Cardiology Nursing 1 Humber Final EXAM
QUESTIONS AND CORRECT DETAILED
ANSWERS
sinus rhythm - ANSWER>>regular rhythm
Set by SA node at 60 to 100 bpm
P waves normal
normal qrs
PR 0.12 - 0.2
normal qrs less than 0.10
wide qrs is - ANSWER>>greater than 0.12
Sinus Tachycardia - ANSWER>>100-160 bpm
SA node
reduced time for ventricle filling
assess for SOB or chest pain
a prolonged QT interval - ANSWER>>more prone to arrhythmia
NSR reflects the heart's - ANSWER>>normal electrical activity, providing
synchrony between the atria and the ventricles.
Sinus tachycardia occurs when the - ANSWER>>sinus node discharges impulses
too fast (100 - 160 beats/minute). All other parameters are normal
Facts about sinus tachycardia - ANSWER>>Normal response of heart in certain
circumstances (for example exercise)
•Begins and ends gradually in contrast to other tachycardias
•Usually benign arrhythmia that goes away when underlying cause is treated
•Common causes: Anxiety, hypoxia, hypovolemia, hypotension, heart failure,
pain, drugs that increase sympathetic tone (epinephrine, norepinephrine,
dopamine, dobutamine, isoproterenol, nitroprusside), and drugs that decrease
parasympathetic tone (atropine)
,•Persistent sinus tachycardia may result in decreased cardiac output due to a
decrease in stroke volume. Cardiac output = stroke volume ×heart rate. A
decrease in either stroke volume or heart rate may result in a decrease in cardiac
output.
Sinus bradycardia occurs when - ANSWER>>the sinus node discharges impulses
too slow (40 - 60 beats/minute). All other parameters are normal.
Sinus bradycardia features - ANSWER>>regular rhythm, rate 40-60 bpm
Normal p waves
PR interval normal 0.12 to 0.2
QRS normal less than 0.1
Facts about sinus bradycardia - ANSWER>>Normal response of heart in certain
circumstances (for example relaxation, sleep)
•Most common arrhythmia associated with acute inferior wall myocardial
infarction
•Other causes: Reperfusion rhythm following myocardial reperfusion procedures
(thrombolytic administration, angioplasty); vagal stimulation; sleep apnea;
hyperkalemia; increased intracranial pressure; disease of SA node; and
administration of drugs, such as digitalis, calcium channel blockers, and beta
blockers
•Persistent bradycardia may result in decreased cardiac output due to a decrease
in heart rate. Cardiac output = stroke volume ×heart rate. A decrease in either
stroke volume or heart rate may result in a decrease in cardiac output.
Treatment of sinus bradycardia - ANSWER>>No treatment is necessary if patient
is asymptomatic.
•Symptomatic bradycardia is initially treated with oxygen and atropine IV push. If
unsuccessful, external pacing or transvenous pacing may be used.
•Chronic sinus bradycardia may require a permanent pacemaker.
Sinus arrhythmia occurs when - ANSWER>>the sinus node discharges impulses
irregularly. The heart rate may be normal range or slow. All other parameters are
normal.
,Sinus arrhythmia ECG features - ANSWER>>irregular rhythm
rate normal or slow
P waves normal
PR interval normal 0.12 to 0.20
QRS normal less than 0.1
Facts about sinus arrhythmia - ANSWER>>Normal phenomenon usually
associated with phases of respiration (heart rate increases with inspiration and
decreases with expiration)
•Most commonly observed in infants, children, and young adults, although it may
occur in any age-group
•Frequently occurs along with sinus bradycardia, in which case it is usually called
sinus arrhythmia with a bradycardic rate
•Treatment: Does not require intervention unless accompanied by symptomatic
bradycardia (follow symptomatic bradycardia protocols)
Sinus pause - ANSWER>>A broad term used to describe a sudden pause in the
basic rhythm with one or more missing beats; two rhythms fall under this
category:
Sinus arrest and Sinus exit block
sinus arrest - ANSWER>>SA node fails to initiate impulse; represents a problem
with SA node automaticity; basic rhythm does not resume on time following
pause.
Sinus exit block - ANSWER>>SA node initiates impulse, but impulse is blocked
as it exits SA node; represents a problem with SA node conductivity; basic
rhythm resumes on time following pause.
Sinus arrest and sinus exit block ECG - ANSWER>>Rhythm: basic is regular with
sudden pause with one or more missing beats, HR may slow for several beats
after pause but then return to basic rate.
P waves: sinus with basic rhythm, absent during pause
, PR interval: normal during basic, absent during pause
QRS normal during basic, absent during pause
Sinus block: basic rhythm resumes on time after pause
Sinus arrest: basic rhythm does not resume on time after pause
irregular sinus rhythm can be associated with phases of respiration -
ANSWER>>During Inspiration, the Sinus Node fires faster
During Expiration, the Sinus Node slows down
Depolarization - ANSWER>>the spread of the electrical stimulus through the
heart muscle, producing the P wave from the atria and the QRS complex from the
ventricles
Repolarization - ANSWER>>the recovery of the stimulated muscle to the resting
state, producing the ST segment, the T wave, and the U wave
Five lead system lead placement - ANSWER>>white - right arm
black - left arm
green - right leg
red - left leg
brown - chest
The 6 chest leads are... - ANSWER>>V1—4th interspace, right sternal border
V2—4th interspace, left sternal border
V3—midway between V2 and V4
V4—5th interspace, left midclavicular line
V5—5th interspace, left anterior axillary line
V6—5th interspace, left midaxillary line
False high rate alarms— - ANSWER>>Patient turning in bed or extremity
movement. Solution: Problem is usually intermittent and no correction is
necessary. Movement artifact can be reduced by avoiding placement of electrode
pads in areas where extremity movement is greatest (bony areas such as the
clavicles).
Seizure activity can also produce high voltage
artifact potentials
QUESTIONS AND CORRECT DETAILED
ANSWERS
sinus rhythm - ANSWER>>regular rhythm
Set by SA node at 60 to 100 bpm
P waves normal
normal qrs
PR 0.12 - 0.2
normal qrs less than 0.10
wide qrs is - ANSWER>>greater than 0.12
Sinus Tachycardia - ANSWER>>100-160 bpm
SA node
reduced time for ventricle filling
assess for SOB or chest pain
a prolonged QT interval - ANSWER>>more prone to arrhythmia
NSR reflects the heart's - ANSWER>>normal electrical activity, providing
synchrony between the atria and the ventricles.
Sinus tachycardia occurs when the - ANSWER>>sinus node discharges impulses
too fast (100 - 160 beats/minute). All other parameters are normal
Facts about sinus tachycardia - ANSWER>>Normal response of heart in certain
circumstances (for example exercise)
•Begins and ends gradually in contrast to other tachycardias
•Usually benign arrhythmia that goes away when underlying cause is treated
•Common causes: Anxiety, hypoxia, hypovolemia, hypotension, heart failure,
pain, drugs that increase sympathetic tone (epinephrine, norepinephrine,
dopamine, dobutamine, isoproterenol, nitroprusside), and drugs that decrease
parasympathetic tone (atropine)
,•Persistent sinus tachycardia may result in decreased cardiac output due to a
decrease in stroke volume. Cardiac output = stroke volume ×heart rate. A
decrease in either stroke volume or heart rate may result in a decrease in cardiac
output.
Sinus bradycardia occurs when - ANSWER>>the sinus node discharges impulses
too slow (40 - 60 beats/minute). All other parameters are normal.
Sinus bradycardia features - ANSWER>>regular rhythm, rate 40-60 bpm
Normal p waves
PR interval normal 0.12 to 0.2
QRS normal less than 0.1
Facts about sinus bradycardia - ANSWER>>Normal response of heart in certain
circumstances (for example relaxation, sleep)
•Most common arrhythmia associated with acute inferior wall myocardial
infarction
•Other causes: Reperfusion rhythm following myocardial reperfusion procedures
(thrombolytic administration, angioplasty); vagal stimulation; sleep apnea;
hyperkalemia; increased intracranial pressure; disease of SA node; and
administration of drugs, such as digitalis, calcium channel blockers, and beta
blockers
•Persistent bradycardia may result in decreased cardiac output due to a decrease
in heart rate. Cardiac output = stroke volume ×heart rate. A decrease in either
stroke volume or heart rate may result in a decrease in cardiac output.
Treatment of sinus bradycardia - ANSWER>>No treatment is necessary if patient
is asymptomatic.
•Symptomatic bradycardia is initially treated with oxygen and atropine IV push. If
unsuccessful, external pacing or transvenous pacing may be used.
•Chronic sinus bradycardia may require a permanent pacemaker.
Sinus arrhythmia occurs when - ANSWER>>the sinus node discharges impulses
irregularly. The heart rate may be normal range or slow. All other parameters are
normal.
,Sinus arrhythmia ECG features - ANSWER>>irregular rhythm
rate normal or slow
P waves normal
PR interval normal 0.12 to 0.20
QRS normal less than 0.1
Facts about sinus arrhythmia - ANSWER>>Normal phenomenon usually
associated with phases of respiration (heart rate increases with inspiration and
decreases with expiration)
•Most commonly observed in infants, children, and young adults, although it may
occur in any age-group
•Frequently occurs along with sinus bradycardia, in which case it is usually called
sinus arrhythmia with a bradycardic rate
•Treatment: Does not require intervention unless accompanied by symptomatic
bradycardia (follow symptomatic bradycardia protocols)
Sinus pause - ANSWER>>A broad term used to describe a sudden pause in the
basic rhythm with one or more missing beats; two rhythms fall under this
category:
Sinus arrest and Sinus exit block
sinus arrest - ANSWER>>SA node fails to initiate impulse; represents a problem
with SA node automaticity; basic rhythm does not resume on time following
pause.
Sinus exit block - ANSWER>>SA node initiates impulse, but impulse is blocked
as it exits SA node; represents a problem with SA node conductivity; basic
rhythm resumes on time following pause.
Sinus arrest and sinus exit block ECG - ANSWER>>Rhythm: basic is regular with
sudden pause with one or more missing beats, HR may slow for several beats
after pause but then return to basic rate.
P waves: sinus with basic rhythm, absent during pause
, PR interval: normal during basic, absent during pause
QRS normal during basic, absent during pause
Sinus block: basic rhythm resumes on time after pause
Sinus arrest: basic rhythm does not resume on time after pause
irregular sinus rhythm can be associated with phases of respiration -
ANSWER>>During Inspiration, the Sinus Node fires faster
During Expiration, the Sinus Node slows down
Depolarization - ANSWER>>the spread of the electrical stimulus through the
heart muscle, producing the P wave from the atria and the QRS complex from the
ventricles
Repolarization - ANSWER>>the recovery of the stimulated muscle to the resting
state, producing the ST segment, the T wave, and the U wave
Five lead system lead placement - ANSWER>>white - right arm
black - left arm
green - right leg
red - left leg
brown - chest
The 6 chest leads are... - ANSWER>>V1—4th interspace, right sternal border
V2—4th interspace, left sternal border
V3—midway between V2 and V4
V4—5th interspace, left midclavicular line
V5—5th interspace, left anterior axillary line
V6—5th interspace, left midaxillary line
False high rate alarms— - ANSWER>>Patient turning in bed or extremity
movement. Solution: Problem is usually intermittent and no correction is
necessary. Movement artifact can be reduced by avoiding placement of electrode
pads in areas where extremity movement is greatest (bony areas such as the
clavicles).
Seizure activity can also produce high voltage
artifact potentials
