PCCN study cards Exam 53 Questions with Verified Answers,100% CORRECT

PCCN study cards Exam 53 Questions with Verified Answers PSVT- Paroxysmal supraventricular tachycardia- simultaneous activation of A & V - retrograde P waves almost lost in QRS - CORRECT ANSWER PSVT mimicking a more serious rhythm called V tach - CORRECT ANSWER Retrograde P waves can be seen in this PSVT - CORRECT ANSWER Good example of the pseudo-R' configuration in lead V1, representing the retrograde P waves of PSVT. - CORRECT ANSWER Episode of PSVT that is broken up with carotid massage. New rhythm of Sinus bradycardia w/a rate of 50 bpm - CORRECT ANSWER Atrial flutter. Carotid massage increases the block from 3:1 to 5:1 - classic sawtooth pattern - A flutter has a single constant reentrant circuit - CORRECT ANSWER A fib - multiple reentrant circuits - totally unpredictable manner. NO TRUE P WAVES - CORRECT ANSWER A-Fib - irregularly irregular appearance of QRS in absence of discrete P waves is key to identifying A-Fib. The only clue in this stip is irregularly irregular appearance of the QRS- including the absence of a baseline. - CORRECT ANSWER What is the pathology of A fib? - CORRECT ANSWER Underlying cardiac pathology is often present, especially mitral valve disease or coronary artery disease, but hyperthyroidism, pulmonary emboli, and pericarditis must always be considered in the differential diagnosis. Longstanding hypertension is still the most common identifiable cause. In many individuals, no obvious precipitant is identified. PVC - bigeminy - the ratio is one normal sinus beat to one PVC - CORRECT ANSWER Trigeminy - every third heartbeat is a PVC - CORRECT ANSWER A run of three or more consecutive PVCs is called ventricular tachycardia (VT), rate is usually between 120 and 200 beats per minute and, unlike PSVT, may be slightly irregular - CORRECT ANSWER A PVC falls on the T wave of the second sinus beat, initiating a run of ventricular tachycardia. VT is the most frequently encountered arrhythmia in adults who experience sudden death - CORRECT ANSWER Accelerated idioventricular rhythm. There are no P waves, the QRS complexes are wide, and the rate is about 75 beats per minute. When rate is below 50 bpm - drop the word "Accelerated" and it's just IR. - CORRECT ANSWER Torsades de pointes - CORRECT ANSWER Atrial fibrillation - CORRECT ANSWER Ventricular tachycardia - CORRECT ANSWER Ventricular fibrillation - CORRECT ANSWER Paroxysmal supraventricular tachycardia - CORRECT ANSWER Sinus bradycardia - CORRECT ANSWER TYPE I -Wenckebach block, with progressive lengthening of the PR interval - CORRECT ANSWER Mobitz type II block, in which the PR interval is constant - CORRECT ANSWER Third-degree AV block. The P waves appear at regular intervals, as do the QRS complexes, but they have nothing to do with one another. The QRS complexes are wide, implying a ventricular origin - CORRECT ANSWER Right bundle branch block. The QRS complex in lead V1 shows the classic wide configuration - can be caused by diseases of the conducting system, it is also a fairly common phenomenon in otherwise normal hearts. - CORRECT ANSWER Left bundle branch block - rarely occurs in normal hearts and almost always reflects significant underlying cardiac disease - CORRECT ANSWER 1. QRS complex widened to greater than 0.12 seconds 2. RSR' in V1 and V2 (rabbit ears) with ST segment depression and T wave inversion An example of critical rate (lead V2). As the heart accelerates, the pattern of right bundle branch block appears. 3. Reciprocal changes in V5, V6, I, and AVL. - CORRECT ANSWER Thomas has had an anterolateral MI. Where so you expect to see changes on the 12-lead EKG? -V1, V2, I, AVL -V2, V3, V4, I, AVL -V2, V3, V4, II, III, AVF -V1, V2, II, III, AVF - CORRECT ANSWER V2, V3, V4, I, AVL Changes in V2, V3, V4, I and AVL indicate an anterolateral MI. The MI could also be detected in V5 and V6 which are also lateral leads. Wolff-Parkinson-White (WPW) syndrome - CORRECT ANSWER Wide-complex PSVT in WPW syndrome. - CORRECT ANSWER (A) T wave peaking in a patient undergoing acute infarction. (B) The same lead in a patient 2 hours later shows T wave inversion. - CORRECT ANSWER ST segment elevation during an infarction. Note how the ST segment and T wave merge into each other without a clear demarcation between them. - CORRECT ANSWER An example of a significant Q wave. Its width (A) exceeds 0.04 seconds and its depth (B) exceeds one-third that of the R wave. Note: Because lead AVR occupies a unique position on the frontal plane, it normally has a very deep Q wave. Lead AVR should not be considered when assessing possible infarction. - CORRECT ANSWER Answers: The Q waves in leads I and AVF are significant. The Q wave in lead V2 is too shallow and narrow to qualify (don't confuse the tiny Q wave with the large S wave). The Q wave in lead AVR is immense, but Q waves in AVR are never significant! - CORRECT ANSWER Are the following Q waves significant? The four basic anatomic sites of myocardial infarction. - CORRECT ANSWER Inferior infarction involves the diaphragmatic surface of the four basic anatomic sites of myocardial infarction. the heart. It is often caused by occlusion of the right coronary artery or its descending branch. The characteristic electrocardiographic changes of infarction can be seen in the inferior leads II, III, and AVF. - CORRECT ANSWER Lateral infarction involves the left lateral wall of the heart. It is often due to occlusion of the left circumflex artery. Changes will occur in the left lateral leads I, AVL, V5, and V6. Anterior infarction involves the anterior surface of the left ventricle and is usually caused by occlusion of the left anterior descending artery. Any of the precordial leads (V1 through V6) may show changes. - CORRECT ANSWER Posterior infarction involves the posterior surface of the heart and is usually caused by occlusion of the right coronary artery. There are no leads overlying the posterior wall. The diagnosis must therefore be made by looking for reciprocal changes in the anterior leads, especially V1. The EKG shows ST segment elevation in leads V2 through V5. There are no Q waves. This pt is in the throes of an acute anterior myocardial infarction. - CORRECT ANSWER Hyperkalemia. - As the potassium begins to rise, the T waves across the entire 12-lead EKG begin to peak. This effect can easily be confused with the peaked T waves of an acute myocardial infarction. One difference is that the changes in an infarction are confined to those leads overlying the area of the infarct, whereas in hyperkalemia, the changes are diffuse. - CORRECT ANSWER Can't diagnosis this b/c you need the other leads, however if the T waves were diffusely elevated what might you think of? The digitalis effect, with asymmetric ST segment depression - look for the scoop on the back of the QRS - CORRECT ANSWER What are the 3 most common risk factors for an MDRO infection? - CORRECT ANSWER impaired immune function, recent surgery, or indwelling cathethers/tubes Pt with pericarditis, receiving coumadin, is at risk for what? - CORRECT ANSWER Cardiac tamponade. Classic signs include hypotension, narrowing pulse pressure, thready pulse, and tachypenea Signs include hypotension, narrowing pulse pressure, thready pulse, and tachypenea - CORRECT ANSWER Cardiac tamponade Why would a post- CABG patient receive an insulin drip? - CORRECT ANSWER To reduce the risk of infection; postoperative glucose control has been shown to decrease the risk of infection in these patients How does AKI cause acidosis? - CORRECT ANSWER Decreased urine output impairs potassium excretion. The resulting hyperkalemia causes a shift in H+, the accumulation results in acidosis A patient with severe abdominal pain for the last week presents with elevated amylase, lipase, and a rigid abdomen. What do you suspect? - CORRECT ANSWER pancreatitis How is acute pancreatitis treated? - CORRECT ANSWER hydration, electrolyte balance, nutrition and pain control What procedure measures heart pressure and diagnoses pulmonary hypertension? - CORRECT ANSWER right-sided heart catheterization; provides measurements of right atrium, right ventricle, pulmonary artery, and pulmonary artery occlusive pressure Why does lowering fever improve prognosis in stroke pts? - CORRECT ANSWER Increased metabolic demands, enhanced neurotransmitter release, and increased free radicals may increase stroke mortality. What is a contraindication to administer nitroglycerin to a pt with a right ventricular infarction? - CORRECT ANSWER nitroglycerin reduces preload, and pts with a RVI are preload dependent What are six risk factors for delirium? - CORRECT ANSWER cognitive impairment, sleep deprivation, dehydration, immobility, hearing impairment, vision impairment What does a pericardial friction rub sound like? - CORRECT ANSWER grating sound with s1 and s2 Normal PR interval - CORRECT ANSWER 0.12-0.20 normal QRS - CORRECT ANSWER 0.04-0.10