CCRN AACN REVISION QUESTIONS
WITH CORRECT ANSWERS
atrial fibrillation adverse consequences - Answer - 1. decreased cardiac output due to loss of atrial kick,
rapid ventricular rate, irregular ventricular rhythm
2. tachycardia induced cardiomyopathy - in rapid afib for prolonged period of time
3. thromboembolism
right bundle branch - Answer - -right side of the interventricular septum and right ventricle
-impulse travels slower as the right ventricle is smaller/thinner
left bundle branch - Answer - two main divisions: anterior fascicle and posterior fascicle carrying
impulses to the left ventricle
PR interval - Answer - delay of AV node to allow filling of ventricles
QRS complex - Answer - ventricular depolarization
shape depends on the lead that is being monitored and the ventricular activation device
T wave - Answer - ventricular repolarization
normally in the same direction as the QRS
,upright, flat, inverted
pathologies of T wave - Answer - MI, E/L levels, drug effect, myocardial disease, and lead being
recorded
u wave - Answer - repolarization of the purkinje fibers
SHOULD BE POSITIVE especially when T wave is positive
large u waves can be seen when repolarization is abnormally prolonged - E/L imbalances like
hypokalemia, hypocalcemia, hypomagnesemia, IICP, LVH, certain medications
ST segment - Answer - early ventricular repolarization
should be at isoelectric line
J point - Answer - where QRS complex ends and ST segment begins
QT interval - Answer - ventricular depolarization and repolarization varies with age, gender, and heart
rate
beginning of the QRS to the end of the T wave
QT must be corrected to a HR of 60 bpm
QTc - Answer - corrected QT interval =
QT/(square root of R-R interval)
normalizes for HR
,long QTc --> torsades, ventricular arrhythmia, Vfib
vertical axis - Answer - each small box is 1mm or 0.1 mV
each large box is 5mm or 0.5 mV
most common complication of ischemic heart disease and MI - Answer - dysrhythmias
best leads for differentiating wide QRS rhythms - Answer - v1 and v6
v1 and v6 - Answer - helps to differentiate VTACH from SVT with aberrant intraventricular conduction
helps to recognize right and left bundle branch blocks
differentiates between right and left ventricular ectopy
differentiates between right and left ventricular pacing
v1 and v6 placement - Answer - v1 - fourth intercostal space at the right sternal border
v6 - left midaxillary line at the v4 level (fifth intercostal space midclavicular line)
primary dysrhythmia monitoring lead - Answer - V1
what is lead II used for? - Answer - used to identify atrial activity if unclear in other leads or for
visualization of R waves during synchronized cardioversion
rhythms with a short PR interval - Answer - may indicate presence of accessory pathway
, lead III or avF - Answer - assists in diagnosis of hemiblock
allows identification of retrograde P waves
allows identification of atrial flutter waves
ectopic beat - Answer - Cardiac beat starting at a point other than the SA node
could be from atria, AV junction, ventricles
sinus bradycardia causes - Answer - inferior MI, OSA, IICP, CNS conditions like stroke, hypothyroidism,
hypothermia, some infectious diseases
digitalis, beta blocker, CCB, ivabradine, antiarrhythmics
Ivabradine - Answer - Cardio
MOA: selective inhibition of funny sodium channels, prolonging slow depolarization phase (phase 4);
decreases SA node firing; negative chronotropic effect without inotropy; reduces cardiac O2
requirements
Use: chronic stable angina in patients who cannot take beta blockers; chronic HF with reduced ejection
fraction
Tox: luminous phenomena/visual brightness, hypertension, bradycardia
medications that cause ST - Answer - atropine, isoproterenol, epinephrine, dopamine, dobutamine,
levo, nitroprusside
persistent tachycardia - Answer - decreased stroke volume, decreased cardiac output, and decreased
coronary artery perfusion secondary to decreased diastolic time that occurs with rapid heart beats
sinus dysrhythmia - Answer - sinus node discharges irregularly and commonly associated with phases of
respiration
WITH CORRECT ANSWERS
atrial fibrillation adverse consequences - Answer - 1. decreased cardiac output due to loss of atrial kick,
rapid ventricular rate, irregular ventricular rhythm
2. tachycardia induced cardiomyopathy - in rapid afib for prolonged period of time
3. thromboembolism
right bundle branch - Answer - -right side of the interventricular septum and right ventricle
-impulse travels slower as the right ventricle is smaller/thinner
left bundle branch - Answer - two main divisions: anterior fascicle and posterior fascicle carrying
impulses to the left ventricle
PR interval - Answer - delay of AV node to allow filling of ventricles
QRS complex - Answer - ventricular depolarization
shape depends on the lead that is being monitored and the ventricular activation device
T wave - Answer - ventricular repolarization
normally in the same direction as the QRS
,upright, flat, inverted
pathologies of T wave - Answer - MI, E/L levels, drug effect, myocardial disease, and lead being
recorded
u wave - Answer - repolarization of the purkinje fibers
SHOULD BE POSITIVE especially when T wave is positive
large u waves can be seen when repolarization is abnormally prolonged - E/L imbalances like
hypokalemia, hypocalcemia, hypomagnesemia, IICP, LVH, certain medications
ST segment - Answer - early ventricular repolarization
should be at isoelectric line
J point - Answer - where QRS complex ends and ST segment begins
QT interval - Answer - ventricular depolarization and repolarization varies with age, gender, and heart
rate
beginning of the QRS to the end of the T wave
QT must be corrected to a HR of 60 bpm
QTc - Answer - corrected QT interval =
QT/(square root of R-R interval)
normalizes for HR
,long QTc --> torsades, ventricular arrhythmia, Vfib
vertical axis - Answer - each small box is 1mm or 0.1 mV
each large box is 5mm or 0.5 mV
most common complication of ischemic heart disease and MI - Answer - dysrhythmias
best leads for differentiating wide QRS rhythms - Answer - v1 and v6
v1 and v6 - Answer - helps to differentiate VTACH from SVT with aberrant intraventricular conduction
helps to recognize right and left bundle branch blocks
differentiates between right and left ventricular ectopy
differentiates between right and left ventricular pacing
v1 and v6 placement - Answer - v1 - fourth intercostal space at the right sternal border
v6 - left midaxillary line at the v4 level (fifth intercostal space midclavicular line)
primary dysrhythmia monitoring lead - Answer - V1
what is lead II used for? - Answer - used to identify atrial activity if unclear in other leads or for
visualization of R waves during synchronized cardioversion
rhythms with a short PR interval - Answer - may indicate presence of accessory pathway
, lead III or avF - Answer - assists in diagnosis of hemiblock
allows identification of retrograde P waves
allows identification of atrial flutter waves
ectopic beat - Answer - Cardiac beat starting at a point other than the SA node
could be from atria, AV junction, ventricles
sinus bradycardia causes - Answer - inferior MI, OSA, IICP, CNS conditions like stroke, hypothyroidism,
hypothermia, some infectious diseases
digitalis, beta blocker, CCB, ivabradine, antiarrhythmics
Ivabradine - Answer - Cardio
MOA: selective inhibition of funny sodium channels, prolonging slow depolarization phase (phase 4);
decreases SA node firing; negative chronotropic effect without inotropy; reduces cardiac O2
requirements
Use: chronic stable angina in patients who cannot take beta blockers; chronic HF with reduced ejection
fraction
Tox: luminous phenomena/visual brightness, hypertension, bradycardia
medications that cause ST - Answer - atropine, isoproterenol, epinephrine, dopamine, dobutamine,
levo, nitroprusside
persistent tachycardia - Answer - decreased stroke volume, decreased cardiac output, and decreased
coronary artery perfusion secondary to decreased diastolic time that occurs with rapid heart beats
sinus dysrhythmia - Answer - sinus node discharges irregularly and commonly associated with phases of
respiration
