12-Lead Book Flashcards by Daniel Fadok

When reviewing the layers of the heart, you will recall that the fibrous sac covering the heart, which is in contact with the pleura, is called the:

A) epicardium
B) myocardium
C) pericardium
D) endocardium

C) pericardium

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The heart chamber with the thickest myocardium is the:

A) right ventricle
B) left ventricle
C) right atrium
D) left atrium

B) left ventricle

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The pulmonic and aortic valves are open during:

A) systole
B) diastole
C) cardiac cycle
D) systole and diastole

A) systole

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The large blood vessel that returns unoxygenated blood from the head and neck to the right atrium is called the:

A) jugular vein
B) carotid artery
C) superior vena cava
D) inferior vena cave

C) superior vena cava

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The innermost layer of the arterial wall is called the:

A) tunica intima
B) tunica media
C) myocardium
D) tunica adventitia

A) tunica intima

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The most numerous blood vessels in the body are the:

A) arteries
B) capillaries
C) venules
D) veins

B) capillaries

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Blood flow between the heart and lungs comprises the:

A) systemic circulation
B) venous circulation
C) myocardial circulation
D) pulmonary circulation

D) pulmonary circulation

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Blood vessels that function under high pressure in order to convey blood from the heart out to the rest of the body are called:

A) venules
B) veins
C) arteries
D) capillaries

C) arteries

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The blood vessel that returns unoxygenated blood from the myocardium to the right atrium is called the great cardiac vein or the:

A) jugular vein
B) carotid artery
C) coronary sinus
D) inferior vena cava

C) coronary sinus

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____ are the fine chords of dense connective tissue that attach to papillary muscles in the walls of the ventricles.

A) Coronary arteries
B) Coronary sinuses
C) Chordae tendineae
D) Purkinje fibers

C) Chordae tendineae

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The right and left coronary arteries branch off of the:

A) coronary sinus
B) right atrium
C) left atrium
D) trunk of the aorta

D) trunk of the aorta

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The central section of the thorax is called the:

A) costal margin
B) mediastinum
C) diaphragm
D) xiphoid

B) mediastinum

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The smooth outer surface of the heart is called the:

A) myocardium
B) epicardium
C) endocardium
D) pericardium

B) epicardium

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An inflammation of the serous pericardium is called:

A) myocarditis
B) pericarditis
C) pulmonitis
D) tendonitis

B) pericarditis

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The coronary ___ is the short trunk that serves to receive deoxygenated blood from the veins of the myocardium.

A) artery
B) fiber
C) sinus
D) tissue

C) sinus

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The left side of the heart is referred to as a low-pressure pump.

A) True
B) False

B) False

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The major blood vessel that receives blood from the head and upper extremities and transports it to the heart is the:

A) aorta
B) superior vena cava
C) inferior vena cava
D) pulmonary artery

B) superior vena cava

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The course of blood flow through the heart and lungs is referred to as ____ circulation.

A) aortic
B) pulmonary
C) systemic
D) collateral

B) pulmonary

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Cardiac output is a product of which of the elements listed below?

A) heart rate
B) stroke volume
C) partial vascular resistance
D) a and b

D) a and b

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The chief chemical neurotransmitter for the parasympathetic nervous system is:

A) acetylcholine
B) norepinephrine
C) epinephrine
D) atropine

A) acetylcholine

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The heart has ___ chambers.

A) two
B) three
C) four
D) six

C) four

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The chief chemical neurotransmitter for the sympathetic nervous system is:

A) acetylcholine
B) norepinephrine
C) ephedrine
D) atropine

B) norepinephrine

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Unoxygenated blood flows from the inferior and superior vena cavae into the:

A) left atrium
B) left ventricle
C) right ventricle
D) right atrium

D) right atrium

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One cardiac cycle occurs every ____ seconds.

A) 0.8
B) 0.5
C) 0.52
D) 1.2

A) 0.8

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With the exception of ____, all of the body’s blood vessels have alpha-adrenergic receptors, whereas the heart and lungs have beta-adrenergic receptors.

A) arterioles
B) capillaries
C) venules
D) aorta

B) capillaries

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The automatic nervous system is divided into the sympathetic nervous system and the ____ nervous system.

A) adrenergic
B) cholinergic
C) parasympathetic
D) neurosympathetic

C) parasympathetic

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The end-diastolic pressure reflective of volume in the ventricles during diastole is called:

A) preload
B) afterload
C) postload
D) endload

A) preload

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Starling’s Law of the heart states that the more the myocardial fibers are stretched (to a point), the more forceful the cardiac contraction will be.

A) True
B) False

A) True

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The nerve endings of the sympathetic nervous system are called:

A) cholinergic
B) adrenergic
C) dopaminergic
D) acetylilnergic

B) adrenergic

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Stroke volume is estimated as ___ cubic centimeters.

A) 60
B) 70
C) 80
D) 90

B) 70

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The primary functions of the myocardial working cells include:

A) automaticity
B) regeneration
C) contraction and relaxation
D) impulse propogation

C) contraction and relaxation

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The ability of cardiac pacemaker cells to spontaneously generate their own electrical impulses without external (or nervous) stimulation is known as:

A) automaticity
B) contractility
C) conductility
D) action potential

A) automaticity

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Which one of the following characteristics is specific to the pacemaker cell sites of the electrical conduction system (the SA node, the AV junction, and the Purkinje network fibers)?

A) automaticity
B) contractility
C) conductility
D) excitability

C) conductility

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The ability of cardiac cells to respond to an electrical stimulus is referred to as:

A) automaticity
B) contractility
C) conductility
D) excitability

D) excitability

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Excitability is also referred to as:

A) irritability
B) automaticity
C) contractility
D) conductility

A) irritability

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The ability of cardiac cells to receive an electrical stimulus and to then transmit the stimulus to other cardiac cells is known as:

A) irritability
B) automaticity
C) contractility
D) conductivity

C) contractility

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Conductivity is a characteristic shared by all cardiac cells.

A) True
B) False

B) False

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Cardiac muscle cells groups that function collectively as a unit are known as:

A) synctyia
B) refractory
C) electrical
D) bundles

C) electrical

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Repolarization is a slower process than depolarization.

A) True
B) False

A) True

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The period during which repolarization is almost complete and the cardiac cell can be stimulated to contract prematurely if the stimulus is stronger than normal is known as the:

A) relative refractory period
B) absolute refractory period
C) action potential phase
D) active depolarization

A) relative refractory period

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The relative refractory period is also known as the ____ period.

A) action
B) vulnerable
C) potential
D) absolute

B) vulnerable

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A decrease in sodium blood levels is called:

A) hypernatremia
B) hyponatremia
C) hyperkalemia
D) hypocalcemia

B) hyponatremia

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An increase in calcium blood level is called:

A) hypercalcemia
B) hypocalcemia
C) hyponatremia
D) hyperkalemia

A) hypercalcemia

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The resting state of a cardiac cell, wherein the inside of the cell is electrically negative relative to the outside of the cell, is called:

A) active state
B) polarized state
C) depolarization
D) repolarization

B) polarized state

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The point at which a stimulus will produce a cell response is called the:

A) threshold
B) J point
C) action potential
D) refractory period

A) threshold

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The sinoatrial node is located in the:

A) right atrium
B) right ventricle
C) Purkinje fiber tract
D) atrioventricular septum

A) right atrium

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The AV junction is located in the:

A) right atrium
B) left ventricle
C) Purkinje fiber tract
D) atrioventricular septum

D) atrioventricular septum

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The instrinsic firing rate of the AV junction is ____ beats per minute.

A) 15-25
B) 25-35
C) 35-45
D) 40-60

D) 40-60

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The intrinsic firing rate of the SA node in the adult is ___ beats per minute.

A) 20-60
B) 40-80
C) 60-100
D) 80-100

C) 60-100

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The electrocardiogram is used to:

A) determine pulse rate
B) detect valvular dysfunction
C) evaluate electrical activity in the heart
D) determine whether the heart is beating

C) evaluate electrical activity in the heart

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The normal conduction patter of the heart follows:

1 - SA node
2 - Purkinje fibers
3 - bundle of His
4 - AV node
5 - bundle branches
6 - internodal pathways

A) 1, 2, 3, 5, 6, 4
B) 1, 6, 4, 3, 5, 2
C) 1, 6, 4, 2, 3, 5
D) 6, 1, 5, 4, 6, 2

B) 1, 6, 4, 3, 5, 2

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The primary pacemaker of the heart is the:

A) AV node
B) SA node
C) Purkinje
D) SV node

B) SA node

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The bundle of His is also traditionally referred to as the:

A) lesser bundle
B) chordae tendinea
C) common bundle
D) coronary sinus

C) common bundle

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The fibers of the Purkinje network can only be identified with the aid of a microscope.

A) True
B) False

A) True

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The heart’s electrical impulse arises in the SA node. The impulse travels through the internodal pathways and joins the bundle of His at an area called the:

A) Bachmann’s bundle
B) AV junction
C) SA junction
D) common bundle

D) common bundle

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The intrinsic firing rate of the Purkinje fibers is ____ beats per minute.

A) 50-60
B) 60-70
C) 10-20
D) 20-40

D) 20-40

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A group of interatrial fibers contained in the left atrium is referred to as:

A) Bachmann’s bundle
B) AV junction
C) SA junction
D) common bundle

A) Bachmann’s bundle

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The interventricular septum is the wall between the:

A) right and left atrium
B) right and left ventricle
C) inferior and superior chambers
D) inferior and superior vena cavae

B) right and left ventricle

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Purkinje’s network fibers are smaller in diameter than ordinary cardiac muscle fibers.

A) True
B) False

B) True

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The SA node receives its blood supply primarily from the:

A) coronary sulcus
B) great cardiac vein
C) SA artery
D) aorta

C) SA artery

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Ventricular diastole refers to ventricular:

A) contraction
B) relaxation
C) filling time
D) pressure ratio

B) relaxation

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The single-lead electrocardiogram primarily is used to:

A) determine cardiac output
B) detect valvular dysfunction
C) evaluate electrical activity in the heart
D) detect left-to-right conduction disorders

C) evaluate electrical activity in the heart

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The PR interval should normally be ____ seconds or smaller.

A) 0.10
B) 0.12
C) 0.08
D) 0.20

D) 0.20

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The QRS complex should normally be ____ seconds or smaller.

A) 0.20
B) 0.12
C) 0.18
D) 0.36

B) 0.12

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The QRS complex is produced when the:

A) ventricles repolarize
B) ventricles depolarize
C) ventricles contract
D) b and c

D) b and c

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The T wave on the EKG strip represents:

A) rest period
B) bundle of His
C) atrial contraction
D) ventricular contraction

A) rest period

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The point at which the QRS complex meets the ST segment is known as the:

A) delta wave
B) end point
C) J point
D) vector

C) J point

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When interpreting dysrhythmias, the health care provider should remember that the most important key is the:

A) PR interval
B) rate and rhythm
C) presence of dysrhythmias
D) patient’s clinical appearance

D) patient’s clinical appearance

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How many cardiac monitor pads are utilized when obtaining a 12-lead EKG?

A) 10
B) 12
C) 3
D) 6

A) 10

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The changes of the QRS complex from a negative deflection to a positive deflection in the V leads is called:

A) the J point
B) biphasic
C) waveform configuration
D) R wave progression

D) R wave progression

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In the aVR lead, the T waveforms are ____ deflected.

A) positively
B) biphasic
C) rarely
D) negatively

D) negatively

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In the aVL lead, the T waveforms are ____ deflected.

A) positively
B) biphasic
C) rarely
D) negatively

B) biphasic

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In the aVF lead, the T waveforms are ____ deflected.

A) positively
B) biphasic
C) rarely
D) negatively

A) positively

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The augmented leads may be referred to as:

A) unipolar
B) bipolar
C) multipolar
D) vector

A) unipolar

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The intrinsic firing rate of the AV node is ____ beats per minute.

A) 15-25
B) 25-35
C) 35-45
D) 40-60

D) 40-60

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The 12-lead EKG is used to evaluate all of the following EXCEPT:

A) heart rate
B) valvular dysfunction
C) electrical activity in the heart
D) isolate waveforms indicative of an MI

B) valvular dysfunction

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The PR interval should normally be ____ seconds or smaller.

A) 0.10
B) 0.12
C) 0.18
D) 0.20

D) 0.20

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The QRS interval should normally be ____ seconds or smaller.

A) 0.20
B) 0.12
C) 0.08
D) 0.20

B) 0.12

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ST segment depression indicates:

A) myocardial ischemia
B) coronary vasospasm
C) Prinzmetal’s angina
D) chronic pericarditis

A) myocardial ischemia

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The QRS complex is produced when the ventricles:

A) repolarize
B) depolarize
C) contract
D) both b and c

D) both b and c

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ST segment elevation is a primary indicator of:

A) ventricular atrophy
B) ventricular hypertrophy
C) myocardial injury
D) atrial aneurysm

C) myocardial injury

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The most common cause of ST segment depression is myocardial ischemia. Other causes may include all of the following EXCEPT:

A) interatrial conduction defects
B) ventricular hypertrophy
C) digitalis toxicity
D) interventricular conduction defects

A) interatrial conduction defects

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The development of the pathologic Q waves indicates:

A) irreversible tissue ischemia
B) coronary artery vasospasm
C) third-degree block
D) irreversible tissue damage

D) irreversible tissue damage

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The right and left coronary arteries branch off of the:

A) ventricular artery
B) myocardial sulcus
C) proximal portion of the aorta
D) distal portion of the aorta

C) proximal portion of the aorta

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Collateral circulation allows for:

A) alternate path of blood flow in the event of occlusion
B) circulation continuum during diastole
C) maintaining artery patency during spasms
D) the ability of blood flow continuum during systole

A) alternate path of blood flow in the event of occlusion

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The pain of angina pectoris:

A) is always constant
B) is typically temporary
C) occurs only during rest
D) is never mistaken for indigestion

B) is typically temporary

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Myocardial infarction is:

A) always temporary
B) usually diagnosed within 24 hours
C) age limited in most patients
D) due to myocardial cell death

D) due to myocardial cell death

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The most common cause of an AMI is:

A) coronary vasospasms
B) atherosclerotic lesions
C) thrombus formation
D) arteriosclerotic blebs

C) thrombus formation

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In acute myocardial infarctions, chest pain is long in duration and not relieved by nitroglycerin.

A) True
B) False

A) True

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Patients experiencing an AMI will always complain of chest pain.

A) True
B) False

B) False

ST segment elevation is a primary indicator of:

A) ventricular atrophy
B) ventricular hypertrophy
C) myocardial injury
D) atrial aneurysm

C) myocardial injury

The primary goal of management of the patient with symptomatic chest pain is to:

A) interrupt the infarction process
B) augment the infarction process
C) institute thrombolytic therapy
D) increase myocardial oxygen consumption

A) interrupt the infarction process

Management of a patient who is suspected of having sustained a myocardial contusion should:

A) focus primarily on the associated and isolated chest injury
B) be similar to the treatment administered to a suspected MI patient
C) only be initiated at the definitive care facility following transport
D) completed in the prehospital arena, prior to transport to the hospital

B) be similar to the treatment administered to a suspected MI patient

Timely assessment and management including immediate oxygen administration must be rapidly completed within a _____ minute time interval.

A) 5
B) 10
C) 12
D) 15

B) 10

The 12-lead EKG is utilized to:

A) rule out the presence of an acute MI
B) confirm the presence of an acute MI
C) identify dysrhythmias and contractile force
D) identify mechanical causes of dysrhythmias

B) confirm the presence of an acute MI

The most important drug any patient experiencing chest pain can receive is:

A) nitroglycerin
B) aspirin
C) oxygen
D) morphine

C) oxygen

The coronary arteries receive oxygenated blood from the:

A) aorta
B) coronary sinus
C) pulmonary veins
D) pulmonary arteries

A) aorta

Signs and symptoms the health care provider may expect to observe in a patient with necrotic heart tissue could include:

A) dysrhythmias
B) congestive heart failure
C) cardiogenic shock (severe)
D) all of the above are possible.

D) all of the above are possible.

The function of the chordae tendineae and papillary muscles is to:

A) prevent backflow of blood into the ventricles
B) protect the coronary orifices when the aortic valve opens
C) prevent backflow of blood into the atrium
D) facilitate backflow of blood from the aorta

C) prevent backflow of blood into the atrium

The coronary sinus returns deoxygenated blood from the:

A) aorta
B) myocardium
C) pulmonary veins
D) pulmonary arteries

B) myocardium

Most cardiac dysrhythmias are caused by ischemia secondary to hypoxia; therefore, the most appropriate drug to give a patient with any dysrhythmia is:

A) oxygen
B) D5W
C) lidocaine
D) morphine

A) oxygen

Defined as death of the myocardial tissue, a myocardial infarction commonly results from:

A) myocardial necrosis
B) myocardial injury
C) myocardial ischemia
D) muscle oxygenation

A) myocardial necrosis

EKG changes that may be anticipated as a result of myocardial ischemia, injury, and/or necrosis of the myocardial tissues include all of the following EXCEPT:

A) PR interval prolongation
B) ST segment elevation
C) ST segment depression
D) pathologic Q wave

A) PR interval prolongation

The development of pathologic Q waves often begins within the first 2 hours after the MI and, in most cases, is complete within ____ hours.

A) 1
B) 1/2
C) 24
D) 48

C) 24

ST segment depression may be evident on a 12-lead EKG strip following both angina and strenuous exercise.

A) False
B) True

B) True

EKG changes of significance with myocardial ischemia include ST segment depression, T wave inversion, or ____ wave.

A) depressed T
B) peaked T
C) peaked P
D) inverted P

B) peaked T

Chest pain should be considered to be cardiac in origin and managed accordingly until proven otherwise.

A) True
B) False

A) True

With myocardial injury, the most significant and frequently identifiable change is:

A) ST depression
B) ST elevation
C) pathologic Q waves
D) peaked T waves

B) ST elevation

Deprivation of oxygen and other nutrients to the heart muscle may be defined as myocardial:

A) injury
B) ischemia
C) necrosis
D) infarction

B) ischemia

A Q wave is considered abnormal if it is equal to or greater than 0.04 seconds (one small box) in width and has a depth of ____ the height of the succeeding R wave.

A) 30% or less
B) 15% or less
C) 45% or more
D) 25% or more

D) 25% or more

Two primary structures are responsible for delivering oxygen-rich blood to the myocardium. These structures are the:

A) coronary sinuses
B) cerebral sinuses
C) coronary arteries
D) cerebral arteries

C) coronary arteries

There are ___ main coronary arteries.

A) six
B) three
C) four
D) two

D) two

Inferior wall infarctions are associated with the:

A) right coronary artery
B) left coronary artery
C) bundle of His
D) coronary sinus

A) right coronary artery

Myocardial infarctions may be classified as either transmural or:

A) supraendocardial
B) subendocardial
C) endocardial
D) precardial

B) subendocardial

Subendocardial infarctions are commonly referred to as:

A) full thickness
B) transmural
C) nontransmural
D) transdermal

C) nontransmural

Leads that record electrical impulses generated from the heart’s electrical conduction system, and that “look at” specific areas of damaged myocardium, are called ____ leads.

A) reciprocal
B) facing
C) viewing
D) specific

B) facing

EKG findings or infarction may occur in a single lead or in a combination of leads.

A) True
B) False

A) True

The most important diagnostic tool that you can use when assessing and treating a patient with a suspected inferior MI is the:

A) 12-lead EKG machine
B) cardiac enzyme
C) patient’s clinical appearance
D) patient’s presenting vital signs

C) patient’s clinical appearance

ST segment elevation is noted in the limb leads, Leads II, III, and aVF. This finding is indicative of _____ myocardial infarction.

A) anterior
B) lateral
C) superior
D) inferior

D) inferior

EKG leads that record the electrical impulse formation in uninvolved myocardium directly opposite from the involved myocardium are called _____ leads.

A) facing
B) viewing
C) reciprocal
D) endocardial

C) reciprocal

If your patient is hypotensive, and is exhibiting EKG changes consistent with an inferior myocardial infarction, you should consider the possibility of ___ infarction.

A) right atrial
B) left atrial
C) right ventricular
D) left interatrial

C) right ventricular

Any patient who complains of chest pain must be thoroughly evaluated and management continued until the possibility of AMI is ruled out by the physician.

A) True
B) False

A) True

Reciprocal leads for the inferior MI are leads:

A) II and III
B) V1 and V2
C) aVL and aVF
D) I and aVL

D) I and aVL

When obtaining a right-sided EKG, the leads that should be moved are:

A) V3, V4, and V5
B) V1, V2, and V3
C) V5, V6, and V7
D) I, II, and III

A) V3, V4, and V5

A non-Q wave MI is consistent with:

A) full thickness
B) nontransmural
C) transmural
D) endocardial

B) nontransmural

The ____ of the heart is considered to be the “workhorse” of the heart.

A) right ventricle
B) left ventricle
C) left atrium
D) right atrium

B) left ventricle

Generally, anterior MIs tend to involve a larger muscle mass than do inferior MIs.

A) True
B) False

A) True

A ____ branch of the left coronary artery supplies blood to the lateral wall of the left ventricle.

A) central
B) peripheral
C) marginal
D) secondary

C) marginal

The ___ branch of the left coronary artery extends around to the posterior side of the heart and its branches supply blood to much of the posterior wall of the heart.

A) marginal
B) descending
C) ascending
D) circumflex

D) circumflex

Because of its size and the large amount of myocardium that it supplies, massive infarction may result if the ____ becomes totally occluded.

A) LAD
B) CAD
C) RAD
D) MBD

A) LAD

Because of the potential for the massive infarction, the LAD is sometimes called the widowmaker.

A) True
B) False

A) True

Leads V3 and V4 visualize the ____ wall of the heart’s left ventricle.

A) medial
B) lateral
C) anterior
D) posterior

C) anterior

If your patient is exhibiting clinical signs and symptoms consistent with a myocardial infarction AND you notice that ST segment elevation is present in leads ____ , your index of suspicion regarding the presence of an anterior MI should being to increase.

A) V2 and aVL
B) V1 and aVF
C) V3 and V4
D) V5 and V6

C) V3 and V4

Regarding the systematic approach to EKG interpretation, you should always follow the logical and workable ____ in order to correctly interpret 12-lead EKG strips.

A) six-step approach
B) 5 + 3 approach
C) 5 + 2 approach
D) four-step approach

B) 5 + 3 approach

In addition to the occurrence of ST segment elevation, ____ and the evolution of significant Q waves in leads V3 and V4 may indicate anterior myocardial infarction.

A) T wave elevation
B) loss of T wave
C) prolonged PR interval D) T wave inversion

D) T wave inversion

Due to the large degree of myocardial muscle involvement, ___ MIs have a greater predisposition for the development of complications such as lethal ventricular dysrhythmias and cardiogenic shock.

A) posterior
B) anterior
C) lateral
D) inferior

B) anterior

Anterior infarctions tend to result in hyperactivity of the sympathetic nervous system.

A) True
B) False

A) True

Anterior MIs are associated with the development of:

A) sinus dysrhythmias
B) first-degree heart blocks
C) wandering atrial pacemakers
D) third-degree heart blocks

D) third-degree heart blocks

Loss of R wave progression rarely occurs with anterior MIs.

A) True
B) False

B) False

The reciprocal lead changes in the anterior MI, though uncommon, are:

A) I, II, and aVR
B) II, III, and aVF
C) II, III, and aVL
D) I, aVR, and aVL

B) II, III, and aVF

Pure (or isolated) septal MIs are a more common occurrence than other types of MI.

A) True
B) False

B) False

Generally, an MI that involves the interventricular septum will also involved the ___ of the heart.

A) left ventricle
B) right ventricle
C) left atrium
D) right atrium

A) left ventricle

The left anterior descending artery has six branches called septal ____ arteries.

A) penetrating
B) protruding
C) perforating
D) piercing

C) perforating

Other branches of the LAD are called _____ arteries and supply blood to the anteriolateral wall of the left ventricle.

A) perforating
B) marginal
C) dissecting
D) diagonal

D) diagonal

The left and right halves of the heart are divided by a wall called the:

A) schism
B) bridge
C) septum
D) ridge

C) septum

The ___ septum is located between and divides the two atria.

A) interatrial
B) interarterial
C) intratrial
D) intraaterial

A) interatrial

The ___ septum is located between and divides the two ventricles.

A) interatrial
B) interventricular
C) intraventricular
D) interarterial

B) interventricular

Leads ____ visualized the interventricular septum of the heart.

A) V4 and V6
B) V2 and V3
C) V5 and aVF
D) V1 and V2

D) V1 and V2

Pathologic Q waves are not an early indicator or EKG finding, but occur as later evidence of myocardial tissue damage.

A) True
B) False

A) True

To diagnose an acute septal MI, evidence of ___ must be present in leads V1 and V2.

A) ST segment depression
B) ST segment elevation
C) pathologic Q waves
D) any of the above

B) ST segment elevation

Pathologic Q waves are indicative of early onset of acute MI.

A) True
B) False

B) False

Electrical conduction system dysrhythmias are a common occurrence in patients with septal MIs.

A) True
B) False

A) True

The left coronary artery leaves the aorta and immediately divides into the left anterior descending artery and the ____ artery.

A) diagonal
B) perforating
C) circumflex
D) marginal

C) circumflex

The reciprocal leads for the septal MI are leads I, II, and III.

A) True
B) False

B) False

ST elevation in leads V1, V2, V3, and V4 are indicative of ____ MI.

A) pure septal
B) anteroposterior
C) anterolateral
D) anteroseptal

D) anteroseptal

Pure lateral MIs are uncommon; infarction of the lateral wall of the left ventricle usually involves the:

A) anterior or inferior wall of the right atrium
B) inferior and posterior wall of the left atrium
C) posterior and superior wall of the left ventricle
D) anterior, inferior, and posterior wall of left ventricle

D) anterior, inferior, and posterior wall of left ventricle

The anatomy of some individuals varies slightly, especially with respect to the distribution areas of the coronary arteries.

A) True
B) False

A) True

Myocardial infarction or myocardial ischemia may be produced by:

A) sudden increase in myocardial workload
B) spasms of the coronary arteries
C) coronary artery occlusion
D) all of the above

D) all of the above

Therapeutic and prognostic implications of lateral MIs will be primarily based on the:

A) clinical picture of your patient
B) serum cardiac enzyme levels
C) 3-lead EKG tracing
D) patient’s vital signs

A) clinical picture of your patient

Due to the location of significant conduction components in the interventricular septum, the predisposition for the development of complications such as conduction system dysrhythmias is relatively common with lateral infarctions.

A) True
B) False

A) True

ST segment elevation that resembles the appearance of a tombstone signifies that the occurring ischemia and injury is massive in nature and is a very serious and acute finding.

A) True
B) False

A) True

When the lateral wall is involved with proximal occlusion of the LAD, this is termed a(n) ____ MI.

A) posterolateral
B) anteroseptal
C) anterolateral
D) posteroseptal

C) anterolateral

Myocardial infarctions of the lateral wall of the heart most commonly occur as a result of an extensions of anterior and/or inferior wall MIs.

A) True
B) False

A) True

Leads ___ visualize the lateral wall of the heart.

A) V2, V2, II, and V3
B) V3, V4, I, and aVF
C) V2, V4, II, and aVR
D) V5, V6, I, and aVL

D) V5, V6, I, and aVL

The interatrial septum is a thick muscular wall that is actually a part of the left ventricle.

A) True
B) False

B) False

Pure lateral MIs are infrequent; thus, EKG changes will commonly indicate the involvement of either the anterior or septal wall in conjunction with lateral wall infarctions.

A) True
B) False

A) True

ST segment depression may be indicative of:

A) cerebral hypoxia
B) myocardial ischemia
C) unstable angina
D) ventricular atrophy

B) myocardial ischemia

Pathologic Q waves indicate:

A) ischemia
B) necrosis
C) atrophy
D) hypoxia

B) necrosis

The concept of poor R wave progression refers to the absence of R waves in lead:

A) V1
B) V2
C) aVF
D) aVR

B) V2

Diagonal arteries supply blood to the posterolateral walls of the left ventricle.

A) True
B) False

A) True

ST segment elevation may indicate:

A) ventricular atrophy
B) ventricular hypertrophy
C) myocardial injury
D) atrial aneurysm

C) myocardial injury

If ST segment elevation is noted in the lower limb leads (II, III, and aVF), this finding is indicative of ____ MI.

A) anterior
B) lateral
C) superior
D) inferior

D) inferior

If your patient is hypotensive and is exhibiting EKG changes consistent with an inferior MI, consider the possibility of ____ infarction.

A) right atrial
B) left atrial
C) right ventricular
D) left ventricular

C) right ventricular

The combination of posterior wall injury evidence, in addition to evidence of ___ , indicates a more extensive infarction and a greater risk of complications.

A) anterior wall ischemia
B) inferior infarction
C) T wave inversion
D) prolonged PR interval

B) inferior infarction

When dealing with inferior and inferoposterior MIs, the appearance of high-degree AV blocks may be present upon admission to the hospital. Examples of high-degree blocks include ____ blocks.

A) first-degree
B) second-degree Type I
C) third-degree
D) Wenckebach (Mobitz I)

C) third-degree

The 12-lead EKG machine is capable of recognizing the posterior V leads (V7, V8, and V9).

A) True
B) False

B) False

Placement of posterior lead V7 is at the level of the:

A) 7th intercostal space, anterior axilla
B) 5th intercostal space, midscapula
C) 5th intercostal space, posterior axilla
D) 3rd intercostal space, midaxilla

C) 5th intercostal space, posterior axilla

Placement of posterior lead V8 is at the level of the:

A) 7th intercostal space, anterior axilla
B) 5th intercostal space, midscapula
C) 5th intercostal space, posterior axilla
D) 3rd intercostal space, midaxilla

B) 5th intercostal space, midscapula

Placement of posterior lead V9 is at the level of the:

A) 7th intercostal space, anterior axilla
B) 5th intercostal space, 2 cm left of the spine
C) 5th intercostal space, posterior axilla
D) 3rd intercostal space, 4 cm lateral to the spine

B) 5th intercostal space, 2 cm left of the spine

When considering the possibility of posterior wall MIs, expect to assess reciprocal leads rather than indicative leads.

A) True
B) False

A) True

When tall R waves are noted in lead V1, this finding should prompt you to think of inferior infarctions.

A) True
B) False

B) False

When conducting the mirror test, the mirror should be placed ____ the V leads on the 12-lead EKG.

A) below
B) beside
C) above
D) the the left of

C) above

In the two-lead method of axis determination, a normal axis is determined by:

A) negative QRS deflection in leads I and aVF
B) positive QRS deflection in leads I and aVF
C) negative QRS deflection in lead I and positive QRS deflection in aVF
D) negative QRS deflection in lead I and positive QRS deflection in aVL

B) positive QRS deflection in leads I and aVF

In the two-lead method of axis determination, a left axis deviation is determined by:

A) negative QRS deflection in leads I and aVF
B) positive QRS deflection in leads I and aVF
C) negative QRS deflection in lead I and positive QRS deflection in aVF
D) positive QRS deflection in lead I and negative QRS deflection in aVF

D) positive QRS deflection in lead I and negative QRS deflection in aVF

In the two-lead method of axis determination, a right axis deviation is determined by:

C) negative QRS deflection in lead I and positive QRS deflection in aVF

In the two-lead method of axis determination, an indeterminate right axis deviation is determined by:

A) negative QRS deflection in leads I and aVF

Which one of the following disease processes can be expected in left axis deviation?

A) left bundle branch block
B) pulmonary hypertension
C) Wolfe-Parkinson-White syndrome
D) pulmonary embolism

C) Wolfe-Parkinson-White syndrome

Which one of the following disease processes can be expected in right axis deviation?

A) ischemic heart disease
B) chronic obstructive pulmonary disease
C) right bundle branch block
D) systemic hypertension

B) chronic obstructive pulmonary disease

The right bundle branch runs down the right side of the interventricular septum and terminates at the ____ in the right ventricle.

A) Purkinje’s network
B) papillary muscles
C) anterior fascicle
D) posterior fascicle

B) papillary muscles

In the prehospital or emergent setting, you should realizes that the presence of EKG evidence indicating bundle branch blocks is always clinically significant.

A) True
B) False

B) False

An incomplete bundle branch block is one in which the width of the QRS complex will measure between 0.10 and 0.11 seconds.

A) True
B) False

A) True

A complete block is one in which the width of the QRS complex will measure 0.12 seconds or greater.

A) True
B) False

A) True

In the presence of an acute MI, a right bundle branch block will obscure EKG evidence.

A) True
B) False

B) False

To determine right bundle branch block, the primary EKG leads to observe are:

A) V1 and V2
B) V5 and V6
C) V2 and V3
D) V2 and V4

B) V5 and V6

The goal of managing the patient with symptomatic chest pain is to attempt to:
A) administer prehospital fibrinolytics
B) stop the infarction process
C) reverse the infarction process
D) alleviate the patient’s symptoms

B) stop the infarction process

The maximum benefit of fibrinolytic therapy is best achieved when the agent is administered within ____ hour(s) after onset of symptoms.

A) 2
B) 10
C) 6
D) 1

C) 6

The most commonly utilized tool to indicate the presence of myocardial damage that may lead to infarction is:

A) ST segment depression
B) ST segment elevation
C) pathologic Q wave
D) prolonged PR interval

B) ST segment elevation

The major complication of fibrinolytic therapy is:

A) urticaria
B) thrombosis
C) dysrhythmia
D) hemorrhage

D) hemorrhage

All of the following clinical presentations may indicate the need for fibrinolytic therapy EXCEPT:

A) pallor
B) diaphoresis
C) ventricular fibrillation
D) chest pain unrelieved by rest

C) ventricular fibrillation

Criteria for fibrinolytic therapy include all of the following EXCEPT:

A) age of less than 75 years
B) onset of chest pain occurring within 12 hours
C) most benefit from fibrinolysis if given within 6 hours
D) ST segment elevation greater than or equal to 1 mm in three contiguous limb leads

B) onset of chest pain occurring within 12 hours

External cardiac pacing (TCP) is sometimes indicated for the treatment of certain reperfusion dysrhythmias, such as:

A) asymptomatic bradycardia
B) symptomatic bradycardia
C) asymptomatic tachycardia
D) symptomatic tachycardia

B) symptomatic bradycardia

One of the more common complications of transcutaneous pacing is:

A) pain
B) burns
C) electrocution
D) muscle damage

A) pain

There are many factors that can determine the amount of transthoracic resistance to current flow. These factors include all of the following EXCEPT:

A) room temperature
B) electrode size
C) energy-level selection
D) electrode position

A) room temperature

In the emergent setting, you must determine whether your patient is perfusing, as evidenced by the presence of a:

A) pulse
B) heart rhythm
C) heart rate
D) blood pressure

A) pulse

Synchronized cardioversion is designed to deliver the shock approximately 10 milliseconds after the peak of the ____ wave of the cardiac cycle.

A) Q
B) R
C) S
D) P

B) R

Energy requirements for synchronized cardioversion are based on the:

A) number of QRS complexes in a 6-second strip
B) type of dysrhythmia being treated
C) defibrillator capacity
D) manufacturer’s guidelines

B) type of dysrhythmia being treated

In biphasic waveforms, energy is delivered through the heat, traveling in one direction from one paddle to the other in one phase.

A) True
B) False

B) False

Certain dysrhythmias, notably those of atrial origin, can be treated with as little as ____ joules.

A) 10
B) 5
C) 15
D) 20

A) 10

If a dysrhythmia appears to be ventricular in origin, the initial energy setting should be _____ joules or equivalent biphasic energy level.

A) 200
B) 100
C) 300
D) 360

A) 200

Atropine 1.o milligram may:

1 - be given via the ET tube
2 - be useful in third-degree AV block
3 - result in undesirable heart block
4 - increase the rate of a sinus bradycardia

A) 1, 2, 3
B) 1, 2, 4
C) 2, 3, 4
D) 1, 3

B) 1, 2, 4

External pacing may be indicated for which one of the following rhythms when the rhythms are refractory to atropine?

A) pulseless electrical activity
B) first-degree atrioventricular block
C) symptomatic bradycardia
D) symptomatic ventricular tachycardia

C) symptomatic bradycardia

An adult weighing 72 kilograms presents with ventricular tachycardia and a palpable pulse. Which one of the following schedules of lidocaine is preferred?

A) IV bolus of 75 milligrams, followed by infusion at 2 to 4 milligrams per minute
B) IV bolus of 150 milligrams every 5 minutes to a total of 300 milligrams
C) 150 milligrams IV bolus followed by infusion of 4 to 6 milligrams per minute
D) 200 milligrams IV bolus followed by infusion of 1 to 2 milligrams per minute

A) IV bolus of 75 milligrams, followed by infusion at 2 to 4 milligrams per minute

Lidocaine may be administered by:

A) IV only
B) ET only
C) IV or IM
D) IV, ET, or IO

D) IV, ET, or IO

Which one of the following statements regarding procainamide administration is FALSE?

A) Administration of this agent should be discontinued if the patient becomes hypotensive.
B) Administration of this agent should be discontinued when 2 grams have been administered.
C) Procainamide is never administered via the endotracheal tube.
D) Discontinue administration of this agent if the original QRS width has widened by 50 percent or more.

B) Administration of this agent should be discontinued when 2 grams have been administered.

Verapamil is an:

A) analgesic
B) alkalinizer
C) antidysrhythmic
D) antihypertensive

C) antidysrhythmic

Epinephrine may be administered:

A) to relieve the pain of angina pectoris
B) via direct epicardial injection
C) by intraosseous injection
D) only via the intravenous route

C) by intraosseous injection

Which of the following drugs increases heart rate?

A) atropine
B) adenosine
C) verapamil
D) sodium bicarbonate

A) atropine

The trade name for dopamine hydrochloride is:

A) amiorone
B) intropin
C) dobutamine
D) diazepam

B) intropin

The administration of an IV solution by regulating its flow rate based upon observation or desired or undesired effects is called:

A) estimation
B) titration
C) approximation
D) calculation

B) titration

The mechanisms of actions of Isuprel include:

1 - increased heart rate
2 - increased cardiac output
3 - increased myocardial oxygen consumption
4 - production of secondary bronchodilation

A) 1, 2
B) 3, 4
C) 2, 3, 4
D) 1, 2, 3, 4

D) 1, 2, 3, 4

A 66-year-old female weighing 132 pounds requires a bolus of sodium bicarbonate. The bicarbonate should be administered in a 1-milliequivalent-per-kilogram bolus. How many milliequivalents should be administered to this patient?

A) 20
B) 40
C) 60
D) 80

C) 60

Diltiazem is utilized in which one of the following rhythms when the rate is stable and does not need electrical cardioversion?

A) wide QRS tachycardia
B) atrial fibrillation and atrial flutter
C) ventricular tachycardia with a pulse
D) sick sinus syndrome

B) atrial fibrillation and atrial flutter

Nitroglycerin is contraindicated when:

A) Viagra has been taken within 24 hours
B) systolic blood pressure is more than 90 mmHg
C) there is a chest pain associated with angina pectoris
D) there is acute pulmonary edema

A) Viagra has been taken within 24 hours

One of the side effects of digitalis is:

A) green vision
B) anxiety and restlessness
C) new-onset heart blocks
D) decreased cardiac contractions

C) new-onset heart blocks

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