ECG Placements Techniques And Recording Flashcards
Where should the V4 electrode be placed on the body?
Left midclavicular line, 5th intercostal space
Rationale
An ECG test is an important diagnostic tool. Proper placement of the ground and leads is necessary. The V4 electrode should be placed at the left midclavicular line, 5th intercostal space. Special care should be taken to properly align the electrode by the center of the active surface area (it should align with the correct part of the patient’s anatomy).
What is the approximate amount of time for the QRS complex to record on an ECG ?
A. 0.06 - 0.10 seconds
B. 0.04 - 0.08 seconds
C. 0.04 - 0.12 seconds
D. 0.04 - 0.06 seconds
0.06 - 0.10 seconds
Rationale
The QRS complex should be recorded for 0.06-0.10 seconds when running an ECG. The PR interval normal range is 0.12-0.2 seconds, the QRS complex range is 0.06-0.10 seconds (greater than 0.12 is considered abnormal and you would need to consider a bundle branch block), the QT interval is approximately 40% of the heart rate.
Which of the following are appropriate actions for the medical professional performing the ECG to take when placing electrodes on a patient’s skin for a 24-hour Holter monitor? (Select the three (3) correct answers.)
A. Avoid scars and incisions.
B. Place tape directly over electrodes to help secure them to the patient’s skin.
C. Tape the lead wires to the patient’s skin.
D. Abrade the skin with an alcohol pad or dry 4x4.
E. Place limb leads with tabs facing up.
A. Avoid scars and incisions., C. Tape the lead wires to the patient’s skin., D. Abrade the skin with an alcohol pad or dry 4x4.
Rationale
A Holter monitor is used to monitor a patient’s heart during normal activity (for a period of 24-48 hours or up to 30 days). It is a small monitor that can be carried in a pouch or strapped to the waist or shoulder. The electrodes should be placed so they will stay in place for the duration of the monitoring. Avoid scars and incisions when selecting where to place electrodes. Electrodes and lead wires should be secured to the patient. Abrading the skin with a dry 4x4 is one approach to preparing the skin. Lead wires can be placed facing any direction.
When performing an ECG on a patient who is obese and wandering baseline is present, which of the actions should the professional performing the ECG take? (Select the two (2) correct answers.)
A. Ensure that the examination table is not touching the wall.
B. Ensure the patient is not touching the frame or side rail.
C. Ensure that new electrodes and clean clips are used.
D. Ensure good skin preparation.
E. Ensure the patient’s arms are folded over the chest.
C. Ensure that new electrodes and clean clips are used. , D. Ensure good skin preparation
Rationale
In this scenario, it is important to make sure good skin preparation and new electrodes and clean clips are used. The other options, though they could potentially create issues on an ECG, are not specific to an obese patient or a wandering baseline. In general, the professional performing the ECG should make sure the patient isn’t touching the frame or side rail because this will cause artifact to be present (most exam tables will be metal and have no side rails). The examination table should not touch the wall in order to prevent alternate current interference.
A patient with Parkinson’s comes in for ECG with noticeably severe tremors. Which of the following should the medical assistant do to ensure a proper reading?
A. Ask the patient to remain calm.
B. Have the patient slide their hands under their buttocks.
C. Have the patient grasp the side of the table.
D. Move the patient into the semi-Fowlers position to ease breathing.
Have the patient slide their hands under their buttocks.
Rationale
A patient with Parkinson’s could cause a somatic tremor artifact. The professional performing the ECG should have the patient place their hands under their buttocks which would help hold the arms still so there would be less movement. Parkinson’s causes involuntary movements so asking the patient to remain calm would not work. If the patient were to grasp the side of the table, they may grasp too hard and cause tension.
What is the abbreviation for electroencephalogram?
A. EEG
B. EKG
C. ECG
D. ENT
A. EEG
Rationale
EEG is the abbreviation for electroencephalogram (a test that measures and records electrical activity in the brain utilizing electrodes). EKG and ECG are both abbreviations for electrocardiogram, and ENT is the abbreviation for ears, nose, and throat.
Which of the following diagnostic procedures uses ultrasound to display an image of the structure of the heart?
A. Electroencephalogram
B. Angiogram
C. Echocardiogram
D. Electrocardiogram
C. Echocardiogram
Rationale
An echocardiogram uses high pitched sound waves to create visual images as blood flows through the heart. The test is noninvasive and may also be called a sonogram. An electroencephalogram looks at activity in the brain, an angiogram is a test that takes pictures of the arteries and how blood is flowing through them, and an electrocardiogram monitors how the heart is beating.
After validating an ECG order, collecting all supplies, and ensuring the machine is in proper working order, the professional performing the ECG’S next action should be to
A. Explain the procedure.
B. Provide for privacy.
C. Apply the electrodes.
D. Identify the patient.
D. Identify the patient
Rationale
While all of these answers apply to the overall performance of an ECG, the professional performing the ECG should first establish positive patient identification by asking his/her name and DOB. Confirm the answers by looking at the identification arm band (if present) or patient chart. Then they would explain the procedure, provide privacy, and apply the electrodes before proceeding with the ECG.
Which of the following actions by the professional performing an ECG are likely to be performed prior to exercise stress testing? ( select the four (4) correct answers.)
A. Inform the patient of expectations during the testing.
B. Explain the symptoms to report if experienced during testing.
C. Obtain the patient’s medical history and current medications.
D. Observe and monitor the patient, documenting symptoms in the chart.
E. Have a crash cart with defibrillator close at hand
A. Inform the patient of expectations during the testing. , B. Explain the symptoms to report if experienced during testing. , C.obtain the patient’s medical history and current medications. , E. Have a crash cart with defibrillator close at hand.
Rationale
An exercise stress test is an important diagnostic tool, but it is not without risk. Several things need to be addressed BEFORE beginning the test. It is important to have a crash cart with defibrillator close at hand. The patient should be informed of what to expect during the testing. The professional performing the ECG should explain the symptoms the patient should report if experienced during stress test. As with most medical procedures, the tech should have documented the patient’s medical history and current medications. DURING the stress test, they will observe and monitor the patient, documenting symptoms in the chart.
The P wave of an ECG indicates
A. Atrial contraction.
B. The heart at rest.
C. Ventricular contraction.
D. Ventricular relaxation
A. Atrial contraction.
Rationale
The P wave on an ECG represents atrial contraction. The baseline is the heart at rest. The QRS complex is ventricular contraction, whereas the T wave is ventricular relaxation.
Which of the following rhythms identified on an ECG prompts the medical assistant to notify the provider immediately ?
A. Sinus bradycardia
B. Premature ventricular contraction
C. Ventricular fibrillation
D. Sinus tachycardia
C. Ventricular fibrillation
Rationale
A ventricular fibrillation is the most life threatening arrhythmia, requiring immediate shock (defibrillation) and BLS intervention to reverse. Though the other choices in this scenario can be important, the ventricular fibrillation could lead to the most dire patient outcome, hence the need for immediate notification of the physician.
Which of the following indicates a normal sinus rhythm ?
A. PR interval of 0.22 second, QRS complex of 0.10 second, QT interval of 0.40 second HR of 78
B. PR interval of 0.22 second, QRS complex of 0.10 second, QT interval of 0.42 second and HR of 72
C. PR interval of 0.14 second, QRS complex of 0.10 second, QT interval of 0.40 second and HR of 78
D. PR interval of 0.14 second, QRS complex of 0.16 second, QT interval of 0.42 second and HR of 72
C. PR interval of 0.14 second, QRS complex of 0.10 second, QT interval of 0.40 second and HR of 78
Rationale
The PR interval normal range is 0.12-0.2 seconds, the QRS complex range is 0.06-0.10 seconds (greater than 0.12 is considered abnormal and you would need to consider a bundle branch block), the QT interval is approximately 40% of the heart rate. The choice in this question that meets all of these criteria is “C” (PR interval of 0.14 second, QRS complex of 0.10 second, QT interval of 0.40 second and HR of 78).
