med 294: cardiac monitoring proceduresmed 294: cardiac monitoring procedures final assessment review...

MED 294: Cardiac Monitoring Procedures

Final Assessment Review Worksheet

Multiple Choice

1. The heart has ___ chambers.

a. 2

b. 4

c. 3

2. The blunt point of the left ventricle is called

a. Base

b. Tip

c. Apex

3. The four valves of the heart are

a. Tricuspid, mitral, pulmonary and aortic

b. Bicuspid, tricuspid, trumpet and pulmonary

c. Pulmonary, mitral, aortic and atrioventrical

4. The four surfaces of the left ventricle are

a. Anterior, lateral, bottom and back

b. Lateral, anterior, posterior and side

c. Lateral, anterior, posterior and inferior

5. The heart receives oxygenated blood from the

a. Coronary arteries

b. Pulmonary arteries

c. Arterioles

6. The ________ _________ receives messages from the autonomic nervous system to

regulate heart rate.

a. Median brain stem

b. Medulla oblongata

c. Medallion oval cell



7. The properties of the myocardial electrical cells include

a. Excitability, automaticity and conductivity

b. Automaticity, electricity and conductivity

c. Electricity, conductivity and contractility

8. The exchange of potassium and sodium across the myocardial electrical cells causes

a. Repolarization

b. Depolarization

c. Polarization

9. Contraction of the myocardium is caused by

a. Polarization

b. Repolarization

c. Depolarization

10. The myocardial mechanical cells are affected by the exchange of magnesium and

a. Calcium

b. Chloride

c. Potassium

11. The 5 waveforms that represent the electrical conduction system of the heart are

a. P, R, B, U, and T

b. P, Q, R, S and T

c. U, P, R, T and A

12. The electrical conduction system (electrical highway or pathway) of the heart begins in

the

a. Left atrium

b. Right atrium

c. Left ventricle



13. What waveform represents the depolarization of the atria?

a. Q wave

b. P wave

c. T wave

14. What waveforms represent the depolarization of the ventricles?

a. PRI

b. QT

c. QRS complex

15. What waveform represents the repolarization of the ventricles?

a. P wave

b. T wave

c. R wave

16. When the atrium is in systole the ventricles are in

a. Diastole

b. Pause

c. Contraction

17. When the ventricles are in diastole the atrium is in

a. Rest

b. Systole

c. Excitability

18. A waveform that is upright from the isoelectric line is considered

a. Positive

b. Negative

c. Neutral

19. One cardiac cycle represents all 5 EKG waveforms.

a. True



b. False

20. The electrical conduction system of the heart is

a. SA node, Intraatrial pathway, intranodal pathway, AV node in the AV junction,

Bundle of His, bundle branches; left and right ending in the purkinje fibers.

b. AV node, bauchmans bundle, SA node to ventricles

c. SA node to AV node to bundle of his to left and right bundle branches to the

purkinje fibers

21. The first negative waveform of the cardiac cycle is the

a. T wave

b. P wave

c. Q wave

22. The T wave is a positive wave form on the EKG tracing.

a. True

b. False

23. The myocardial mechanical cell properties include

a. Contractility and extensibility

b. Conduction and contraction

c. Excitability and contraction

24. The isoelectric line represents neutral polarity or is a reference line.

a. True

b. False



25. One box on the EKG graph paper is equal to

a. 0.02 sec

b. 0.04 sec

c. 0.06 sec

26. The normal duration of the QRS complex is:

a. 0.04 – 0.10 sec

b. 0.06 – 0.08 sec

c. 0.04 – 0.14 sec

d. 0.20 -0.28 sec

27. The PR interval is considered prolonged if it is more than ____ seconds in duration.

a. 0.06

b. 0.12

c. 0.18

d. 0.20

28. On the ECG, the time necessary for the spread of an electrical impulse through the AV

node, bundle of His, right and left bundle branches, and the Purkinje fibers is reflected

by the:

a. TP –segment

b. PR segment

c. QT interval

d. QRS duration

29. A line between waveforms is called a(n):

a. Isoelectric wave

b. Segment

c. Interval

d. Space



30. The four electrolytes of cardiac cells are:

a. Chloride, salt, pepper and garlic

b. Potassium, magnesium, calcium and sodium

c. Magnesium, calcium, salt, and RBCs

d. Potassium, sodium, hemoglobin, and chloride

31. When the number of atrial waves remain the same between QRS complexes in atrial

flutter this is called:

a. Variable conduction

b. Many conductions

c. Ratio conduction

d. Abnormal conduction

32. What arrhythmia has a changing p wave shape, indicating that pacemaker impulses are

coming from different areas in the atrium?

a. Sinus bradycardia

b. Atrial flutter

c. Atrial fibrillation

d. Wandering atrial pacemaker

33. What is an abnormal beat coming from the atrium called?

a. Premature sinus beat

b. Premature atrial contraction (PAC)

c. Pretty special beat

d. Extra beat

34. What arrhythmia is always GROSSLY IRREGULAR?

a. Atrial tachycardia

b. Sinus tachycardia


d. Wandering atrial pacemaker



35. What arrhythmia has flutter waves rather than p waves?

a. Atrial flutter

b. Atrial fibrillation

c. Wandering atrial pacemaker

d. Ventricular rhythm

36. This beat may have its p wave hidden in the previous T wave.

a. PAC

b. Atrial escape beat

c. Funny beat

37. This arrhythmia may have a rapid ventricular response rate.

a. Atrial fibrillation

b. Sinus tachycardia

c. Atrial flutter

38. This arrhythmia may be regular or irregular if the PRI is changing as well as the p wave shape.


b. Wandering atrial pacemaker


39. This word means another rhythm interrupts the underlying rhythm.

a. Premature

b. Pretty early rhythm

c. Paroxysmal

40. Three or more beats that interrupt a rhythm is

a. A rhythm within a rhythm

b. A burst of premature beats

c. A entirely new rhythm



41. This arrhythmia occurs because of frequently interrupting PACs

a. PJT

b. PAT

c. POT

42. This rhythm may be regular or irregular because of the number of waves between the R waves.

a. SR with frequent PACs

b. Atrial fibrillation

c. Atrial flutter

43. The ectopic beat from the atrium will have a non-compensatory pause after the beat.

a. PAC

b. Sinus escape beat

c. Premature beat

44. This rhythm can be considered to be either coarse of fine.

a. Atrial fibrillation

b. Atrial flutter

c. Wandering Atrial Pacemaker

45. What ectopic beats interrupt the underlying rhythms

a. Extra beats

b. PACs

c. Late beats

46. What abnormal beat originates in the junction?

a. PAC

b. PVC

c. PJC

d. PPC



47. Where is the pacemaker site when the p wave is inverted in a rhythm strip?

a. Sinus

b. AV node

c. Ventricles

d. Purkinje fibers

48. The QRS complex duration is not affected when the pacemaker site is from the AV node.

a. True

b. False

49. If the pacemaker site originates from high in the AV node, the p wave will be:

a. Upright

b. Biphasic

c. Inverted

d. Round

50. If the pacemaker site originates from the middle of the AV node, the p wave will be:

a. Inverted

b. Upright

c. Hidden in the QRS (not visible)

d. After the QRS

51. The PRI will be shorter if the pacemaker site is in the AV node.

a. True

b. False

52. If the pacemaker site originates from low in the AV node, the p wave will be:

a. Inverted before the QRS

b. Round and upright before the QRS

c. Hidden in the QRS

d. Inverted after the QRS



53. The AV node as the pacemaker site initiates an impulse:

a. 40 – 50 bpm

b. 30 – 50 bpm

c. 40 – 60 bpm

d. 50 – 80 bpm

54. A new regularity or rhythm is established after a PJC.

a. True

b. False

55. The delay in the rhythm that occurs after a PJC is called a

a. Complete pause

b. Non-compensatory pause

c. Compensatory pause

d. Block

56. What arrhythmia has a constantly prolonged PRI and only one p wave to each QRS?

a. 1 degree AV block

b. 2nd degree AV block Type I

c. 2nd degree AV block, Type II

d. Complete AV heart block

57. What arrhythmia has more p waves than QRS complexes without a constant PRI?

a. 2nd degree AV block, Type I

b. 2nd degree AV block, Type II

c. Complete Heart Block

d. Ventricular rhythm



58. What arrhythmia has a progressively lengthen PRI until a missing QRS complex?

a. 1st degree AV block

b. 2nd degree AV block, Type I


d. Complete heart block

59. What arrhythmia has a heart block but the underlying rhythm must be identified?


b. 1st degree AV heart block


d. Heart block

60. In what arrhythmia does the atrium beat independently of the ventricles; two

independent pacemaker sites; one in the atrium and one in the ventricles?

a. Complete heart block

b. 2nd degree AV heart block, Type I

c. 2nd degree AV heart block, Type II

d. Heart block

61. What heart block may have a ratio or a variable conduction?


b. 1st degree AV heart block


d. Complete heart block

62. What arrhythmia has more p waves than QRS complexes but a constant PRI?

a. 1st degree AV heart block

b. 2nd degree AV heart block, Type I

c. 2nd degree AV heart block, Type II

d. 3rd degree AV heart block



63. When the electrical impulse is delayed too long in the AV node, creating a prolonged

PRI, this is known as

a. Heart block

b. Heart rhythm delay

c. Abnormal electrical function

d. Normal electrical function

64. What AVHB may be regular or irregular depending on number of p waves present?

a. 1st degree AV block

b. 2nd degree AV heart block Type II

c. 3r degree AV heart block

65. What AVHB has p waves which are regular and they must be “marched out” to be

found?

a. 2nd degree AV block Type I

b. 3rd degree AV heart block

c. 2nd degree AV block Type II

66. When the pacemaker site is in the ventricles the heart rhythm is called

a. Atrial rhythm

b. Nodal rhythm

c. Ventricular rhythm

d. Sinus rhythm

67. A ventricular pacemaker site originates a heart beat

a. 20 – 40 bpm

b. 40 – 50 bpm

c. 50 – 100 bpm

d. Less than 20 bpm



68. Ventricular rhythms are regular, do not have p waves and

a. The QRS is narrow

b. The QRS is greater than .12 seconds

c. The QRS is inverted

d. The QRS is less than .12 seconds

69. This arrhythmia from the ventricles has a rate similar to normal sinus rhythm.

a. Ventricular rhythm

b. Ventricular tachycardia

c. Accelerated ventricular rhythm

d. Ventricular fibrillation

70. What is the pause that occurs after a PVC?

a. Compensatory pause

b. Non-compensatory pause

c. Delay

d. Heart block

71. What arrhythmia has wide QRS with regular or irregular rhythm with heart rate between 150 –

250 bpm?

a. Ventricular Tachycardia

b. Ventricular Fibrillation

c. Ventricular Flutter

72. What arrhythmia is regular with wide QRS complexes with rate 150 – 250 bpm?


b. Ventricular tachycardia

c. Ventricular fibrillation

73. What arrhythmia has a wide QRS complex beat and then changes to isoelectric line?

a. Asystole

b. Ventricular standstill

c. Ventricular asystole



74. What arrhythmia has no waveforms?

a. Asystole

b. Flat line

c. Ventricular asystole

75. What arrhythmia represents no mechanical activity of the heart, only electrical?

a. PAD

b. PEA

c. PPA

Short Answer

1. List blood flow through the heart.

2. List the electrical conduction pathway through the heart.



3. List the characteristics for Normal Sinus Rhythm.

4. What is the 5 step approach or “Bible” for rhythm interpretation?

5. Why is cardiac monitoring a critical part of a patient’s health assessment?

Identify the following rhythm strips.

med 294: cardiac monitoring proceduresmed 294: cardiac monitoring procedures final assessment review...

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