaker bc SA node failed; rate 40-60 BPM, equal rhythm, inverted P waves, possibly invisible PR interval Difference between Afib and Junctional Rhythm? - CORRECT ANSWER Afib beat is greater than 60 BPM, JR is 40-60 BPM Treatment for JR? - CORRECT ANSWER Check the pt, treat underlying cause, symptomatic pts treated same as bradycardia A client arrives at the emergency room complaining of chest pain and dizziness. The client has a history of angina. The primary healthcare provider prescribes an electrocardiogram (ECG) and lab tests. A change in which component of the ECG tracing should the nurse recognize as the client actively having a myocardial infarction (MI)? QRS complex S-T segment P wave R wave - CORRECT ANSWER In ECG tracing, the displacement of the S-T segment is caused by an active ischemic injury in the myocardium. The QRS complex, the P wave, and the R wave are not associated with an MI. The nurse is watching the technician obtain a 12-lead ECG. In which area should the nurse make sure the technician places the V1 lead? 1 Halfway between V2 and V4 2 Fourth intercostal space, left sternal border 3 Fourth intercostal space, right sternal border 4 Fifth intercostal space, left midclavicular line - CORRECT ANSWER Positions for these six leads are as follows: V1: fourth intercostal space, right sternal border; V2: fourth intercostal space, left sternal border; V3: halfway between V2 and V4; V4: fifth intercostal space, left midclavicular line; V5: fifth intercostal space, left anterior axillary line; V6: fifth intercostal space, left midaxillary line. The nurse is providing information about blood pressure to an unlicensed health care worker and recalls that the factor that has the greatest influence on diastolic blood pressure is what? 1 Renal function 2 Cardiac output 3 Oxygen saturation 4 Peripheral vascular resistance - CORRECT ANSWER Peripheral vascular resistance is the impedance of blood flow, or back pressure, by the arterioles, which is the most influential component of diastolic blood pressure. Renal function through the renin-angiotensin-aldosterone system regulates fluid balance and does influence blood pressure. Cardiac output is the determinant of systolic blood pressure. Oxygen saturation does not have a direct effect on diastolic blood pressure. An electrocardiogram (ECG) is prescribed for a client who reports chest pain. Which early finding does the nurse expect on the lead over the infarcted area? 1 Flattened T waves 2 Absence of P waves 3 Elevated ST segments 4 Disappearance of Q waves - CORRECT ANSWER Elevated ST segments are an early, typical finding after a myocardial infarct because of altered contractility of the heart. Flattened or depressed T waves indicate hypokalemia. Absence of P waves occurs in atrial and ventricular fibrillation. Q waves may become distorted with conduction or rhythm problems, but they do not disappear unless cardiac standstill occurs. What is the priority nursing action when caring for a client with disseminated intravascular coagulation? 1 Monitor for Homans sign. 2 Avoid giving intramuscular injections. 3 Take temperatures via the rectal route. 4 Apply sequential compression stockings. - CORRECT ANSWER Massive amounts of clots formed in the microcirculation deplete platelets and clotting factors, leading to bleeding; the trauma of an injection may cause excessive bleeding. Monitoring for Homans sign is associated with thrombophlebitis. Taking temperatures via the rectal route could be traumatic and precipitate bleeding. Sequential compression stockings are used to prevent thrombophlebitis. The nurse is caring for a client who is admitted with the diagnosis of mild heart failure. Which type of lung sounds should the nurse expect to hear? 1 Stridor 2 Crackles 3 Wheezes 4 Friction rubs - CORRECT ANSWER Left-sided heart failure causes fluid accumulation in the capillary network of the lungs; fluid eventually enters alveolar spaces and causes crackling sounds at the end of inspiration. Stridor is not heard in heart failure, but with tracheal constriction or obstruction. Wheezes are not heard with heart failure, but with asthma. Friction rubs are not heard with heart failure, but with pleurisy.