Question 1

Which of the following can prevent a wandering baseline?
A) Avoid the use of paper clips on the tracing
B) Make sure all the leads are connected properly
C) Eliminate other sources of electricity in the room
D) Be sure the skin is prepared adequately
E) Make sure the temperature of the room is comfortable

Accepted Answer

The answer of Which of the following can prevent a...

Question 2

How do you determine the heart rate from a regular ECG tracing?
A) Count the number of ST segments in a 60-second strip
B) Multiply the number of QRS complexes in a 6-second strip by 10
C) Multiply the number of QRS complexes in a 10-second strip by 10
D) Count the P waves in a 20-second strip
E) Count the number of QRS complexes in a 30-second strip

Accepted Answer

To determine the heart rate from an ECG, you count the number of QRS complexes in a 6-second strip and multiply by 10 to get the beats per minute.

Question 3

After preparing the ECG machine, you explained the procedure to Mrs. Thomas, connected the electrodes, and began the tracing, as shown in the picture. You rechecked the electrodes and they are all placed correctly. None of the wires are loose. However, you notice that Mrs. Thomas's skin smells fragrant, as though she has used a body lotion recently. Which of the following describes the problem, its possible cause, and the correct solution?
A) Extraneous marks caused by paper clips; remove the paper clips
B) Somatic interference caused by patient shivering; offer a warm blanket
C) Wandering baseline caused by lotion on the skin; re-prep the skin with isopropyl alcohol
D) AC interference caused by nearby equipment; turn equipment off
E) Flat line caused by crossed wires; reconnect the wires correctly

Accepted Answer

Lotion on the skin can cause wandering baseline on ECG tracings. The correct solution is to re-prep the skin with isopropyl alcohol to remove any lotion or oil residue. Removing paper clips (A), offering a warm blanket (B), turning off nearby equipment (D), or reconnecting wires (E) would not address the issue of a wandering baseline caused by lotion on the skin. The fragrant lotion on Mrs. Thomas's skin can cause the electrodes to wander, leading to a wandering baseline. The correct solution is to re-prep the skin with isopropyl alcohol to remove the lotion before continuing with the ECG tracing.

Question 4

Which of the following measures the patient's response to a constant or increasing workload?
A) Holter monitor test
B) Exercise ECG
C) resting ECG
D) Ultrasound
E) Peak expiratory flow rate

Accepted Answer

The exercise ECG, also known as a stress test, measures the patient's response to a constant or increasing workload by monitoring their heart activity while engaging in physical activity, such as walking or running on a treadmill or riding a stationary bike. This test is commonly used to diagnose and monitor heart disease. An exercise ECG measures the patient's response to a constant or increasing workload. A Holter monitor test records the heart's activity over a 24-48 hour period, a resting ECG is taken while the patient is at rest, an ultrasound is used to visualize internal organs, and peak expiratory flow rate is a measure of lung function.

Question 5

AC interference can be prevented by ____.
A) keeping the patient warm to prevent shivering
B) making sure lead wires are not crossed and following the contour of the body
C) making certain that a lead has not been disconnected from the electrode
D) preparing the patient's skin adequately
E) avoiding the use of paper clips

Accepted Answer

AC interference is caused by external sources of electrical activity, often resulting from crossed lead wires or improper electrode placement. By ensuring lead wires are not crossed and following the contour of the body, the interference can be prevented. Keeping the patient warm, preventing lead disconnection, and preparing the skin adequately are important for other reasons but do not directly prevent AC interference. Avoiding the use of paper clips is irrelevant to this issue. AC interference can be caused by lead wires being crossed or not following the contour of the body, which can create an antenna effect and pick up electromagnetic interference. Therefore, ensuring lead wires are not crossed and following the contour of the body can prevent AC interference. Keeping the patient warm, checking for disconnected leads, preparing the skin, and avoiding paper clips are all important for reducing artifact but are not specifically related to preventing AC interference.

Question 6

Which of the following delays the electrical impulse to give time for the atria to complete contraction and the ventricles to fill?
A) Bundle of His
B) SA node
C) Bundle branches
D) AV node
E) Purkinje fibers

Accepted Answer

The AV node delays the electrical impulse to give time for the atria to complete contraction and the ventricles to fill. This delay ensures that blood is efficiently pumped out of the heart by allowing time for the ventricles to fill with blood before contracting. The AV node delays the electrical impulse to give time for the atria to complete contraction before sending it down to the ventricles, allowing them to fill with blood before contracting.

Question 7

Gillian is a cheerful, active teenager who is having an ECG as part of a physical required by her school to participate in cheerleading activities. You explain that she needs to remain very still while you record the ECG. You begin the tracing, as shown in the picture. Although Gillian remains still, when she sees the look on your face, she asks, "What's wrong?" What abnormality is visible in lead V₆, and what is your best choice of action? A) Somatic interference; ask Gillian again to remain still B) Wandering baseline; check for loose electrodes C) AC interference; turn off nearby electrical equipment D) Flat line; check pulse and respirations and begin CPR E) Flat line; look for loose or disconnected wires

Accepted Answer

The abnormality described as "lead V₆" is likely a typographical error or a fictional lead for the purpose of the question. However, the mention of a "flat line" in the choices indicates a complete lack of electrical activity on the ECG, which is not consistent with a patient who is conscious and talking, as Gillian is. This suggests that the issue is likely due to a technical problem such as loose or disconnected wires rather than a medical emergency requiring CPR.

Question 8

If a patient is uncomfortable lying flat on the examining table for an ECG test, he can be placed in the ____.
A) prone position
B) supine position
C) Fowler's position
D) Sims' position
E) proctologic position

Accepted Answer

Fowler's position is a semi-sitting position where the patient's head and shoulders are elevated. This can be more comfortable for patients who have difficulty lying flat and can be the ideal position for an ECG test. The prone and Sims' positions are lying on the stomach and side, respectively, and would not be suitable for an ECG test. The supine position is lying on the back, which is the standard position for an ECG, but if the patient is uncomfortable in this position, Fowler's position is a good alternative. The proctologic position is used for rectal exams and is not relevant to an ECG test. Fowler's position allows the patient to be in a semi-sitting position, which may be more comfortable than lying flat. A prone position is lying face down and not suitable for an ECG test. A supine position is lying flat on the back, which the patient is uncomfortable with. Sims' position is lying on the side with one leg bent and the other straight, which is also not suitable for an ECG test. The proctologic position is used for rectal exams and is not applicable for an ECG test.

Question 9

The urgent care center where you work is being remodeled, and the room usually used for obtaining ECGs is currently unavailable. The ECG equipment has been moved around the corner to the room next to the X-ray room. When you begin your first patient ECG of the day, the tracing looks as shown in the figure. What problem is present and how can you fix it?
A) Extraneous marks; avoid using paper clips on the graph paper
B) Somatic interference; ask the patient to be very still while you record the ECG
C) Wandering baseline; check and reconnect loose leads
D) Flat line; check for crossed wires or loose leads
E) AC interference; move the ECG equipment to a room farther from other electric equipment

Accepted Answer

AC interference is indicated by regular, small spikes in the ECG tracing, which is commonly caused by electrical interference from nearby equipment. Moving the ECG equipment away from other electrical devices, such as those in the X-ray room, can reduce this interference.

Question 10

You are attempting to record an ECG for Mr. Potter, a 72-year-old patient who has Parkinson's disease. Knowing this, you automatically place the limb electrodes close to the trunk. However, the tracing looks as shown in the picture. What artifact is present and what can you do to fix it?
A) Extraneous marks; avoid using paper clips on the graph paper
B) Somatic interference; wait until Mr. Potter's tremors subside
C) wandering baseline; check for loose electrodes
D) AC interference; turn off nearby electrical equipment
E) Flat line; check pulse and respiration, then begin CPR

Accepted Answer

Somatic interference is caused by involuntary muscle movements, such as tremors in Parkinson's disease, which can distort the ECG tracing. Waiting until the tremors subside or finding a moment of relative calm can help reduce this artifact.

Question 11

The arrhythmia in which P waves cannot be identified because of rapid multiple electrical signals that fire from areas of the atria other than the SA node is ____.
A) atrial fibrillation
B) PVCs
C) ventricular fibrillation
D) bundle branch block
E) ventricular tachycardia

Accepted Answer

Atrial fibrillation is a type of arrhythmia where multiple electrical signals fire from areas of the atria other than the SA node, leading to irregular and rapid heartbeats. This can cause the P waves to be obscured or absent on an ECG.

Question 12

The ____ send(s) out electrical impulses to initiate depolarization.
A) bundle branches
B) AV node
C) Purkinje fibers
D) SA node
E) bundle of His

Accepted Answer

The SA node, or sinoatrial node, is considered the natural pacemaker of the heart and initiates depolarization by sending out electrical impulses that propagate through the atria and ultimately cause the contraction of the heart. The other choices are also involved in the electrical conduction system of the heart, but they do not initiate depolarization like the SA node does. The SA node, also known as the sinoatrial node, is the normal pacemaker of the heart and sends out electrical impulses to initiate depolarization. The other structures listed are involved in the conduction of the electrical impulses throughout the heart, but the SA node is responsible for initiating them.

Question 13

What is the arrhythmia pictured here?
A) Atrial fibrillation
B) PVCs
C) Ventricular fibrillation
D) Bundle branch block
E) Cardiac arrest

Accepted Answer

The answer of What is the arrhythmia pictured here?
A) Atrial...

Question 14

Which of these arrhythmias is due to a heartbeat originating in the ventricles that occurs early in the cycle and is followed by a pause before the next cycle?
A) Atrial fibrillation
B) PVCs
C) Ventricular fibrillation
D) Bundle branch block
E) Ventricular tachycardia

Accepted Answer

Premature ventricular contractions (PVCs) can cause a heartbeat to originate in the ventricles early in the cycle, followed by a pause before the next cycle. Atrial fibrillation is characterized by a rapid and chaotic heartbeat originating in the atria, while ventricular fibrillation is a life-threatening arrhythmia where the ventricles quiver instead of contracting. Bundle branch block refers to a delay in electrical conduction in the specialized heart cells that coordinate heart rhythm, while ventricular tachycardia is an abnormally fast heartbeat that starts in the ventricles.

Question 15

Which of the following is a correct statement about the stylus temperature control?
A) A lower temperature produces a heavier line.
B) It has no effect on the ECG tracing.
C) A higher temperature produces a heavier line.
D) Lower temperatures cause smearing.
E) A higher temperature produces a thinner line.

Accepted Answer

A higher temperature produces a heavier line. This is because the heat causes the stylus to melt more of the recording paper, leaving a thicker line. Conversely, a lower temperature produces a thinner line. Stylus temperature control affects the pressure applied by the stylus on the ECG paper. A higher temperature produces a softer tip and a heavier line, while a lower temperature produces a harder tip and a thinner line.

Question 16

What is the arrhythmia pictured here?
A) Atrial fibrillation
B) PVCs
C) Ventricular fibrillation
D) Bundle branch block
E) Cardiac arrest

Accepted Answer

The rhythm strip shows premature ventricular contractions (PVCs), which are identifiable by the wide and bizarre QRS complexes occurring prematurely. The other options listed are not supported by the provided rhythm strip.

Question 17

How do you prevent somatic interference on an ECG tracing?
A) Make sure lead wires follow the contour of the body
B) Ground the machine
C) Prepare the skin properly
D) Remind the patient to lie still and to refrain from talking
E) Unplug other electrical devices in the room

Accepted Answer

Somatic interference on an ECG tracing is often caused by patient movement or muscle activity, so reminding the patient to lie still and refrain from talking can help prevent it.

Question 18

Electrodes for limb leads should be attached to ____.
A) a bony area on each limb
B) a highly vascular area
C) fleshy portions of the limbs
D) the wrists and ankles
E) the knees and elbows

Accepted Answer

Electrodes for limb leads in electrocardiography (ECG) are typically attached to the fleshy portions of the limbs to ensure good electrical contact and reduce interference from bone or other structures.

Question 19

The arrhythmia pictured here is ____.
A) atrial fibrillation
B) PVCs
C) ventricular fibrillation
D) bundle branch block
E) cardiac arrest

Accepted Answer

The ECG shows irregular, disorganized P waves indicative of atrial fibrillation. PVCs (B) would have a premature QRS complex, ventricular fibrillation (C) would show chaotic and irregular waves with no discernible pattern, bundle branch block (D) would show a widened QRS complex, and cardiac arrest (E) would not necessarily have any specific ECG pattern as it is a state of cessation of cardiac activity. The ECG shown in the picture depicts an irregular ventricular rhythm with no clear P waves and irregular QRS complexes. This is characteristic of atrial fibrillation. PVCs (B) are identified by abnormal QRS complexes, ventricular fibrillation (C) is characterized by disorganized and chaotic QRS complexes, bundle branch block (D) is identified by a delay in ventricular activation on the affected side, and cardiac arrest (E) would show a flat line on ECG.

Question 20

Which of these is a life-threatening arrhythmia that results in no cardiac output?
A) Atrial fibrillation
B) PVCs
C) Ventricular fibrillation
D) Bundle branch block
E) Ventricular tachycardia

Accepted Answer

Ventricular fibrillation is a life-threatening arrhythmia that results in no cardiac output, meaning the heart is unable to pump blood effectively. This can lead to cardiac arrest and ultimately death if not treated promptly. Atrial fibrillation, PVCs, bundle branch block, and ventricular tachycardia may also be serious arrhythmias, but they do not always result in no cardiac output.

Quiz 46: Electrocardiography and Pulmonary Function Testing

Which of the following can prevent a wandering baseline?

How do you determine the heart rate from a regular ECG tracing?

Which of the following measures the patient's response to a constant or increasing workload?

AC interference can be prevented by ____.

Which of the following delays the electrical impulse to give time for the atria to complete contraction and the ventricles to fill?

If a patient is uncomfortable lying flat on the examining table for an ECG test, he can be placed in the ____.

You are attempting to record an ECG for Mr. Potter, a 72-year-old patient who has Parkinson's disease. Knowing this, you automatically place the limb electrodes close to the trunk. However, the tracing looks as shown in the picture. What artifact is present and what can you do to fix it?

The arrhythmia in which P waves cannot be identified because of rapid multiple electrical signals that fire from areas of the atria other than the SA node is ____.

The ____ send(s) out electrical impulses to initiate depolarization.

What is the arrhythmia pictured here?

Which of these arrhythmias is due to a heartbeat originating in the ventricles that occurs early in the cycle and is followed by a pause before the next cycle?

Which of the following is a correct statement about the stylus temperature control?

What is the arrhythmia pictured here?

How do you prevent somatic interference on an ECG tracing?

Electrodes for limb leads should be attached to ____.

The arrhythmia pictured here is ____.

Which of these is a life-threatening arrhythmia that results in no cardiac output?