HOAG ECG ACTUAL FINAL PAPER UPDATED QUESTIONS
AND ANSWERS GRADED A+
✔✔exclusionary criteria for ST monitoring - ✔✔1. 100% paced
2. intermittent (not continuous) right bundle branch block
3. L BBB with frequent HR change
4. atrial fibrillation/flutter with very coarse baseline
5. noisy signal due to restlessness or confusion
✔✔2 questions need to know before evaluating a paced rhythm strip - ✔✔what kinds of
pacing wires are present?
what is the pacemakers programmed mode?
✔✔ways to figure out the pacemaker programming - ✔✔looking in the chart
wallet card
recent CXR for lead placement
✔✔ventricular pacing characteristic - ✔✔wide QRS
✔✔Dual chamber pacing - ✔✔A pacer spike before both the P wave and wide QRS
complex
✔✔pacemaker code categories - ✔✔1: chambers paced
2: chambers sensed
3: response to sensing
4: rate modulation
5: multisite pacing
✔✔letters meanings in pacemaker code for 1 & 2 - ✔✔O = none
A = atrim
V = ventricle
D = dual (A+V)
✔✔letter meanings in pacemaker code for 3 - ✔✔o = none
T = triggered
I = inhibited
D = dual (T+I)
✔✔letter meanings in pacemaker code for 4 - ✔✔O= none
R = rate modulation
✔✔letter meanings in pacemaker code for 5 - ✔✔O = none
A = atrium
V = ventricle
D = dual (A+V)
, ✔✔failure to pace/fire meaning - ✔✔pacemaker is not firing when it should be - no spike
✔✔s/s of failure to pace/fire - ✔✔no activity on ECG
bradycardia
hypotension
✔✔possible causes of failure to pace/fire - ✔✔mA output too low
dead battery
loose connections
wires not in contact with muscle
perforation on heart
✔✔other problems for failure to pace/fire - ✔✔undocumented pacing mode change
pacing spikes not visible in present lead
pacemaker is sensing artifact
✔✔interventions of failure to pace/fire - ✔✔* always check on pt first
tighten connections
increase mA output
check other leads
change battery
left side lying position
check polarity
have transcutaneous pacemaker present at bedside
✔✔failure to capture meaning - ✔✔pacing spike is present but no wide QRS is following
to depolarize the myocardium. spike is ineffective
✔✔s/s of failure to capture - ✔✔spike has no QRS or P wave after
bradycardia
hypotension
fatigue
✔✔possible causes of failure to capture - ✔✔same as failure to pace
✔✔other causes of failure to capture - ✔✔metabolic imbalances
physiologic issue changes
drug effects
✔✔interventions for failure to capture - ✔✔* always check on pt
increase mA
check connections
check polarity
check setting for desired mode
AND ANSWERS GRADED A+
✔✔exclusionary criteria for ST monitoring - ✔✔1. 100% paced
2. intermittent (not continuous) right bundle branch block
3. L BBB with frequent HR change
4. atrial fibrillation/flutter with very coarse baseline
5. noisy signal due to restlessness or confusion
✔✔2 questions need to know before evaluating a paced rhythm strip - ✔✔what kinds of
pacing wires are present?
what is the pacemakers programmed mode?
✔✔ways to figure out the pacemaker programming - ✔✔looking in the chart
wallet card
recent CXR for lead placement
✔✔ventricular pacing characteristic - ✔✔wide QRS
✔✔Dual chamber pacing - ✔✔A pacer spike before both the P wave and wide QRS
complex
✔✔pacemaker code categories - ✔✔1: chambers paced
2: chambers sensed
3: response to sensing
4: rate modulation
5: multisite pacing
✔✔letters meanings in pacemaker code for 1 & 2 - ✔✔O = none
A = atrim
V = ventricle
D = dual (A+V)
✔✔letter meanings in pacemaker code for 3 - ✔✔o = none
T = triggered
I = inhibited
D = dual (T+I)
✔✔letter meanings in pacemaker code for 4 - ✔✔O= none
R = rate modulation
✔✔letter meanings in pacemaker code for 5 - ✔✔O = none
A = atrium
V = ventricle
D = dual (A+V)
, ✔✔failure to pace/fire meaning - ✔✔pacemaker is not firing when it should be - no spike
✔✔s/s of failure to pace/fire - ✔✔no activity on ECG
bradycardia
hypotension
✔✔possible causes of failure to pace/fire - ✔✔mA output too low
dead battery
loose connections
wires not in contact with muscle
perforation on heart
✔✔other problems for failure to pace/fire - ✔✔undocumented pacing mode change
pacing spikes not visible in present lead
pacemaker is sensing artifact
✔✔interventions of failure to pace/fire - ✔✔* always check on pt first
tighten connections
increase mA output
check other leads
change battery
left side lying position
check polarity
have transcutaneous pacemaker present at bedside
✔✔failure to capture meaning - ✔✔pacing spike is present but no wide QRS is following
to depolarize the myocardium. spike is ineffective
✔✔s/s of failure to capture - ✔✔spike has no QRS or P wave after
bradycardia
hypotension
fatigue
✔✔possible causes of failure to capture - ✔✔same as failure to pace
✔✔other causes of failure to capture - ✔✔metabolic imbalances
physiologic issue changes
drug effects
✔✔interventions for failure to capture - ✔✔* always check on pt
increase mA
check connections
check polarity
check setting for desired mode
