Question 1

In order to determine the patient and family caregiver's level of understanding of the rationale for obtaining the 12-lead ECG,the nurse most effectively utilizes which of the following statements?

Accepted Answer

Use teach-back statement: I want to be sure that I explained why you need this ECG.Can you tell me about why you need the test? This determines the patient and family caregiver's level of understanding of the topic.Pain is assessed during the test and helps to correlate changes in the ECG tracing.The timing of the results does not assess rationale for the test.Patient identifiers are required to ensure patient safety.

Question 2

The nurse determines the needs to obtainment of a 12-lead ECG on a patient.The nurse assesses two identifiers to ensure patient safety.This practice is in compliance with which safety organization?

Accepted Answer

Identifying a patient using two identifiers such as name and date of birth and medical record ensures patient safety and complies with The Joint Commission standards.

Question 3

The nurse is obtaining a 12-lead ECG on a patient with chest discomfort and interprets the results as a very thick-lined waveform tracing.The nurse troubleshoots this tracing by performing which appropriate intervention?

Accepted Answer

Artifact that looks like a very thick-lined waveform is 60-cycle interference.The nurse should unplug battery-operated equipment in the room one item at a time to see if the interference disappears.60-cycle interference is rare.The tracing needs to be repeated.The electrode placement and the patient's breathing pattern do not cause 60-cycle interference.

Question 4

The nurse is observing a nursing assistive personnel (NAP)perform a 12-lead ECG tracing on a newly admitted patient.The nurse recognizes that the NAP requires additional training on this skill when she observes which of the following erroneous lead placements?

Accepted Answer

The V2 electrode is placed at the fourth intercostal space at the left sternal border.

Question 5

The nurse is supervising a nursing assistive personnel (NAP)while applying electrodes for continuous cardiac monitoring to an elderly patient.The nurse recognizes the need for further education when the NAP attaches which monitor lead to the electrode?

Accepted Answer

Colors of the leads represent their polarity.The black lead is positive.

Question 6

The nurse changes the ECG electrodes on a patient who is on a continuous cardiac monitor.The patient tells the nurse that the electrodes were just changed the previous day.Which of the following rationales is the correct explanation for the nurse to share with the patient?

Accepted Answer

The nurse recognizes that the ECG electrodes should be changed daily or more often if electrode contact to the skin is loose.Changing the ECG electrodes will decrease the number of false alarms.If there is poor skin contact,it may be necessary to change the electrodes more frequently;this will not cause skin breakdown.

Question 7

Reduction of alarm fatigue is an important nursing practice.The nurse addresses this concern when which of the following actions is implemented?

Accepted Answer

Electrodes should be changed daily.Monitor only those patients with clinical indications for monitoring.Patient with cancer is not an indication for continuous cardiac monitoring.Provide initial and ongoing education about devices with alarms (intravenous pumps).Customize delay and threshold settings on oxygen saturation via pulse oximetry monitors.

Question 8

The nurse has explained to the patient that a 12-lead ECG is indicated.The patient refused to have the procedure done citing that she fears that the electrodes will cause harm to her heart.The nurse recognizes that which of the following patient rationales are contraindications for a 12-lead ECG?

Accepted Answer

No absolute contraindications to performing an electrocardiogram exist other than patient refusal.

Question 9

The nurse is caring for a patient on continuous cardiac monitoring.The nurse assesses the rhythm as regular with a normal PQRST complex and a rate of 62 beats per minute.Which analysis is the correct interpretation of this cardiac rhythm?

Accepted Answer

Characteristics of normal sinus rhythm include regular rhythm,rate 60 to 99 beats per minute,and a normal PQRST complex.Sinus bradycardia is a heart rate less than 60 beats per minute.Sinus tachycardia is a heart rate 100 to 180 beats per minute.There is no rhythm known as premature bradycardia.

Question 10

The nurse is preparing to apply electrodes for continuous cardiac monitoring to a newly admitted adult with syncope.Which action by the nurse follows appropriate procedure?

Accepted Answer

The chest area is prepared for electrode placement with soap and water.There are no limb electrodes for continuous cardiac monitoring.Ensure the patient's abdomen and thighs are covered.Roughening the skin helps to remove the epidermis outer layer to allow electrical signals to travel.Do not roughen the dermis layer of skin.Electrodes should be applied when the patient is in the supine position.

Question 11

Identify the first step toward establishing appropriate alarms and response expectations.

Accepted Answer

The American College of Cardiology and American Heart has determined that the first step toward establishing appropriate alarms and response expectations is appropriate patient selection.Ensuring appropriate patient selection supersedes a physician's order and adjustment of alarm volume.Instruction of the patient and family members is addressed after the patient is identified for ECG monitoring.

Question 12

The student nurse is preparing to perform a 12-lead ECG on an adult patient.Which action by the student should the nursing instructor question?

Accepted Answer

Cleanse and prepare the isolated electrode area with soap and water.Wipe the area with a rough washcloth or gauze or use the edge of the electrode to gently scrape the area.Clip excessive hair from the electrode area.Never use alcohol to cleanse the area as it will dry out the skin.

Question 13

The nurse is caring for a 6-year-old child after open-heart surgery.When assessing the patient,the nurse notes that the position of the leads may be different in the pediatric population.Which lead placement explains this special consideration?

Accepted Answer

The position of the brown lead can be changed to mirror one of the precordial (chest)lead positions,V1 to V6.The standard placement is for V1 at the fourth intercostal space,right sternal border.In general,the mechanisms of dysrhythmias are the same in children as they are in adults;however,the appearance of the arrhythmias on the ECG may differ because of developmental issues such as heart size,baseline heart rate,sinus and AV node function,and autonomic innervation.

Question 14

The nurse is reviewing the patient's Do Not Resuscitate orders when the cardiac alarm sounds.The rhythm is chaotic with no identifiable waves and the rate cannot be determined.Based on these clinical findings,the nurse determines that the patient is in which of the following cardiac rhythms?

Accepted Answer

Ventricular fibrillation is a chaotic rhythm with no identifiable waves and therefore a rate cannot be identified.Asystole is a flat line with no waves.Ventricular tachycardia is a rate of 100 to 200 beats per minute.Sinus bradycardia is a rate of less than 60 beats per minute.

Question 15

While the nurse is performing a 12-lead ECG tracing,the patient complains of crushing chest pain.The nurse recognizes that the timing of the chest pain is important to note for which of the following reasons?

Accepted Answer

The nurse should note and document if the patient experiences any chest discomfort during the procedure as this helps to correlate ECG changes to symptoms of chest pain.

Question 16

The nurse is assessing several patients who have returned from surgery when a 12-lead ECG is ordered for a newly admitted patient.Prioritizing patient needs,the nurse determines that obtaining the 12-lead ECG can be most appropriately delegated to which member of the health care team?

Accepted Answer

The skill of obtaining a 12-lead ECG can be delegated to nursing assistive personnel (NAP)who are specifically trained in obtaining the measurement.The RN who is covering breaks and the ECG technician are not appropriate choices as this is a skill that a NAP can perform.The administrative secretary is typically not trained to perform this skill.

Question 17

When applying ECG electrodes to a woman,it is important to give special consideration to which of the following objectives?

Accepted Answer

When applying ECG electrodes to a woman,take special consideration to place the electrode as close to the chest wall as possible,avoiding the breast tissue.

Question 18

Proper placement of the ECG electrodes is essential for which reason?

Accepted Answer

Proper placement of the ECG electrodes is essential to ensure real-time detection of arrhythmias.Proper placement is not related to a less painful removal procedure.One primary lead is chosen to view the electrical activity of the heart and this determines where the electrodes are placed.Ventricular arrhythmias are not reduced by ECG electrode placement.

Question 19

The nurse analyzes the patient's cardiac rhythm as follows: regular rhythm,rate 108 beats per minute,normal PQRS complex.The nurse interprets that the clinical significance of this cardiac rhythm is most likely related to which indication?

Accepted Answer

The rhythm is identified as sinus tachycardia: regular rhythm,rate 100 to 180 beats per minute,normal PQRS complex.This rhythm is common as a normal response to exercise,pain,fever,hyperthyroidism,and certain drugs.Decreased cardiac output,dizziness,and syncope are indicators of sinus bradycardia.

Question 20

The nurse understands that it is a priority to obtain the 12-lead ECG on the patient newly admitted with chest pain because the ECG must be obtained within how many minutes of the onset of pain?

Accepted Answer

Patients suffering from chest pain need to have their 12-lead ECG within 10 minutes of the assessment and onset of pain.

Quiz 26: Cardiac Care