Inflammatory Heart conditions and ECG Basics Flashcards by Flower Garden

True or False: Cardiac tamponade is caused by increased fluid in the pericardial sac that reduces cardiac output.

True
✅ Rationale: Cardiac tamponade results from fluid accumulation in the pericardial sac, compressing the heart and reducing cardiac output.

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True or False: The left ventricle has thicker muscular walls than the right ventricle because it pumps blood to the entire body.

True
✅ Rationale: The left ventricle has a thicker wall than the right because it must pump oxygenated blood throughout the entire body, requiring more force.

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True or False: A pericardial friction rub is best heard with the patient lying flat on their back.

False
❌ Rationale: A pericardial friction rub is best heard at the lower left sternal border with the patient leaning forward, not lying flat.

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True or False: In infective endocarditis, poor oral hygiene and dental procedures are potential risk factors.

True
✅ Rationale: Poor oral hygiene and dental procedures can introduce bacteria into the bloodstream, increasing the risk of infective endocarditis.

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True or False: Sinus bradycardia always requires emergency treatment.

False
❌ Rationale: Sinus bradycardia is not always an emergency; it depends on the patient’s symptoms and hemodynamic stability.

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True or False: In atrial fibrillation, there is an increased risk of stroke due to blood pooling in the atria.

True
✅ Rationale: Atrial fibrillation increases stroke risk due to blood pooling and clot formation in the atria from loss of the atrial “kick.”

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True or False: A pacemaker with a sensing device will trigger impulses at all times, regardless of the heart’s intrinsic activity.

False
❌ Rationale: Demand pacemakers sense intrinsic activity and fire only when the heart rate falls below a set limit.

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True or False: Pericarditis pain typically worsens when sitting up and leaning forward

False
❌ Rationale: Pericarditis pain improves when sitting up and leaning forward and worsens when lying supine.

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Which of the following are complications of infective endocarditis?
Select all that apply.

A. Stroke

B. Pulmonary embolism

C. Heart failure

D. Appendicitis

E. Splenomegaly

Correct answers: A, B, C, E

A. ✅ Stroke – Emboli from vegetations can travel to the brain.

B. ✅ Pulmonary embolism – Especially from right-sided endocarditis.

C. ✅ Heart failure – Damaged valves can lead to heart failure.

D. ❌ Appendicitis – Not a related complication.

E. ✅ Splenomegaly – Caused by emboli or immune response.

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Which are clinical manifestations of myocarditis?
Select all that apply.

A. Fatigue and malaise

B. Crackles and S3 heart sound

C. Joint hypermobility

D. Syncope

E. Edema

Correct answers: A, B, D, E

A. ✅ Fatigue and malaise – Common early signs.

B. ✅ Crackles and S3 heart sound – Late cardiac symptoms indicating heart failure.

C. ❌ Joint hypermobility – Not associated with myocarditis.

D. ✅ Syncope – Can result from decreased cardiac output.

E. ✅ Edema – A sign of right-sided heart failure.

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Which interventions are appropriate after a pacemaker insertion?
Select all that apply.

A. Monitor ECG rhythm

B. Encourage immediate full range-of-motion shoulder exercises

C. Monitor insertion site for infection

D. Restrict arm movement on the affected side

E. Instruct patient on pacemaker follow-up

Correct answers: A, C, D, E

A. ✅ Monitor ECG rhythm – Essential to confirm pacemaker function.

B. ❌ Encourage full range-of-motion shoulder exercises immediately – May dislodge leads.

C. ✅ Monitor for infection – Important post-op care.

D. ✅ Restrict arm movement – Reduces risk of lead displacement.

E. ✅ Pacemaker follow-up – Ensures device is functioning properly.

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What are symptoms of pericardial tamponade?
Select all that apply.

A. Muffled heart sounds

B. Jugular vein distention

C. Increased cardiac output

D. Pulsus paradoxus

E. Dyspnea

Correct answers: A, B, D, E

A. ✅ Muffled heart sounds – Due to fluid around the heart.

B. ✅ Jugular vein distention – From impaired venous return.

C. ❌ Increased cardiac output – Cardiac output decreases in tamponade.

D. ✅ Pulsus paradoxus – A drop in SBP during inspiration.

E. ✅ Dyspnea – Due to reduced cardiac function and possible lung compression.

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Which are nursing interventions for a patient with suspected infective endocarditis?
Select all that apply.

A. Collect blood cultures before starting antibiotics

B. Encourage daily exercise

C. Administer IV antibiotics

D. Educate on signs of complications like stroke or heart failure

E. Monitor vital signs regularly

Correct answers: A, C, D, E

A. ✅ Collect blood cultures before antibiotics – Crucial for identifying the causative organism.

B. ❌ Encourage daily exercise – Rest is preferred during active infection.

C. ✅ Administer IV antibiotics – Primary treatment.

D. ✅ Educate on signs of complications – Helps prevent recurrence or worsening.

E. ✅ Monitor VS – Fever and hemodynamic changes must be tracked.

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SATA : Which dysrhythmias are typically treated with defibrillation?
Select all that apply.

A. Ventricular fibrillation

B. Atrial flutter

C. Ventricular tachycardia without a pulse

D. Sinus bradycardia

E. Asystole

Correct answers: A, C

A. ✅ Ventricular fibrillation – Requires immediate defibrillation.

B. ❌ Atrial flutter – Usually treated with medications or cardioversion.

C. ✅ Ventricular tachycardia without a pulse – Shockable rhythm.

D. ❌ Sinus bradycardia – Treated with meds or pacing.

E. ❌ Asystole – Not shockable; treated with CPR and epinephrine.

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True or False: The PR interval represents the time it takes for the electrical impulse to travel from the SA node to the Purkinje fibers.

False
The PR interval represents the time from atrial depolarization (SA node firing) to the beginning of ventricular depolarization, mainly through the atria and AV node.

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True or False: In sinus tachycardia, the QRS complex is typically wide and irregular.

❌ False
Rationale: Sinus tachycardia has narrow, regular QRS complexes, just at a faster rate (>100 bpm).

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True or False: A patient with Dressler’s syndrome may present with pericarditis weeks after a myocardial infarction.

True
Rationale: Dressler’s syndrome is a post-MI inflammatory response that can lead to pericarditis.

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True or False: Elevated ESR and CRP levels may indicate inflammation in myocarditis or pericarditis.

True
Rationale: ESR and CRP are non-specific markers of inflammation, often elevated in inflammatory heart conditions.

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True or False: Atrial fibrillation is characterized by regular, saw-toothed flutter waves.

False
Rationale: A saw-toothed pattern is seen in atrial flutter, while atrial fibrillation has no clear P waves and an irregular rhythm.

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Which findings would suggest acute pericarditis?
Select all that apply.

A. Sharp chest pain worse when lying down

B. Murmur heard best at apex

C. Pericardial friction rub

D. Pain radiating to trapezius

E. Diffuse ST elevation on ECG

Correct answers: A, C, D, E

Rationale:

A: Correct – Sharp, pleuritic chest pain that worsens when lying down is characteristic of pericarditis.

B: Incorrect – A murmur at the apex typically relates to mitral valve disorders.

C: Correct – A hallmark sign of pericarditis is the pericardial friction rub.

D: Correct – Pain that radiates to the trapezius muscle is unique to pericarditis.

E: Correct – Diffuse ST elevation is a key ECG finding in pericarditis.

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Which are signs and symptoms of heart failure secondary to myocarditis?
Select all that apply.

A. Crackles on auscultation

B. Edema

C. S3 heart sound

D. Jugular vein distension

E. Pulsus paradoxus

Correct answers: A, B, C, D

Rationale:

A: Correct – Crackles suggest fluid buildup in the lungs, a sign of left-sided heart failure.

B: Correct – Edema is a common finding in right-sided heart failure.

C: Correct – An S3 sound indicates fluid overload and poor ventricular compliance.

D: Correct – JVD is a sign of elevated right atrial pressure.

E: Incorrect – Pulsus paradoxus is more commonly associated with cardiac tamponade, not myocarditis.

Which actions are appropriate when monitoring ECG in a hospitalized patient?
Select all that apply.

A. Ensure electrodes have good skin contact

B. Assess for changes in waveforms and rate

C. Label and date all ECG strips

D. Ignore brief pauses if the patient is asymptomatic

E. Compare findings to baseline ECG

Correct answers: A, B, C, E

Rationale:

A: Correct – Good contact ensures accurate tracing.

B: Correct – Constant assessment for changes helps identify abnormalities early.

C: Correct – Proper labeling ensures reliable documentation and interpretation.

D: Incorrect – All irregularities, even brief, must be assessed.

E: Correct – Comparing to baseline helps identify new changes.

What are the characteristics of atrial fibrillation?
Select all that apply.

A. Irregularly irregular rhythm

B. Visible P waves

C. Increased stroke risk

D. Loss of atrial kick

E. Requires anticoagulation if >48h duration

Correct answers: A, C, D, E

Rationale:

A: Correct – A hallmark of Afib is its irregularly irregular rhythm.

B: Incorrect – P waves are absent in Afib due to chaotic atrial activity.

C: Correct – Blood pooling in the atria increases the risk of clot formation.

D: Correct – Without coordinated atrial contraction, cardiac output decreases.

E: Correct – Anticoagulation is recommended to reduce embolic risk if Afib persists.

Which are potential complications of pacemaker therapy?
Select all that apply.

A. Failure to capture

B. Pericardial effusion is common

C. Failure to sense

D. Infection at insertion site

E. Lead displacement

Correct answers: A, C, D, E

Rationale:

A: Correct – Failure to capture occurs when the pacemaker’s signal does not cause a contraction.

B: Incorrect – Pericardial effusion is not a common pacemaker complication.

C: Correct – Failure to sense occurs when the device fails to detect intrinsic cardiac activity.

D: Correct – Infection is a key risk after implantation.

E: Correct – Leads may become dislodged, especially if movement restrictions are not followed.

Which clinical manifestations are associated with infective endocarditis? Select all that apply. A. Heart murmur B. Janeway lesions C. Crackles in the lungs D. Splinter hemorrhages E. Roth's spots

Correct answers: A, B, D, E Rationale: A: Correct – A new or changed heart murmur is found in 80% of IE patients. B: Correct – Janeway lesions are painless vascular lesions associated with IE. C: Incorrect – Crackles may suggest HF but are not primary signs of IE. D: Correct – Splinter hemorrhages are linear lesions under fingernails seen in IE. E: Correct – Roth’s spots are retinal hemorrhages often seen in IE.

Which of the following are components of the cardiac electrical conduction system? Select all that apply. A. SA node B. AV node C. Bundle of His D. Tricuspid valve E. Purkinje fibers

Correct answers: A, B, C, E Rationale: A: Correct – The SA node is the heart’s natural pacemaker. B: Correct – The AV node delays the impulse before it moves to the ventricles. C: Correct – The bundle of His carries impulses through the septum. D: Incorrect – The tricuspid valve is a mechanical valve, not part of conduction. E: Correct – Purkinje fibers distribute the impulse through the ventricles.

What nursing actions are appropriate during the care of a patient with pericarditis? Select all that apply. A. Keep head of bed at 45 degrees B. Encourage lying flat to relieve pain C. Administer NSAIDs with food D. Monitor ECG for ST elevation E. Assess for signs of tamponade

Correct answers: A, C, D, E Rationale: A: Correct – Elevating the HOB reduces pressure and helps breathing. B: Incorrect – Pain typically worsens when lying flat. C: Correct – NSAIDs reduce inflammation; giving with food prevents GI upset. D: Correct – ST elevation may be seen in pericarditis. E: Correct – Monitor for tamponade signs like muffled heart sounds and JVD.

What are indications for synchronized cardioversion? Select all that apply. A. Unstable atrial fibrillation B. Pulseless ventricular tachycardia C. Unstable atrial flutter D. SVT with symptoms E. Ventricular fibrillation

Correct answers: A, C, D Rationale: A: Correct – Unstable Afib (with hypotension or chest pain) may require cardioversion. B: Incorrect – Pulseless VT is treated with defibrillation, not synchronized shock. C: Correct – Atrial flutter with symptoms may be treated with synchronized cardioversion. D: Correct – SVT with signs of instability also requires this. E: Incorrect – VF is treated with defibrillation.

Which are characteristics of ventricular fibrillation? Select all that apply. A. Irregular, chaotic waveform B. No measurable QRS complex C. Loss of consciousness D. Presence of P wave E. No cardiac output

Correct answers: A, B, C, E Rationale: A: Correct – VF is chaotic and irregular. B: Correct – QRS complexes are absent. C: Correct – Loss of consciousness occurs rapidly due to lack of perfusion. D: Incorrect – P waves are not visible in VF. E: Correct – VF results in no cardiac output.

True or False: Atrial flutter typically originates from multiple ectopic foci in the atria.

False Rationale: Atrial flutter usually arises from a single ectopic focus in the atria, unlike Afib.

True or False: A patient with a PICC line is more likely to receive long-term IV antibiotics for infective endocarditis.

True Rationale: Long-term therapy (4–6 weeks) for IE often requires reliable IV access, such as a PICC line.

True or False: The T wave represents ventricular depolarization.

False Rationale: The T wave reflects ventricular repolarization, not depolarization.

True or False: Sinus bradycardia always requires intervention.

False Rationale: It only requires treatment if the patient is symptomatic or hemodynamically unstable.

True or False: Myocarditis may require immunosuppressive therapy to prevent further myocardial damage.

True Rationale: If myocarditis is due to immune or inflammatory causes, immunosuppressive therapy may be used.

A 66-year-old male presents with a heart rate of 35 bpm, dizziness, and fatigue. His ECG shows sinus bradycardia. Which nursing actions are appropriate? Select all that apply. A. Monitor for hypotension and syncope B. Prepare for potential transcutaneous pacing C. Administer IV epinephrine as ordered D. Encourage physical activity to increase heart rate E. Notify the healthcare provider

Correct answers: A, B, E Rationale: A: Correct – Bradycardia can cause low cardiac output and hypotension. B: Correct – Emergency pacing may be required for unstable bradycardia. C: Incorrect – Atropine is typically used first; epinephrine is not first-line. D: Incorrect – Activity could worsen symptoms. E: Correct – Provider should be notified due to symptomatic bradycardia.

A 72-year-old patient with a history of atrial fibrillation reports sudden shortness of breath and confusion. What assessments and interventions are appropriate? Select all that apply. A. Assess for signs of stroke B. Obtain a 12-lead ECG C. Monitor oxygen saturation D. Administer anticoagulants without orders E. Prepare for possible cardioversion

Correct answers: A, B, C, E Rationale: A: Correct – Afib can cause cerebral emboli leading to stroke. B: Correct – ECG confirms rhythm and guides treatment. C: Correct – SOB may indicate hypoxia or pulmonary edema. D: Incorrect – Anticoagulants require a provider’s order. E: Correct – Cardioversion may be necessary in unstable Afib with symptoms.

A patient with a new permanent pacemaker is being discharged. What teaching points should the nurse include? Select all that apply. A. Avoid lifting the arm on the affected side for several weeks B. Report dizziness or palpitations C. Check pulse daily and report significant changes D. Avoid MRI unless cleared by provider E. Keep cell phone on the same side as the pacemaker

Correct answers: A, B, C, D Rationale: A: Correct – Prevents lead displacement. B: Correct – Could indicate pacemaker malfunction. C: Correct – Pulse checks help monitor function. D: Correct – MRI may interfere with device. E: Incorrect – Cell phones should be kept on the opposite side to avoid interference.

True or False: Ventricular tachycardia with a pulse is treated with synchronized cardioversion.

True Rationale: If the patient is unstable but has a pulse, synchronized cardioversion is used.

True or False: Coxsackievirus B is a common viral cause of myocarditis.

True Rationale: This virus is a frequent cause of myocarditis in North America

True or False: The QRS complex represents atrial repolarization.

False Rationale: The QRS complex shows ventricular depolarization; atrial repolarization is hidden.

True or False: NSAIDs should be taken on an empty stomach to maximize absorption in pericarditis treatment.

False Rationale: NSAIDs should be taken with food to reduce GI upset and ulcers.

True or False: Patients with infective endocarditis should be taught to notify their provider before future dental procedures.

True Rationale: Prophylactic antibiotics may be needed for high-risk individuals to prevent recurrence.

A nurse is interpreting an ECG strip and notices the following: P waves are present, each followed by a QRS, rate is 52 bpm, and rhythm is regular. What can be concluded? Select all that apply. A. This is sinus bradycardia B. This rhythm is life-threatening C. It may be normal in an athlete D. A pacemaker is always required E. Monitor the patient’s symptoms

Correct answers: A, C, E Rationale: A: Correct – Rate is below 60 bpm with normal conduction = sinus bradycardia B: Incorrect – Not necessarily life-threatening unless symptomatic C: Correct – Well-trained athletes may have a low resting heart rate D: Incorrect – Pacemaker is only indicated if symptoms or instability occur E: Correct – Always assess symptoms like dizziness or hypotension

The nurse sees a rhythm with no visible P waves, irregular R-R intervals, and narrow QRS complexes. What can be concluded? Select all that apply. A. Atrial fibrillation is likely B. There is regular atrial activity C. The patient may require anticoagulation D. The rhythm is usually lethal E. Risk of stroke is increased

Correct answers: A, C, E Rationale: A: Correct – Absence of P waves and irregular rhythm = Afib B: Incorrect – Atrial activity is chaotic, not regular C: Correct – Afib lasting >48 hours requires anticoagulation to prevent emboli D: Incorrect – It is not usually lethal, but does need management E: Correct – Blood pooling increases stroke risk

Which medications may be used in the treatment of symptomatic bradycardia? Select all that apply. A. Atropine B. Epinephrine C. Amiodarone D. Dopamine E. Adenosine

Correct answers: A, B, D Rationale: A: Correct – First-line medication to increase heart rate B: Correct – Used if atropine is ineffective C: Incorrect – Amiodarone is used for tachyarrhythmias, not bradycardia D: Correct – Dopamine is a second-line option for symptomatic bradycardia E: Incorrect – Adenosine is used for SVT, not bradycardia

A nurse is preparing to administer amiodarone. What are the correct indications for its use? Select all that apply. A. Ventricular fibrillation B. Asystole C. Ventricular tachycardia D. Sinus bradycardia E. Atrial fibrillation

Correct answers: A, C, E Rationale: A: Correct – Amiodarone is used after defibrillation for VF B: Incorrect – Asystole is not treated with amiodarone C: Correct – Treats both pulsed and pulseless VT D: Incorrect – Amiodarone can worsen bradycardia E: Correct – Also used for rate/rhythm control in Afib

True or False: Patients with pericarditis typically experience chest pain that improves when lying flat.

False Rationale: Chest pain worsens when lying flat and improves when sitting forward.

True or False: Endocarditis commonly affects individuals with prosthetic heart valves or a history of IV drug use

True Rationale: These are high-risk groups due to direct entry of bacteria into the bloodstream.

True or False: Myocarditis can lead to dilated cardiomyopathy if untreated.

True Rationale: Ongoing inflammation weakens the heart muscle, leading to dilated chambers and heart failure.

True or False: A pericardial friction rub is a low-pitched rumbling sound heard best at the apex.

False Rationale: It is a high-pitched, grating sound best heard at the lower left sternal border when the patient is leaning forward.

True or False: Roth’s spots, Osler’s nodes, and Janeway lesions are classic signs of pericarditis.

False Rationale: These are classic signs of infective endocarditis, not pericarditis.