ADVANCED MED/SURG EXAM 1 NEW LATEST VERSION WITH
ALL QUESTIONS FROM ACTUAL PAST EXAM AND 100%
CORRECT ANSWER
P wave - CORRECT ANSWERS-caused by atrial depolarization
QRS complex - CORRECT ANSWERS--ventricular depolarization
-*less than 0.12 seconds*
-Q wave greater than 1/3 the height of the R wave, greater than 0.04 seconds are abnormal and may
represent an MI (if Q wave is wider or taller than a box it can be a pathological Q)
T wave - CORRECT ANSWERS-results from ventricular repolarization
dysrhythmias - CORRECT ANSWERS--disorder of impulse formation, conduction of impulses,
or both
ECG heart rate calculation - CORRECT ANSWERS--always want at least a 6 second strip
-*count the "R" points (in QRS wave) within the 6 second strip to calculate HR*
-R points = high points / tips on reading
-8 R points in 6 sec. strip = HR of 80
(6 sec x 10 = 1 minute, 8 x 10 = 80)
Priorities when Assessing a Cardiac Rhythm - CORRECT ANSWERS-1. P wave (does q QRS have
a P before?)
2. Atrial rate and rhythm (is rate regular / equal?)
3. P-R interval (equal?)
4. QRS complex (6 sec. strip: normal HR, too narrow or wide?)
normal sinus rhythm - CORRECT ANSWERS--SA node fires 60-100 bpm
-follows normal conduction pattern
,sinus bradycardia - CORRECT ANSWERS--slow heart rate
-normal rhythm in aerobically trained athletes and during sleep
-can occur in response to parasympathetic nerve stimulation and certain drugs and some disease states
TX: atropine, pacemaker, stop offending drugs
S/S of sinus bradycardia - CORRECT ANSWERS--hypotension
-pale, cool skin
-weakness
-angina
-dizziness or syncope
-confusion or disorientation
-shortness of breath
sinus tachycardia - CORRECT ANSWERS--fast heart rate
-associated with physiologic and psychologic stressors
TX: guided by cause, vagal maneuver, B-adrenergic blockers (metoprolol)
s/s of sinus tachycardia - CORRECT ANSWERS--dizziness
-dyspnea
-hypotension
-angina in patients with CAD
Premature Atrial Contraction (PAC) - CORRECT ANSWERS--contraction originating from
ectopic focus in atrium in location other than SA node
-travels across atria by abnormal pathway, creating distorted P wave
,TX: monitor for more serious dysrhythmias, withhold sources of stimulation, B-adrenergic blockers
S/S of PAC - CORRECT ANSWERS-palpitations
causes of PAC - CORRECT ANSWERS-stress, fatigue, caffeine, tobacco, alcohol, hypoxia,
electrolyte imbalance, disease states
atrial flutter - CORRECT ANSWERS-"saw tooth pattern"
-typically assoc w/ disease
-s/s result from high ventricular rate and loss of atrial "kick"-->decreased CO--> heart failure
-increases risk of CVA
TX: pharmacologic agent, electrical cardioversion, radiofrequency ablation
atrial fibrillation - CORRECT ANSWERS--paroxysmal or persistant
-usually occurs in pts w/ underlying heart disease
-can also occur with other disease states
-at risk for CVA
atrial fibrillation treatment - CORRECT ANSWERS--drugs to control ventricular rate and or
convert to sinus rhythm (*AMIODARONE*)
-electrical cardioversion
-anticoagulation
-radiofrequency ablation
-maze procedure with cryoablation
premature ventricular contraction (PVC) - CORRECT ANSWERS--wide, big, distorted QRS
complex
-can be unifocal, multifocal, bigeminal, or couplet
-associated w/ stimulants, electrolyte imbalance
, TX: correct cause, antidysrhythmics (*Amiodarone*)
unifocal PVCs - CORRECT ANSWERS-multiple PVCs that look the same and typically means the
same place is sending the impulse
multifocal PVCs - CORRECT ANSWERS--does NOT look the same
-firing from multiple impulses
bigeminal PVCs - CORRECT ANSWERS--happens w/ every second beat
-will have a normal heart beat, then PVC, normal heart beat, then PVC
couplet PVCs - CORRECT ANSWERS--coupled together
-may have multiple normal heart beats, the a couple, etc
ventricular tachycardia - CORRECT ANSWERS--usually 150-200 bpm or even more
-check pt. immediately (can be stable or unstable)
-life-threatening bc of decreased CO and possibility of deterioration to ventricular fibrillation
tx of V Tac - CORRECT ANSWERS--precipitating causes must be identified and treated (ex.
hypoxia)
-with pulse treated w/ antidysrhythmics or cardioversion
-pulseless treated with CPR and rapid defibrillation
ventricular fibrillation - CORRECT ANSWERS--quivering ventricles
-associated w/ MI, ischemia, disease states, procedures
-multiple things firing / nothing working together
-very deadly if not treated rapidly
-can be coarse vs. fine
ALL QUESTIONS FROM ACTUAL PAST EXAM AND 100%
CORRECT ANSWER
P wave - CORRECT ANSWERS-caused by atrial depolarization
QRS complex - CORRECT ANSWERS--ventricular depolarization
-*less than 0.12 seconds*
-Q wave greater than 1/3 the height of the R wave, greater than 0.04 seconds are abnormal and may
represent an MI (if Q wave is wider or taller than a box it can be a pathological Q)
T wave - CORRECT ANSWERS-results from ventricular repolarization
dysrhythmias - CORRECT ANSWERS--disorder of impulse formation, conduction of impulses,
or both
ECG heart rate calculation - CORRECT ANSWERS--always want at least a 6 second strip
-*count the "R" points (in QRS wave) within the 6 second strip to calculate HR*
-R points = high points / tips on reading
-8 R points in 6 sec. strip = HR of 80
(6 sec x 10 = 1 minute, 8 x 10 = 80)
Priorities when Assessing a Cardiac Rhythm - CORRECT ANSWERS-1. P wave (does q QRS have
a P before?)
2. Atrial rate and rhythm (is rate regular / equal?)
3. P-R interval (equal?)
4. QRS complex (6 sec. strip: normal HR, too narrow or wide?)
normal sinus rhythm - CORRECT ANSWERS--SA node fires 60-100 bpm
-follows normal conduction pattern
,sinus bradycardia - CORRECT ANSWERS--slow heart rate
-normal rhythm in aerobically trained athletes and during sleep
-can occur in response to parasympathetic nerve stimulation and certain drugs and some disease states
TX: atropine, pacemaker, stop offending drugs
S/S of sinus bradycardia - CORRECT ANSWERS--hypotension
-pale, cool skin
-weakness
-angina
-dizziness or syncope
-confusion or disorientation
-shortness of breath
sinus tachycardia - CORRECT ANSWERS--fast heart rate
-associated with physiologic and psychologic stressors
TX: guided by cause, vagal maneuver, B-adrenergic blockers (metoprolol)
s/s of sinus tachycardia - CORRECT ANSWERS--dizziness
-dyspnea
-hypotension
-angina in patients with CAD
Premature Atrial Contraction (PAC) - CORRECT ANSWERS--contraction originating from
ectopic focus in atrium in location other than SA node
-travels across atria by abnormal pathway, creating distorted P wave
,TX: monitor for more serious dysrhythmias, withhold sources of stimulation, B-adrenergic blockers
S/S of PAC - CORRECT ANSWERS-palpitations
causes of PAC - CORRECT ANSWERS-stress, fatigue, caffeine, tobacco, alcohol, hypoxia,
electrolyte imbalance, disease states
atrial flutter - CORRECT ANSWERS-"saw tooth pattern"
-typically assoc w/ disease
-s/s result from high ventricular rate and loss of atrial "kick"-->decreased CO--> heart failure
-increases risk of CVA
TX: pharmacologic agent, electrical cardioversion, radiofrequency ablation
atrial fibrillation - CORRECT ANSWERS--paroxysmal or persistant
-usually occurs in pts w/ underlying heart disease
-can also occur with other disease states
-at risk for CVA
atrial fibrillation treatment - CORRECT ANSWERS--drugs to control ventricular rate and or
convert to sinus rhythm (*AMIODARONE*)
-electrical cardioversion
-anticoagulation
-radiofrequency ablation
-maze procedure with cryoablation
premature ventricular contraction (PVC) - CORRECT ANSWERS--wide, big, distorted QRS
complex
-can be unifocal, multifocal, bigeminal, or couplet
-associated w/ stimulants, electrolyte imbalance
, TX: correct cause, antidysrhythmics (*Amiodarone*)
unifocal PVCs - CORRECT ANSWERS-multiple PVCs that look the same and typically means the
same place is sending the impulse
multifocal PVCs - CORRECT ANSWERS--does NOT look the same
-firing from multiple impulses
bigeminal PVCs - CORRECT ANSWERS--happens w/ every second beat
-will have a normal heart beat, then PVC, normal heart beat, then PVC
couplet PVCs - CORRECT ANSWERS--coupled together
-may have multiple normal heart beats, the a couple, etc
ventricular tachycardia - CORRECT ANSWERS--usually 150-200 bpm or even more
-check pt. immediately (can be stable or unstable)
-life-threatening bc of decreased CO and possibility of deterioration to ventricular fibrillation
tx of V Tac - CORRECT ANSWERS--precipitating causes must be identified and treated (ex.
hypoxia)
-with pulse treated w/ antidysrhythmics or cardioversion
-pulseless treated with CPR and rapid defibrillation
ventricular fibrillation - CORRECT ANSWERS--quivering ventricles
-associated w/ MI, ischemia, disease states, procedures
-multiple things firing / nothing working together
-very deadly if not treated rapidly
-can be coarse vs. fine
