NUR 213 Exam #1 Question with verified answers
What is the inherent pacemaker of the heart?- √√SA node (sino-atrial node) 60-100 per
minute is normal pace
What does the P wave indicate?- √√Atrial depolarization, we cannot for sure say that the
atria contracted because you can have the electricity without the pump (is there a pulse
with that rhythm?)
What does the QRS wave indicate?- √√Ventricular depolarization, at the same time the
atria is re-polarizing. We cannot for sure say that the ventricle contracted because you can
have the electricity without the pump (is there a pulse with that rhythm?)
What does the T wave indicate?- √√Ventricular re-polarization
What is the appropriate time measurement for the PR interval?- √√0.12-0.2 seconds, 3-5
small boxes on graph paper
What is the appropriate time measurement for the QRS
interval?- √√Less than 0.12 seconds
What is the resting state for an ECG?- √√Isoelectric line
When you are feeling a pulse what are you feeling?- √√The QRS, which is the ventricle
depolarizing. You cannot feel the atria depolarize because it doesn't have a strong enough
beat
How long is each small box?- √√0.04 seconds
What is the time measurement of one LARGE box on the EKG paper?- √√0.2 seconds
How do you calculate heart rate?- √√Feel patients pulse, count the R's in a six second strip
and multiply by 10
What are the RULES for Normal Sinus Rhythm?- √√Rhythm needs to be regular (measured
R to R) and is either regular or irregular, then Rate (60-100), then P-waves (do we have one
for every QRS and is their morphology the same and are they upright), PR interval (measure
from where the P wave leaves the isoelectric line and stop measuring at the beginning of
,the QRS complex) it should be 0.12-0.2 seconds, then look at QRS and it should be less than
0.12
ECG labeled- √√
Positive deflection, negative deflection and biphasic deflection- √√
Measurements for ECG- √√PR interval- .12 - .20 sec.
QRS complex- less than .10 seconds
P- P- Regular
R- R- Regular
Analyzing a rhythm strip step-by-step- √√1. Determine the regularity of R waves
2. Calculate the heart rate
3. Identify and examine P waves
4. Measure the PR Interval
5. Measure the QRS complex
Precise rate calculation for HR- √√Precise rate calculation
Count the number of small squares between two consecutive R waves
Divide the number of small squares into 1500 or use a conversion chart
Only accurate for regular rhythms
Identifying and examine P waves- √√One P wave preceding each QRS
All P waves identical in shape, size, and position
P to P interval should be regular
Examine the ST segment- √√Normal ST segment is flat and at the isoelectric line
Elevation or depression measuring 1mm above or below is abnormal
Elevation = acute myocardial injury
Depression = myocardial ischemia, hypokalemia, digitalis
Assess the patient when using an ECG- √√Is there a PULSE with that Rhythm???!!!
ALWAYS take a pulse before you treat a high or low alarm
False high alarms
False low alarms
Artifact- junk
,Normal Sinus Rhythm (NSR)- √√Rhythm: Regular
Rate: 60- 100
P waves: 1 P wave before each QRS, Normal in appearance
PR: .12- .20 seconds
QRS: < .12 seconds
Sinus Tachycardia (ST)- √√Rhythm: Regular
Rate: 100- 160
P waves: 1 P wave before each QRS, Normal in appearance
PR: .12 seconds- .20 seconds
QRS: < .12 seconds
Sinus Bradycardia (SB)- √√Rhythm: Regular
Rate: 40- 60
P waves: 1 P wave before each QRS, Normal in appearance
PR: .12 seconds- .20 seconds
QRS: < .10 seconds
Sinus Arrhythmia- √√Rhythm: Irregular
Rate: 60- 100
P waves: 1 P wave for each QRS, Normal in appearance
PR: .12 seconds- .20 seconds
QRS: < .10 seconds
Seen a lot in pediatric patients (called a respiratory variance because when they breathe in
and out their HR changes, this is normal for kids)
Premature Atrial Contractions (PAC)- √√Rhythm: Underlying rhythm regular, Irregular with
PAC
Rate: Rate of underlying Rhythm
P waves: PAC P Wave is premature, Abnormal in size, shape or direction, May be hidden
PR: .12 seconds- .20 seconds (may be prolonged
QRS: < .10 seconds
When you see a PAC it is superimposed on another rhythm, usually normal sinus rhythm
, Atrial Tachycardia (PAT)- √√Rhythm: Regular
Rate:140-250
P waves: Hidden in preceding T wave
PR: Not measurable
QRS: < .10 seconds
-When these happen the body tries to fix it by making you cough or bear down to get you
to have a vagal response to slow the HR
-This is not a sustainable rhythm because the ventricle doesn't have enough time to re-fill
so they are not getting good output
-Anxiety is the brain telling us that they are not getting enough oxygenation (sometimes)
Atrial flutter- √√Rhythm: Regular or irregular
Rate: Atrial rate 250- 400
Ventricular rate varies depending on AV node conduction
P wave: Absent, Flutter waves present
PR: Not measurable
QRS: < .10 seconds
-Typically a rhythm seen post cardiac event, like MI, surgery or heart cath
-will go away and become either AFIB or NSR usually
-AV node is the gatekeeper and stops some of these electrical charges from going through
until the ventricle is ready for another contraction because otherwise the ventricles just
cannot keep up
-No P wave because atria is not repolarizing and depolarizing its fluttering
-Extremely routine rhythm in the flutter, nothing else marches out like that
-Has a sawtooth pattern
-If the ventricular rate is over 100 then we say it is uncontrolled because the AV node is not
controlling the rate well, then we have to control it
-If ventricular rate is less than 100 than we call it controlled because the AV node is doing a
good job controlling it
Atrial Fibrillation- √√Rhythm: Very irregular
Rate: Atrial rate 400 or more
Ventricular rate varies depending on AV node conduciton
P wave: Absent, Fibrillatory waves present
PR: Not measurable
What is the inherent pacemaker of the heart?- √√SA node (sino-atrial node) 60-100 per
minute is normal pace
What does the P wave indicate?- √√Atrial depolarization, we cannot for sure say that the
atria contracted because you can have the electricity without the pump (is there a pulse
with that rhythm?)
What does the QRS wave indicate?- √√Ventricular depolarization, at the same time the
atria is re-polarizing. We cannot for sure say that the ventricle contracted because you can
have the electricity without the pump (is there a pulse with that rhythm?)
What does the T wave indicate?- √√Ventricular re-polarization
What is the appropriate time measurement for the PR interval?- √√0.12-0.2 seconds, 3-5
small boxes on graph paper
What is the appropriate time measurement for the QRS
interval?- √√Less than 0.12 seconds
What is the resting state for an ECG?- √√Isoelectric line
When you are feeling a pulse what are you feeling?- √√The QRS, which is the ventricle
depolarizing. You cannot feel the atria depolarize because it doesn't have a strong enough
beat
How long is each small box?- √√0.04 seconds
What is the time measurement of one LARGE box on the EKG paper?- √√0.2 seconds
How do you calculate heart rate?- √√Feel patients pulse, count the R's in a six second strip
and multiply by 10
What are the RULES for Normal Sinus Rhythm?- √√Rhythm needs to be regular (measured
R to R) and is either regular or irregular, then Rate (60-100), then P-waves (do we have one
for every QRS and is their morphology the same and are they upright), PR interval (measure
from where the P wave leaves the isoelectric line and stop measuring at the beginning of
,the QRS complex) it should be 0.12-0.2 seconds, then look at QRS and it should be less than
0.12
ECG labeled- √√
Positive deflection, negative deflection and biphasic deflection- √√
Measurements for ECG- √√PR interval- .12 - .20 sec.
QRS complex- less than .10 seconds
P- P- Regular
R- R- Regular
Analyzing a rhythm strip step-by-step- √√1. Determine the regularity of R waves
2. Calculate the heart rate
3. Identify and examine P waves
4. Measure the PR Interval
5. Measure the QRS complex
Precise rate calculation for HR- √√Precise rate calculation
Count the number of small squares between two consecutive R waves
Divide the number of small squares into 1500 or use a conversion chart
Only accurate for regular rhythms
Identifying and examine P waves- √√One P wave preceding each QRS
All P waves identical in shape, size, and position
P to P interval should be regular
Examine the ST segment- √√Normal ST segment is flat and at the isoelectric line
Elevation or depression measuring 1mm above or below is abnormal
Elevation = acute myocardial injury
Depression = myocardial ischemia, hypokalemia, digitalis
Assess the patient when using an ECG- √√Is there a PULSE with that Rhythm???!!!
ALWAYS take a pulse before you treat a high or low alarm
False high alarms
False low alarms
Artifact- junk
,Normal Sinus Rhythm (NSR)- √√Rhythm: Regular
Rate: 60- 100
P waves: 1 P wave before each QRS, Normal in appearance
PR: .12- .20 seconds
QRS: < .12 seconds
Sinus Tachycardia (ST)- √√Rhythm: Regular
Rate: 100- 160
P waves: 1 P wave before each QRS, Normal in appearance
PR: .12 seconds- .20 seconds
QRS: < .12 seconds
Sinus Bradycardia (SB)- √√Rhythm: Regular
Rate: 40- 60
P waves: 1 P wave before each QRS, Normal in appearance
PR: .12 seconds- .20 seconds
QRS: < .10 seconds
Sinus Arrhythmia- √√Rhythm: Irregular
Rate: 60- 100
P waves: 1 P wave for each QRS, Normal in appearance
PR: .12 seconds- .20 seconds
QRS: < .10 seconds
Seen a lot in pediatric patients (called a respiratory variance because when they breathe in
and out their HR changes, this is normal for kids)
Premature Atrial Contractions (PAC)- √√Rhythm: Underlying rhythm regular, Irregular with
PAC
Rate: Rate of underlying Rhythm
P waves: PAC P Wave is premature, Abnormal in size, shape or direction, May be hidden
PR: .12 seconds- .20 seconds (may be prolonged
QRS: < .10 seconds
When you see a PAC it is superimposed on another rhythm, usually normal sinus rhythm
, Atrial Tachycardia (PAT)- √√Rhythm: Regular
Rate:140-250
P waves: Hidden in preceding T wave
PR: Not measurable
QRS: < .10 seconds
-When these happen the body tries to fix it by making you cough or bear down to get you
to have a vagal response to slow the HR
-This is not a sustainable rhythm because the ventricle doesn't have enough time to re-fill
so they are not getting good output
-Anxiety is the brain telling us that they are not getting enough oxygenation (sometimes)
Atrial flutter- √√Rhythm: Regular or irregular
Rate: Atrial rate 250- 400
Ventricular rate varies depending on AV node conduction
P wave: Absent, Flutter waves present
PR: Not measurable
QRS: < .10 seconds
-Typically a rhythm seen post cardiac event, like MI, surgery or heart cath
-will go away and become either AFIB or NSR usually
-AV node is the gatekeeper and stops some of these electrical charges from going through
until the ventricle is ready for another contraction because otherwise the ventricles just
cannot keep up
-No P wave because atria is not repolarizing and depolarizing its fluttering
-Extremely routine rhythm in the flutter, nothing else marches out like that
-Has a sawtooth pattern
-If the ventricular rate is over 100 then we say it is uncontrolled because the AV node is not
controlling the rate well, then we have to control it
-If ventricular rate is less than 100 than we call it controlled because the AV node is doing a
good job controlling it
Atrial Fibrillation- √√Rhythm: Very irregular
Rate: Atrial rate 400 or more
Ventricular rate varies depending on AV node conduciton
P wave: Absent, Fibrillatory waves present
PR: Not measurable
