Cardiology Test 2 Flashcards by Henry Kwan

There are three large boxes between R waves on an ECG tracing. What is the heart rate?

150

100

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Which of the following is the correct sequence of cardiac electrical activity?

AV node

Internodal pathways

Bundle of His

SA node

Purkinje fibers

Bundle branches

1, 2, 4, 3, 6, 5

4, 1, 2, 3, 6, 5

1, 2, 4, 3, 5, 6

4, 2, 1, 3, 6, 5

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You have begun transcutaneous pacing of a 52-year-old male who is in third-degree heart block. He was initially unresponsive to all stimuli, with a pulse of 32, blood pressure 60 by palpation, and a respiratory rate of 12. Which of the following is LEAST helpful when determining the effectiveness of transcutaneous pacing?

Evidence of mechanical capture

Increased level of consciousness

Evidence of electrical capture

Increased blood pressure

Evidence of electrical capture

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A single beat that arises from a focus outside of the SA node is called a(n):

Premature Ventricular Contraction.

compensatory pause.

Atrial Tachycardia.

ectopic beat.

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An early sign of hyperkalemia is:

Flat T waves on an ECG

Widening of the QT interval

Presence of an Osborn wave

Tall, peaked T waves on an ECG

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In a junctional rhythm, the electrical impulses originate in the:

bundle branch.

atrial node.

AV junction.

SA node.

AV junction.

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The rate for Junctional Escape Rhythm is ________ beats per minute.

30-60

40-60

60-100

100-120

40-60

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The rate for an Accelerated Junctional Rhythm is ________ beats per minute.

40-60

60-100

100-120

100-180

60-100

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In a Junctional Escape Rhythm, the QRS complex is ________ seconds.

less than .04

less than .12

greater than .12

greater than .20

greater than .12

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The type of block in which the P waves have no relationship to the QRS complexes is:

First Degree Heart Block.

Wenckebach (Second Degree Heart BlockType I).

Second Degree Heart Block (Type II).

Third Degree Heart Block.

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Which of the following is most likely to be associated with torsades de pointes?

Concomitant use of an antidysrhythmic and antihistamine

Idiopathic ventricular irritability

Block at the Bundle of Kent

Preexcitation syndrome

Concomitant use of an antidysrhythmic and antihistamine

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The term “agonal” is used to describe a:

painful arrhythmia.

rapid rhythm.

lethal arrhythmia.

chronic arrhythmia.

lethal arrhythmia.

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Which of the following is NOT a consideration when deciding to withhold resuscitative efforts?

Documentation of the patient’s wishes

Patient’s age

The nature of injury

Indications of the “down time”

Patient’s age

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The most serious characteristic of PVCs according to the Lown grading system is:

Greater than 30 per hour

Multifocal

Couplets

R on T phenomenon

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Based on the clinical information given, which of the following patients is MOST likely experiencing a myocardial infarction?

A 42-year-old male presents with a two-month history of a burning sensation extending from his epigastric region to his throat. He typically experiences the pain after eating. His skin is warm and dry.

A 19-year-old female presents complaining of shortness of breath and left-sided chest pain. She describes acute onset while at rest, and she describes the pain as sharp and nonradiating. Social history includes smoking; meds include PCPs.

A 24-year-old male with warm, diaphoretic skin complains of an acute onset of sharp, left-sided chest pain while playing soccer. He states that the pain is worse with deep inspiration.

A 68-year-old female with cool, pale, diaphoretic skin complains of substernal chest pressure radiating across her chest. She also complains of nausea, dizziness, and weakness.

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Which of the following is most likely to be related to unequal blood pressures in the upper extremities?

Thoracic aortic aneurysm

Abdominal aortic dissection

Abdominal aortic aneurysm

Transecting trauma of the thoracic aorta

Thoracic aortic aneurysm

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Multifocal PVCs have:

a variety of configurations.

constant configuration.

constant pacemakers.

a classic configuration.

a variety of configurations.

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In First Degree Heart Block, the PR interval is ________ seconds.

.12

less than .12

less than .20

greater than .20

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A Second Degree Heart Block is caused by the:

SA node failure.

resistance in ventricles.

intermittent AV conduction.

loss of fail-safe mechanism.

intermittent AV conduction.

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A First Degree Heart Block is caused by a delay at the:

SA node.

AV node.

ventricles.

Bundle of His.

AV node.

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In Sinus Arrhythmia, the R-R intervals are:

slow.

normal.

constant.

irregular.

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Common chief complaints and symptoms associated with cardiac disease include all of the following EXCEPT:

Dyspnea

Syncope

Chest pain

Vertigo

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Which of the following best describes the physiology of anastomoses?

Allow right-to-left shunt

Receive blood from the great cardiac and lateral marginal veins of the heart

Provide collateral circulation of the myocardium

Provide alternative routes of myocardial conduction

Provide collateral circulation of the myocardium

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In a junctional rhythm, the impulse that depolarizes the ventricles travels toward the ________ electrode.

negative

pacemaker

positive

wandering

positive

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In Second Degree Heart Block (Type II), you will have more ________ than QRS complexes. ectopics T waves P waves heart beats

P waves

The mitral valve is also known as the ________ valve. Pulmonic Right atrioventricular Left atrioventricular Tricuspid

Left atrioventricular

Atrial Fibrillation has: normal P waves. wide QRS complexes. normal R-R intervals. no discernible P waves.

no discernible P waves.

The term "tachycardia" means: slow heart. fast heart. normal heart. sinus rhythm.

fast heart.

Ventricular Tachycardia that has a rate below 150 is identified as: Ventricular Fibrillation. slow Ventricular Tachycardia. blocked Ventricular Tachycardia. Asystole.

slow Ventricular Tachycardia.

A decrease in preload results in a(n): Decrease in afterload Decrease in cardiac output Increase in stroke volume Decrease in peripheral vascular resistance

Decrease in cardiac output

In First Degree Heart Block, the PR interval will be: prolonged. blocked. intermittent. normal.

prolonged.

Which of the following is NOT a likely immediate cause of acute myocardial infarction? Atherosclerotic occlusion of a coronary artery Hyperlipidemia Coronary artery spasm Coronary artery occlusion by microemboli

Hyperlipidemia

An atrial arrhythmia caused when the pacemaker role switches from the SA node to the atria and back again is called: Normal Sinus Rhythm. Wandering Pacemaker. Atrial Tachycardia. sinus rhythm.

Wandering Pacemaker.

In Normal Sinus Rhythm, the PR interval must fall between ________ seconds. .04-.06 .08-.22 .12-.20 .20-.60

.12-.20

The rate for an Idioventricular Rhythm is ________ beats per minute. 20-40 40-60 60-100 100-120

20-40

The intrinsic firing rate of the AV node is ________ to ________ times per minute. 40, 60 20, 40 60, 80 80, 100

40, 60

On a properly calibrated ECG machine, 1 mV is equivalent to a height of ________ boxes. Five small Ten small One large Four large

Ten small

A Premature Junctional Contraction is a(n): Normal Sinus Rhythm. inverted rhythm. normal beat. single beat.

single beat.

Your patient has a history of progressively worsening angina that comes on at rest. This mostcommonly indicates ________ angina. Prinzmetal's Ludwig's Decubitus Unstable

Unstable

Cardioversion can be used to treat all of the following rhythms EXCEPT: Ventricular tachycardia with a pulse Rapid atrial fibrillation Ventricular fibrillation Supraventricular tachycardia

Ventricular fibrillation

Slowing of the electrical impulse at the AV node is necessary to allow time for the ________ to fill with blood. Coronary sinus Coronary arteries Ventricles Atria

Ventricles

The rate for Sinus Bradycardia is ________ beats per minute. less than 60 more than 100 between 60 and 100 equal to 110

less than 60

For Sinus Tachycardia, the QRS complex should be less than ________ seconds. .01 .12 .18 .20

.12

The rhythm that is the result of an absence of cardiac electrical activity is referred to as: Asystole. Idioventricular Rhythm. Ventricular Tachycardia. Ventricular Fibrillation.

Asystole.

The rhythm in which there is a series of atrial waves with a sawtooth appearance is called: Atrial Flutter. Atrial Tachycardia. Atrial Fibrillation. Premature Atrial Contraction.

Atrial Flutter.

Which of the following can be determined by lead II cardiac monitoring? Impulse conduction time Chamber enlargement Axis deviation Presence of a myocardial infarction, but not its location

Impulse conduction time

PVCs falling in a pattern of every other beat are referred to as: runs. bigeminy. trigeminy. quadrigeminy.

bigeminy.

In junctional rhythms, the P wave can be: upright or inverted. upright or normal. normal or inverted. hidden or inverted.

hidden or inverted.

A positive dromotropic agent will: Decrease the speed of impulse conduction through the myocardium Increase the force of myocardial contractions Increase the speed of impulse conduction through the myocardium Decrease the force of myocardial contractions

Increase the speed of impulse conduction through the myocardium

The PR interval in Ventricular Tachycardia is: less than .08 seconds. less than .12 seconds. greater than .12 seconds. not present.

not present.

Third Degree Heart Block is a(n): Complete Heart Block. First Degree Block. SA node block. bundle branch block.

Complete Heart Block.

In Atrial Fibrillation, the rhythm is: grossly irregular with no pattern. irregular in a repeating pattern. normal in appearance. reliably regular.

grossly irregular with no pattern.

An elevation of the ST segment is associated with: Hyperkalemia Left ventricular hypertrophy Slowed conduction through the AV node Myocardial injury

Myocardial injury

The pericardial sac normally holds about ________ mL of ________. 30, blood 1 to 2, serous fluid 100, blood 25, straw-colored lubricant

25, straw-colored lubricant

Unifocal PVCs have: changing pacemakers. changing conduction. constant configuration. multifocal configurations.

constant configuration.

The rhythm in which ALL atrial activity is depicted as chaotic undulations of the baseline is called: Atrial Flutter. Sinus Tachycardia. Atrial Tachycardia. Atrial Fibrillation.

Atrial Fibrillation.

Which of the following ECG findings would indicate a possible pacemaker failure? Occasional QRS complexes without pacer spikes A QRS duration of 0.20 seconds Pacemaker spikes without associated QRS complexes A pacemaker spike preceding each P wave

Pacemaker spikes without associated QRS complexes

At standard speed a 1 mm box on ECG paper represents ________ seconds. 0. 12 0. 04 0. 08 0. 10

0.04

The rate for Sinus Tachycardia is ________ beats per minute. less than 60 less than 80 60-100 greater than 100

greater than 100

Which of the following arteries supplies blood to the left ventricle, interventricular septum, and portions of the cardiac conduction system? Right coronary Left coronary Posterior descending Marginal

Left coronary

In a Third Degree Heart Block: the Bundle of His is blocked. the SA node and ventricles are blocked. some beats are conducted, while others are not. atria and ventricles are completely dissociated.

atria and ventricles are completely dissociated.

In a First Degree Heart Block, the pacemaker site is usually in the: AV node. SA node. ventricles. Bundle of His.

SA node.

Artifacts such as muscle tremors can make assessment of a paced rhythm difficult because: Artifacts can obscure the pacer spikes Artifacts can cause the pacer to fire prematurely The pacemaker may take the artifact for an electrical impulse and not fire The QRS complexes may be obscured by the pacer spikes

Artifacts can obscure the pacer spikes

A compensatory pause is a(n): AV conduction defect. delay within atria. delay that causes a PVC. delay following a PVC.

delay following a PVC.

Your patient is a 55-year-old male who is in moderate distress and complaining of chest pain. He states that he experienced an acute onset of left-sided crushing chest pain while playing basketball with his grandson. He complains of weakness and near-syncope with exertion. His skin is pale, cool, and diaphoretic. HR = 40, BP = 72/40, RR = 20, SaO2 = 95%. The monitor shows a third-degree AV block. Which of the following is most appropriate? Sedation and transcutaneous pacing Atropine, 0.5 mg, up to 2.0 mg Dopamine at 5 mcg/kg/min Aspirin, nitroglycerin, and morphine

Sedation and transcutaneous pacing

An early or premature ectopic beat could be an indication of: PRI. irritability. normal QRS complex. Normal Sinus Rhythm.

irritability.

Your patient is experiencing substernal chest pain radiating to his jaw and left shoulder, rated an 8 on a scale of 1 to 10. He describes an acute onset of pain that started while he was mowing his lawn and that is unrelieved with rest. Which of the following would be LEAST likely to be present? Bradycardia Increased pain with palpation Anxiety Denial

Increased pain with palpation

In Normal Sinus Rhythm, the heart rate is ________ beats per minute. 40-60 60-100 80-120 100-120

60-100

The heart rate for Ventricular Tachycardia is ________ beats per minute. 40-60 60-100 100-120 150-250

150-250

The thick middle tissue layer of the heart is the: Epicardium Endocardium Myocardium Pericardium

Myocardium

A Normal Sinus Rhythm has all of the following characteristics EXCEPT: P waves are uniform. heart rate is normal. the R-R intervals vary. QRS is less than .12 seconds.

the R-R intervals vary.

In a Wenckebach rhythm, not every P wave is followed by a: T wave. PR interval. QRS complex. P wave.

QRS complex.

A patient's ECG shows a rhythm at a rate of 42, regular RR intervals, a PR interval of 0.16 seconds, and a QRS of 0.12 seconds. This best fits the criteria for: Sinus bradycardia Sinus dysrhythmia Atrial flutter Atrial fibrillation

Sinus bradycardia

A 42-year-old female is alert and oriented, complaining of chest pain. Which of the following questions would be the LEAST productive with regard to performing a history? "What were you doing when the pain started?" "When did the pain start?" "Are you having trouble breathing?" "When did you last see your doctor?"

"When did you last see your doctor?"

A Premature Ventricular Contraction is a(n): single irritable beat. atrial malfunction. escape mechanism. heart block.

single irritable beat.

In a Complete Heart Block, the PR interval is: normal. longer than normal. constant. unrelated.

unrelated.

Which of the following is NOT a compensatory mechanism in cardiogenic shock? Dromotropy Increased parasympathetic tone Inotropy Chronotropy

Increased parasympathetic tone

It is very common for the P waves in Atrial Tachycardia to be: inverted. biphasic. hidden in the T wave. premature.

hidden in the T wave.

The predominant effect of a drug with primarily alpha properties would result in which of the following? Vasodilation Increased heart rate Decreased heart rate Vasoconstriction

Vasoconstriction

The QRS in Atrial Fibrillation is ________ seconds. greater than .12 less than .12 .12-.20 .20

less than .12

Which of the following does not affect cardiac output? Stroke volume Preload Venous return Blood viscosity

Blood viscosity

A 12-lead ECG that reveals slight ST segment elevation; Q waves in leads II, III, and aVF; and ST elevation in V1 and V2 most indicate which of the following? The patient is experiencing myocardial ischemia in her inferior wall that is extending into the septum. The patient is experiencing myocardial injury in her lateral wall. The patient has had a myocardial infarction in her inferior wall and is experiencing ischemia extending into the right ventricle. The patient is experiencing ischemia and injury in her left ventricle and septum.

The patient has had a myocardial infarction in her inferior wall and is experiencing ischemia extending into the right ventricle.

Junctional Tachycardia is: irregular. inverted. regular. slow.

regular.

An accelerated junctional rhythm has a rate between ________ and ________. 40, 60 20, 40 100, 150 60, 100

60, 100

In Sinus Arrhythmia, the heart rate is usually ________ beats per minute. less than 60 less than 80 60-100 greater than 100

60-100

Two PVCs attached to each other are referred to as a: PVC. couplet. bigeminy PVC. trigeminy PVC.

couplet.

In Sinus Arrhythmia, the rate changes with the patient's: respirations. SA node. AV node. pulse.

respirations.

The mechanism that enables the AV junction to depolarize the atria with a backward flow of electricity is called ________ conduction. retrograde positive normal non-

retrograde