1
Q
The amount of blood that is pumped out by either ventricle per minute is called: A) ejection fraction. B) cardiac output. C) stroke volume. D) minute volume.
A
b
2
Q
21. Cardiac output is influenced by: A) heart rate. B) stroke volume. C) heart rate and/or stroke volume. D) ejection fraction and heart rate.
A
c
3
Q
- In contrast to the right side of the heart, the left side of the heart:
A) drives blood out of the heart against the relatively high resistance of the systemic circulation.
B) is a high-pressure pump that sends blood through the pulmonary circulation and to the lungs.
C) is a relatively low-pressure pump that must stretch its walls in order to force blood through the aorta.
D) drives blood out of the heart against the relatively low resistance of the pulmonary circulation.
A
a
4
Q
54. The duration of the QRS complex should be \_\_\_\_ milliseconds or less. A) 100 B) 120 C) 140 D) 150
A
b
5
Q
- A demand pacemaker:
A) generates pacing impulses only when it senses that the heart’s natural pacemaker has fallen below a preset rate.
B) sends out single electrical impulses when the patient’s inherent pacemaker rate exceeds 150 beats/min.
C) is easily identified on a cardiac rhythm strip by noting the presence of pacer spikes before all of the QRS complexes.
D) attaches to the atria and the ventricles and only generates an impulse if it senses that the
patient is in ventricular fibrillation.
A
a
6
Q
- The firing of an artificial ventricular pacemaker causes:
A) a change in the shape of the preceding P waves.
B) a vertical spike followed by a wide QRS complex.
C) a small spike followed by a narrow QRS complex.
D) a wide QRS complex followed by a vertical spike.
A
b
7
Q
- Unlike an idioventricular rhythm, an agonal rhythm:
A) is associated with a faster rate.
B) does not produce a palpable pulse.
C) is associated with a lower mortality rate.
D) indicates a regular ventricular pacemaker.
A
b
8
Q
- What is the R-on-T phenomenon?
A) A premature ventricular complex (PVC) that occurs when the ventricles are not fully repolarized
B) When the R wave occurs at the J point of the next cardiac cycle
C) A unifocal PVC that occurs during the upslope of any given T wave
D) A PVC that occurs during a time when the ventricles are depolarizing
A
a
9
Q
- Ventricular bigeminy occurs when:
A) two premature ventricular complexes (PVCs) occur in a row.
B) every second complex is a PVC.
C) at least two differently shaped PVCs occur.
D) a 6-second strip contains at least two PVCs.
A
b
10
Q
205. Premature ventricular complexes (PVCs) that originate from different sites in the ventricle: A) are called unifocal PVCs. B) produce a palpable pulse. C) are also called fusion PVCs. D) will appear differently on the ECG.
A
d
11
Q
- Premature ventricular complexes:
A) are ectopic complexes that originate from a different pacemaker site.
B) are extra systolic beats that break the regularity of the underlying rhythm.
C) are in themselves considered arrhythmias, but are generally insignificant.
D) occur later than the next expected complex, causing an irregular rhythm.
A
a
12
Q
- Torsade de pointes:
A) presents with wide QRS complexes that are all of the same shape, size, and vector direction.
B) is a lethal ventricular rhythm that is usually caused by ingestion or injection of CNS depressant drugs.
C) is generally less serious than monomorphic ventricular tachycardia and is usually not treated in the field.
D) is a variant of polymorphic ventricular tachycardia and is often caused by a prolonged QT interval.
A
d
13
Q
- Monomorphic ventricular tachycardia:
A) is characterized by QRS complexes that vary in size.
B) presents with wide QRS complexes of a common shape.
C) is treated as ventricular fibrillation if a pulse is present.
D) is often irregular with occasional nonconducted P waves.
A
b
14
Q
- Which of the following statements regarding an idioventricular rhythm is correct?
A) Most patients with an idioventricular rhythm are hemodynamically unstable.
B) Treatment for an idioventricular rhythm focuses on increasing blood pressure.
C) Idioventricular rhythms are typically accompanied by nonconducted P waves.
D) The most common cause of an idioventricular rhythm is failure of the SA node.
A
a
15
Q
- Which of the following occurs at the AV node during a third-degree heart block?
A) There is an abnormal delay in conducting impulses.
B) Every third impulse is allowed to enter the ventricles.
C) Impulses bypass the AV node and enter the ventricles.
D) All impulses are blocked from entering the ventricles.
A
d
16
Q
- A key to interpreting a Mobitz type II second-degree heart block is to remember that:
A) unlike a Mobitz type I second-degree heart block, a type II heart block is always regular.
B) in this type of heart block, the PR interval gets progressively longer until a P wave is not conducted.
C) the PR interval of all of the conducted P waves and their corresponding QRS complexes is constant.
D) most type II second degree AV blocks have more than two nonconducted P waves that occur in succession.
A
c
17
Q
- If an impulse generated by the AV node begins moving upward through the atria before the other part of it enters the ventricles:
A) the PR intervals will be greater than 0.20 seconds.
B) an upright P wave will appear after the QRS complex.
C) an inverted P wave will appear before the QRS complex.
D) a small inverted P wave will be buried in the QRS complex.
A
c
18
Q
- A major complication associated with atrial fibrillation is:
A) clot formation in the fibrillating atria.
B) a significant reduction in atrial filling.
C) pulmonary congestion and hypoxemia.
D) a profound increase in the atrial kick.
A
a
19
Q
- A classic sign of atrial flutter is:
A) a constant 2:1 conduction ratio.
B) the presence of sawtooth F waves.
C) a ventricular rate less than 100 beats/min.
D) an irregular but consistent R-R interval.
A
b
20
Q
181. Patients with a heart rate greater than 150 beats/min usually become unstable because of: A) reduced ventricular filling. B) an increase in the atrial kick. C) increased right atrial preload. D) a significantly reduced afterload.
A
a
21
Q
- Supraventricular tachycardia is MOST accurately defined as:
A) any tachycardic rhythm with a heart rate greater than 130 beats/min and absent P waves.
B) a tachycardic rhythm originating from a pacemaker site above the level of the ventricles.
C) an irregular tachycardic rhythm that originates just below the AV junction.
D) a regular tachycardic rhythm between 150 and 180 beats/min with P waves buried in the QRS complexes.
A
b
22
Q
177. A wandering atrial pacemaker: A) has consistent P-wave shapes. B) is generally faster than 100 beats/min. C) may have variable PR intervals. D) is generally treated with atropine.
A
c
23
Q
174. Sinus dysrhythmia is: A) observed in all patients. B) an irregular sinus rhythm. C) a sign of myocardial ischemia. D) most common in hypotensive patients.
A
b
24
Q
166. When analyzing a cardiac rhythm strip in lead II, you should routinely evaluate all of the following components, EXCEPT the: A) QRS width. B) PR interval. C) ST segment. D) R-R interval.
A
C
25
163. The 6-second method for calculating the rate of a cardiac rhythm:
A) involves counting the number of QRS complexes in a 6-second strip and multiplying that number by 10.
B) is an accurate method for calculating the heart rate if the cardiac rhythm is grossly irregular and very fast.
C) will yield an estimated heart rate that is typically within 2 to 3 beats per minute of the actual heart rate.
D) takes longer than other methods of calculating the rate and is thus impractical to use with critical patients.
A
26
158. The downslope of the T wave:
A) is the point of ventricular repolarization to which a defibrillator is synchronized to deliver electrical energy.
B) is the strongest part of ventricular depolarization and is often the origin of dangerous ventricular arrhythmias.
C) represents a state of absolute ventricular refractoriness in which another impulse cannot cause depolarization.
D) represents a vulnerable period during which a strong impulse could cause depolarization, resulting in a lethal arrhythmia.
D
27
155. A wide QRS complex that is preceded by a normal P wave indicates:
A) that the rhythm is ventricular in origin.
B) rapid conduction through the ventricles.
C) a delay in conduction at the AV junction.
D) an abnormality in ventricular conduction.
D
28
153. A prolonged PR interval:
A) is greater than 120 milliseconds.
B) indicates that the AV node was bypassed.
C) indicates an abnormal delay at the AV node.
D) is a sign of rapid atrial depolarization.
C
29
146. An electrical wave moving in the direction of a positive electrode will:
A) cause a positive deflection on the ECG.
B) produce a significant amount of artifact.
C) cause a negative deflection on the ECG.
D) manifest with narrow QRS complexes.
A
30
143. A decreased cardiac output secondary to a heart rate greater than 150 beats/min is caused by:
A) myocardial stretching due to increased preload.
B) decreases in stroke volume and ventricular filling.
C) increased automaticity of the cardiac pacemaker.
D) ectopic pacemaker sites in the atria or ventricles.
B
31
```
13. Approximately 80% of ventricular filling occurs:
A) during systole.
B) during diastole.
C) when the semilunar valves are open.
D) when the AV valves close.
```
B
32
14. Atrial kick is defined as:
A) the blood that flows passively into the ventricles.
B) pressure on the AV valves during ventricular contraction.
C) an attempt of the atria to contract against closed valves.
D) increased preload pressure as a result of atrial contraction.
D
33
25. Administering a drug that possesses a positive chronotropic effect will have a direct effect on:
A) stroke volume.
B) blood pressure.
C) cardiac output.
D) the heart rate.
D
34
27. Automaticity is defined as the ability of the heart to:
A) generate an electrical impulse from the same site every time.
B) spontaneously conduct an electrical impulse between cardiac cells.
C) generate its own electrical impulses without stimulation from nerves.
D) increase or decrease its heart rate based on the body's metabolic needs.
C
35
30. The AV junction:
A) includes the AV node but not the bundle of His.
B) is the dominant and fastest pacemaker in the heart
C) receives its blood supply from the circumflex artery.
D) is composed of the AV node and surrounding tissue.
D
36
40. The SA node:
A) cannot depolarize faster than 100 times/min.
B) will outpace any slower conduction tissue.
C) functions as the heart's secondary pacemaker.
D) has an intrinsic firing rate of 40 to 60 times per minute.
B
37
41. The farther removed the conduction tissue is from the SA node:
A) the slower its intrinsic rate of firing.
B) the longer the PR interval will be.
C) the faster its intrinsic rate of firing.
D) the narrower the QRS complex will be.
A
38
42. If the heart's secondary pacemaker becomes ischemic and fails to initiate an electrical impulse:
A) the AV junction will begin pacing at 40 to 60 times/min.
B) you will see a brief period of bradycardia followed by asystole.
C) the P wave and PR interval will have an abnormal appearance.
D) you should expect to see a heart rate slower than 40 beats/min.
D
39
```
43. The P wave represents:
A) SA nodal discharge.
B) atrial depolarization.
C) a delay at the AV node.
D) contraction of the atria.
```
B
40
44. The brief pause between the P wave and QRS complex represents:
A) depolarization of the inferior part of the atria.
B) the period of time when the atria are repolarizing.
C) full dispersal of electricity throughout both atria.
D) a momentary conduction delay at the AV junction.
D
41
```
45. Which of the following ECG waveforms represents ventricular depolarization?
A) T wave
B) ST segment
C) QRS complex
D) U wave
```
C
42
```
46. The PR interval should be no shorter than ____ seconds and no longer than ____ seconds in duration.
A) 0.12, 0.20
B) 0.14, 0.30
C) 0.16, 0.40
D) 0.18, 2.0
```
A
43
```
47. Normally, the ST segment should be:
A) at the level of the isoelectric line.
B) elevated by no more than 1 mm.
C) depressed by no more than 2 mm.
D) invisible on a normal ECG tracing.
```
A
44
48. Stimulation of the parasympathetic nervous system:
A) completely blocks the AV node, preventing ventricular depolarization.
B) causes a decrease in the production of epinephrine and norepinephrine.
C) is characterized by a large P wave and a PR interval that is shorter than normal.
D) slows SA nodal discharge and decreases conduction through the AV node.
D
45
```
55. Stimulation of alpha and beta receptors affects the:
A) heart only.
B) heart and blood vessels.
C) blood vessels and lungs.
D) heart, lungs, and blood vessels.
```
D
46
```
56. Vasoconstriction occurs following stimulation of:
A) beta-1 receptors.
B) beta-2 receptors.
C) alpha receptors.
D) alpha and beta receptors.
```
C
47
110. When monitoring a patient's cardiac rhythm, it is MOST important to remember that:
A) a heart rate below 60 beats per minute must be treated immediately.
B) many patients with acute myocardial infarction experience asystole.
C) the ECG does not provide data regarding the patient's cardiac output.
D) the presence of a QRS complex correlates with the patient's pulse.
C
48
1. The intrinsic firing rate of the AV ____ to ____ times per minute
40 to 60
49
2. The amount of resistance that must be overcome by the left ventricle during systole is called.
Afterload
50
3. The relative refractory period of the myocardium is represented by the
down slope of the T wave
51
6. Which of the following features distinguishes a PAC from a PVC?
The PAC will have a QRS that is < or = to 0.12 seconds and will look similar to the other QRS complexes.
52
9. An accelerated junctional rhythm has a rate between __ and ___
60 – 80
53
WHAT is responsible for moving blood through the body?
MYOCARDIUM
54
21. What is appropriate to describe the atrio-ventricular valve that separates the right ventricle and the right atria?
Tricuspid valve
55
22. What other occurrences happen when the left ventricle contracts
The aortic valve opens and the tricuspid valve closes
56
24. At standard speed, a 1mm box on ECG paper represents ___ seconds.
0.04
57
27. What is the correct sequence of cardiac electrical activity?
```
SA node
Internodal pathways
AV node
Bundle of His
Bundle branches
Purkinje fibers
```
58
28. A patient’s ECG shows regular RR intervals of 0.48 seconds, a PR interval of 0.12 seconds, and a QRS of 0.08 seconds.
Sinus tachycardia
59
29. A patient’s ECG shows a rhythm at a rate of 64, regular RR intervals, a PR interval of 0.24 seconds, and a QRS of 0.12 seconds. This best fits the criteria for
first degree AV block
60
30. A patient’s ECG shows a rhythm at a rate of 40, regular RR intervals, a varying PR interval, and a QRS of 0.28 seconds
third degree AV block
61
32. Blood enters the left atrium via
Pulmonary vein
62
33. Your patient is a 54 ear male who is unresponsive, cyanotic, and has agonal respirations. The monitor shows ventricular tachycardia. Which of the following is most important when determining the immediate treatment of this patient?
Does the patient have a pulse.
63
35. The pressure in the left ventricle at the end of diastole is called
preload
64
Inherent Rate for SA Node
60-100
65
Inherent Rate for AV Node
40-60
66
Inherent Rate for Ventricles
20-40
67
P Wave represents what electrical activity?
Atrial Depolarization
68
PR Segment represents what electrical activity?
Delay at AV node
69
QRS complex represents what electrical activity?
Ventricular depolarization
70
T Wave represents what electrical activity?
Ventricular repolarization
71
Isoletric line represents what electrical activity?
No electrical activity
72
```
Rate: Less than 60
Rhythm: Regular
Pacemaker Site: SA node
P Waves: Upright and normal
PRI: Normal
QRS: Normal
```
Sinus Bradycardia
73
```
Rate: Greater than 100
Rhythm: Regular
Pacemaker Site: SA node
P Waves: Upright and normal
PRI: Normal
QRS: Normal
```
Sinus Tachycardia
74
```
Rate: 60-100
Rhythm: Irregular
Pacemaker Site: SA node
P Waves: Upright and normal
PRI: Normal
QRS: Normal
```
Sinus Dysrhythmia
75
Rate: Usually normal
Rhythm: Slightly irregular
Pacemaker Site: Varies among the SA node, atrial tissue, and AV Junction
P Waves: Variable or absent
PRI: Varies depending on source of impulse
QRS: Normal
Atrial Tachycardia
76
```
Rate: Depends on underlying rhythm
Rhythm: Usually regular
Pacemaker Site: SA node or atial
P Waves: Normal
PRI: >0.20 Seconds (Long PRI)
QRS: Usually <0.12 Seconds
```
First-Degree AV Block
77
Rate: Atrial, normal; ventricular, slow
Rhythm: Mat be regular or irregular
Pacemaker Site: SA node or atrial
P Waves: Normal, some P waves not followed by QRS
PRI Constant for conducted beats, may be >0.21 Seconds
QRS: Normal or >0.12 Seconds
Second-Degree Type II Mobitz
78
Rate: Atrial, normal; ventricular, 40-60
Rhythm: Both atrial and ventricular are regular
Pacemaker Site: SA node and AV junction or ventricle
P Waves: Normal, with no correlation to QRS
PRI: No relationship to QRS
QRS: 0.12 seconds or greater
Third-Degree AV Block
79
```
Rate: Depends on underlying rhythm
Rhythm: Depends on underlying rhythm
Pacemaker Site: Ectopic focus in the AV junction
{P Waves: Inverted, may occur after QRS}
PRI: Normal if P occurs before QRS
QRS Usually normal
```
Premature Junctional Contractions
80
```
Rate: 40-60
Rhythm: Irregular in single occurrence, regualr in escape rhythm
Pacemaker Site: AV junction
P Waves: inverted, may occur after QRS
PRI: Normal if P occurs before QRS
QRS: Usually normal
```
Junctional Escape Complexes and Rhythms
81
```
Rate: 60-100
Rhythm: Regular
Pacemaker Site: AV junction
P Waves: Inverted, may occur after QRS
PRI: Normal if P occurs before QRS
QRS: Normal
```
Accelerated Juncional Rhythm
82
```
Rate: 100-180
Rhythm: Regular
Pacemaker Site: AV junction
P Waves: Inverted, may occur after QRS
PRI: Normal if P occurs before QRS
QRS: Normal
```
Junctional Tachycardia
83
```
Rate: Underlying rhythm
Rhythm: Interrupts regular underlying rhythm
Pacemaker Site: Ventricle
P Waves: None
PRI: None
QRS: >0.12 seconds, bizarre
```
Premature Ventricular Contractions
84
```
Rate: 100-250
Rhythm: Usually regular
Pacemaker Site: Ventricle
P Waves: If present, not associate with QRS
PRI: None
QRS: >0.12 seconds, bizarre
```
Ventricular Tachycardia
85
```
Rate: No organized rhythm
Rhythm: No organzied rhythm
Pacemaker Site: Numerous venticular foci
P Waves: Usually absent
PRI: None
QRS: None
```
Ventricular Fibrillation
86
Rate: Varies with pacemaker
Rhythm: May be regular or irregular
Pacemaker Site: Depends upon electrode placement
P Waves: None produced by ventricular pacemakers; pacemaker spike
PRI: If present, varies
QRS: >0.12 seconds, bizarre
Artificial Pacemaker Rhythm
87
```
Rate: 150-250
Rhythm: Regual
Pacemaker Site: Atrial (outside SA Node)
P Waves: Often burried in preceding T wave
PRI: Usually normal
QRS: Usually normal
```
SVT
88
Look for rhythm that is may be irregular, with heart rate that is normal (60-100 bpm). Notice that the P wave is changing shape and size from beat to beat (at least three different forms). The PR interval is variable. The QRS is typically normal (0.06-0.10 sec). T wave normal
Wandering Atrial Pacemaker
89
rhythm that is irregular, varying with respiration, with heart rate that is normal (60-100 bpm) and rate may increase during inspiration. Notice that the P wave is normal. The PR interval is normal (0.12-0.20 sec). The QRS is typically normal (0.06-0.10 sec). Heart rate frequently increases with inspiration, decreasing with expiration
Sinus Arrhythmia
90
rhythm that is irregular, with heart rate that is usually normal but depends on underlying rhythm. Notice that the P wave is premature, positive and shape is abnormal. The PR interval is normal or longer. The QRS is typically 0.10 sec or less
Premature Atrial Complex
91
rhythm that is irregular, with heart rate that is slow or normal. Pacemaker spikes are not followed by P waves or QRS complexes. Wandering baseline artifact can be seen in this tracing
Pacemaker Failure to Capture
