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Cardiology week 4/5 quiz
Terms in this set (87)
Parasympathetic innervation of the heart is mediated by the:
Vagus nerve (X)
The starting dose of atropine for adult bradycardia with a pulse is:
Discharges impulses too fast
Dicharges impulses irregularly
Sinus exit block
Impulses initiated are blocked as they try to exit the SA node
Discharges impulses too slow
Fails to initiate an impulse
When differentiating between sinus arrest and sinus exit block on an ECG, you should evaluate the:
In adult mildly symptomatic bradycardia, this medication may be considered:
Ectopic beats originate from any site other than the:
The most common cause of sinus dysrhythmia is:
To confirm the diagnosis of wander atrial pacemaker or multifocal atrial pacemaker, you should identify at least _______ different P wave morphologies.
A single impulse causes more than 1 depolarization event
Typically in response to an adverse condition
Pacemaker other than the SA node accelerates its rate
Multifocal atrial tachycardia is most commonly observed in patients with:
The term "paroxysmal" should be used for rhythms which:
Start or stop abruptly
In adult severely unstable supraventricular tachycardia (SVT), this procedure should be considered:
A patient with marked bradycardia who is unstable and symptomatic will likely have:
Hypotension and decreased cerebral perfusion
Sinus bradycardia may become a dangerous condition if the heart rate decreases significantly or the patient becomes hemodynamically unstable.
In sinus dysrhythmia, the heart rate increases with inspiration and decreases with expiration.
Which of the following correctly reflects the ECG criteria for a sinus rhythm?
P waves that are uniform in appearance and upright in lead II, one preceding each QRS complex
Identify this rhythm:
Regular sinus rhythm (normal rate)
A dysrhythmia caused by episode of failure of the automaticity of the SA node resulting in bradycardia or asystole is called:
Patients taking this medication may have a slow heart rate:
Identify this rhythm
ID this rhythm
Unstable symptomatic sinus bradycardia must be treated with:
Transcutaneous pacing and/or atropine
You and your partner respond to assess a 68 year old male who presents with sudden onset of severe dyspnea, but denies having any chest pain. His only medical history is recent knee surgery and he states he has been somewhat immobile during his recuperation. The patient is normotensive, has a respiratory rate of 28, oxygen saturation of 90%, and shows the following rhythm on the monitor. Breath sounds are clear and equal bilaterally. You suspect his dyspnea to be related to:
This rhythm occurs when the SA node fails to initiate an electrical impulse for one or more beats:
Originates from the SA node and has a ventricular rate > 100 bpm
SA impluse is blocked upon exit of the SA node
Regular sinus rhythm (normal rate)
Originates from the SA node and has a ventricular rate of 60 - 100 bpm
Common dysrhythmia associated with ventilatory rate
SA node fails causing periods of cardiac standstill
Originates from the SA node and has a ventricular rate < 60 bpm
Definition of dysrhythmia
Variation from a normal rhythm
The wave or complex that ends a sinus arrest can only be initiated from the SA node.
Typically, the heart rate ____________ during inspiration and _____________ during expiration.
Your patient is a 42 year old female who called 911 because she has a "funny feeling" in her chest. Upon placing the patient on a cardiac monitor, you note that she has the following rhythm. Her blood pressure is 98/72, which she states is a little low for her, and she does say that she is feeling a bit weak. The medication of choice for this patient is:
Your patient is a 72 year old female who has chest pain and shortness of breath. She states, "This feels like my last heart attack." She is showing the following rhythm on the ECG and she has a blood pressure of 82/50. After administering oxygen and aspirin, you should immediately consider:
Prepare the patient for transport
The appropriate initial dose for the medication that would be indicated for a patient in this rhythm is:
Sudden onset and/or cessation of a rhythm
What are the main ECG findings for Wolff-Parkinson-White?
Short PR interval, delta wave, prolonged QRS
Your patient is a 78 year old male who has crushing substernal chest pain that also radiates to his left jaw. He states, "This feels like my last heart attack." He is showing the following rhythm on the ECG and he has a blood pressure of 76/46. After administering oxygen and aspirin, you should immediately consider:
Prepare the patient for transport
It is clinically important to recognize Wolff-Parkinson-White (WPW) syndrome when patients are demonstrating ventricular rates greater than 150 because:
If the underlying rhythm is actually A-fib combined with WPW, adenosine may increase the tachycardia
What is the accessory pathway for Lown-Ganong-Levine?
Bundle of James
What are the main ECG findings for Mahaim fibers?
Normal PR interval, delta wave, prolonged QRS
The dysrhythmias most likely to respond to synchronized cardioversion at lower energy settings are:
SVT and atrial flutter
Junction escape rhythm
40 - 60 bpm
Greater than 100 bpm
Accelerated junctional rhythm
60 - 100 bpm
Junctional escape beats
Occur later than the next expected beat
Occur earlier than the next expected beat
Characteristics of an supraventricular tachycardia would include: (Pick all that apply)
Rate usually greater than 150
may not be able to view P waves
Usually QRS less than 0.10
You have arrived to a 59yo female complaining of her chest racing. She states that she has been under a lot of stress recently and has been taking Xanax prescribed by her doctor. Her vital signs are: HR 174, RR 25, BP 100/48, and SPO2 at 96%. You apply the EKG monitor and see SVT. Your partner apply's oxygen and you start an IV in the AC area and push adenosine. You note the following on the EKG monitor.
This is considered a normal affect of the adenosine when treating supraventricular tachycardia
Which of the following causes could cause atrial tachycardia? (Pick all that apply)
Excess alcohol use
You have arrived for a 48yo female who is supine in bed complaining of discomfort in her chest. She is pale and diaphoretic and rates her pain which is substernal at a 3/10. Her vital signs are: HR 210, RR 24, BP 80/palp, and SPO2 92%. If she tries to sit up she complains of vertigo. Your EKG shows:
You have responded to a "man down" call at the Cottonwood Mall. On arrival you find a group of people gathered around a patient lying supine in the mall. You approach the patient and note that they are unconscious but appear to be breathing. Your partner checks ABC's while you get the EKG monitor set up. Your partner states that patient is unconscious but breathing with a weak pulse of 280. You place your monitor on quick look and use your paddles to see the following rhythm. You should now: (Pick all that apply)
Synchronize Cardiovert at 50 joules
Start an IV
Give high flow oxygen
The term "Paroxysmal" when associated with EKG interpretation represents:
A rhythm that begins and/or ends suddenly
A 41-year-old man complains of chest heaviness and mild shortness of breath that began about 2 hours ago. He is conscious and alert. As you are assessing him, he tells you that he has high blood pressure for which he takes Clonidine. His blood pressure is 160/90 mm Hg, heart rate is 140 beats/min and regular, and respirations are 22 breaths/min and somewhat labored. The cardiac monitor displays a narrow complex tachycardia in lead II. Which of the following interventions is NOT indicated for this patient?
A 39-year-old man in asystole has been unresponsive to high-quality CPR and two doses of epinephrine. The patient is intubated and an IO catheter is in place. You should focus on:
searching for reversible causes.
Which of the following statements regarding asystole is correct?
Asystole is the result of prolonged myocardial hypoxia
You are performing CPR on an 80-year-old woman whose cardiac arrest was witnessed by her husband. Several intubation attempts have been unsuccessful, but ventilations with a bag-mask device are producing adequate chest rise. IV access has been obtained and 1 mg of epinephrine has been administered. The cardiac monitor displays a narrow QRS complex rhythm at a rate of 70 beats/min. According to the patient's husband, she has had numerous episodes of diarrhea over the past 24 hours and has not had much of an appetite. The MOST appropriate next action should be to:
continue CPR and administer crystalloid fluid boluses.
You respond to the scene of an assault, where a 20-year-old man was struck in the chest with a steel pipe. Your assessment reveals that the patient is unresponsive, apneic, and pulseless. The MOST appropriate next intervention is to:
perform 5 cycles of well-coordinated CPR.
Sick sinus syndrome is also known as:
In the elderly, sinus dysrhythmia may be a precursor to:
Sick sinus syndrome
In adult severe symptomatic bradycardia, this procedure should be considered:
The underlying etiology of this rhythm is a pacemaker site shifting back and forth between the SA node, various atrial sites, and the AV node.
Wandering atrial pacemaker (multifocal atrial pacemaker)
The starting dose of adenosine for adult symptomatic supraventricular tachycardia with a pulse is:
"F waves" come in 2 varieties which include:
"Bearing down" in an effort to convert supraventricular tachycardia (SVT) is also known as:
This medication may be used to increase heart rate if the QRS is narrow and the patient is symptomatic because of a slow rate:
The SA node normally generates 60 - 100 electrical impulses per minute.
Adenosine is indicated for treatment of atrial flutter if the patient is hemodynamically compromised.
The process by which the myocardium is restimulated by the original impulse is called:
What are the main ECG findings for Lown-Ganong-Levine?
Short PR interval, no delta wave
The normal dosing scheme for adenosine is:
An initial dose of 6 mg followed by up one additional doses at 12 mg if previous dose do not work
Junctional rhtyhms produce a wave of depolarization that spreads:
Antegrade into the ventricles
Retrograde into the atria
Junctional tachycardia is:
Vagal maneuvers are used on tachydysrhythmias because:
It stimulates the parasympathetic nervous system and it slows the heart rate down
You have applied the defibrillator pads to a pulseless and apneic 60-year-old woman and observe a slow, wide QRS complex rhythm. Your next action should be to:
resume CPR at once.
Which of the following pulseless rhythms is NOT treated as pulseless electrical activity?
Pericardial tamponade can be differentiated from a tension pneumothorax by the presence of:
clear and equal breath sounds.
When performing CPR on an adult patient in cardiac arrest, it is important to:
allow the chest to fully recoil between compressions.
When managing cardiac arrest, the appropriate dosing regimen for epinephrine is:
1 mg of a 1:10,000 solution every 3 to 5 minutes.
Common causes of cardiac arrest include all of the following, EXCEPT:
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