ECG Interpretation Review 2014ECG Interpretation Review...

ECG Interpretation Review 2014

ECG Interpretation Review 2014ECG Interpretation Review 2014ECG Interpretation Review 2014ECG Interpretation Review 2014

Name__________________Name__________________Name__________________Name__________________ Due Date_______________Due Date_______________Due Date_______________Due Date_______________


Part A: General Knowledge

1. The cardiac action potential is a reflection of the difference in the concentration of charged particles across a cell membrane at any

given time. True False 2. Ventricular depolarization is reflected on the ECG as the T wave. True False 3. The normal duration of the QRS complex is � 0.06 second or less � 0.11 second or less � 0.04 to 0.14 second � 0.20 to 0.38 second 4. The main electrolytes that affect cardiac function are � sodium, potassium, calcium and chloride � phosphate, sodium, sulfate and potassium � chloride, sulfate, phosphate and bicarbonate � bicarbonate, calcium, magnesium and chloride 5. Which part of the conduction system receives an impulse from the SA node but delays that impulse to the bundle of His, allowing

time for the atria to empty their contents into the ventricles before the onset of ventricular contraction? � AV node � Right atrium � Left bundle branch � Right bundle branch 6. Stimulation of parasympathetic nerve fibres typically result in which of the following actions? � Constriction of coronary blood vessels. � Increased strength of cardiac muscle contraction. � Increased rate of discharge of the SA node. � Slowed conduction through the AV node.


7. Explain the difference between “electrical capture” and “mechanical capture” 8. List four primary characteristics of cardiac cells. 9. List the steps involves in ECG rhythm analysis.


10. Match the terms with their definitions by placing the letter of each correct answer in the space provided.

____ 0.04 second ____ QT ____ 0.11 second or less ____ Interval ____ Segment ____ 0.5 second ____ 3 seconds ____ Complex ____ 0.06 to 0.08 second ____ Waveform ____ 0.12 to 0.20 second ____ J point ____ Millimeters ____ ST segment elevation

a. A line between waveforms

b. Several waveforms

c. Normal duration of the PR interval

d. The area where the QRS complex and the ST segment meet

e. This ECG change provides the strongest ECG evidence for the early recognition of myocardial infarction

f. The ___________ interval represents total ventricular activity.

g. The amplitude of a waveform is measured in ________.

h. A corrected QT interval of more than _______ in either gender has been correlated with a higher risk for ventricular dysrhythmias.

i. On ECG paper, each horizontal 1 mm box represents ___________.

j. Normal duration of the QRS complex.

k. ST segment displacement is measured __________ after the J point.

l. Movement away from the baseline in either a positive or negative direction

m. A waveform and a segment.

n. On the ECG paper, 15 large boxes represents _____________.


Part B: Interpret /analyze the following rhythm strips Include rate (atrial and ventricular); rhythm (identify the underlying rhythm - regular; essentially regular; regularly irregular; irregular); analysis of PR interval; QRS duration; and interpretation (what is the underlying or basic rhythm; what dysrhythmia(s) are present?). Decide whether the rhythm is clinically significant and, if so, two nursing interventions you would recommend.

1. Atrial Rate ________ Vent. Rate ________ Reg ______ Irreg _______ PRI _______ QRS _______

Rhythm _________________________________________________________________ Clinically significant? Yes No

If yes, list at least two nursing interventions ____________________________________________________________________________________


Rhythm ________________________________________________________________ Clinically significant? Yes No

If yes, list at least two nursing interventions____________________________________________________________________________________







If yes, list at least two nursing interventions___________________________________________________________________________________




If yes, list at least two nursing interventions ____________________________________________________________________________________









Rhythm _______________________________________________________________ Clinically significant? Yes No

If yes, list at least two nursing intervention __________________________________________________________________________________


Part C: Case Studies 1. Mr. Garson is a 30 year old male. He has a history of paroxysmal atrial dysrhythmias and has been placed on propafenone for rhythm

control. He has not had an episode in about 6 months and is considered to be stable on this medication. Mr. Garson is independent, lives alone, and holds a high level position with a local software company. Recently, he came to the ED with complaints of shortness of breath, dizziness, and intermittent "palpitations". Physical Assessment: Neuro: Alert, O x 3, follows commands, moves all extremities equally. Complains of intermittent dizziness. CVS: Pulse rapid and irregular, nail beds pink, peripheral pulses present, but weak. Complains of intermittent chest pain and palpitations. Resp: Respirations rapid, lungs clear in all lobes. GI: Normal bowel sounds. Complains of nausea. GU: Normal Vitals: HR- 150 and irregular, Respiratory rate 28, BP 102/56, Temp. 37C, SpO2 96% RA History: Mr. Garson states that he is just recovering from a serious episode of the flu. He has experienced diarrhea and vomiting for several days. He began feeling better and resumed his medications and went back to work. Medications: Propafenone 300 mg bid Vitamins ASA 80mg/day Diagnostic studies: CXR: Normal Labs: Na 135, K 3.2, BUN 27, Creat. 1.4, Blood glucose 6.1 EKG rhythm strip:


1. Identify the dysrhythmia. � Atrial fibrillation � PSVT � Torsade de Pointes � 3rd Degree Heart Block 2. What could have caused the above dysrhythmia? � Food poisoning � Hypokalemia � Hypercalcemia � Stopping his propafenone 3. What is the mechanism that starts this dysrhythmia? � Prolonged PR internal � Shortened QRS � Prolonged QT � Elevated ST segment 4. Why are ventricular dysrhythmias dangerous? � The atria and ventricles are not beating in an organized manner � There is a loss of atrial kick and coordinated ventricular contractions � Treatment options are extremely limited � Because no atria impulses are conducted through to the ventricles 5. What are nursing interventions for this dysrhythmia? � ABCs, CPR if pulseless � Monitor, discontinue contributing medications � CPR, electrolyte replacement as ordered � Give beta blocker as ordered, IV fluids

2. Jessica is a 67 year old female with a history of heart failure. She is an ex-smoker and has committed to living a healthy lifestyle. She is careful with her diet and exercise and her goal is to be able to discontinue her cardiac medications. Jessica believes that if she can get back into shape, her body will no longer require medical intervention. Jessica has been noticing an increase in shortness of breath when doing simple tasks around the house and also has noticed some "heart skipping". She comes to the clinic for a check up.


Physical Assessment: Neuro: Alert, Ox 3, moves all extremities to command, and exhibits equal strength. CVS: Pulse irregular, nail beds pink, peripheral pulses strong. 2+ edema in lower extremities Resp: Exhibits shortness of breath when walking; lung auscultation reveals bilateral crackles in the bases. GI: Bowel sounds normal; abdomen is non-tender to palpation. GU: Clear yellow urine, no abnormalities. Vitals: HR 100-150, Respiratory rate 30, BP 156/88, Temp 36.5 C, Weight 75 kg (note: her weight has increased by 7 kg since her last check up 1 month ago). History: Jessica states that she discontinued her digoxin and her lasix last week because she felt like she didn’t need them any more. Medications: Digoxin 0.125 mg PO daily Lasix 40 mg PO daily KCL 20mEg PO daily Multivitamin PO daily ASA 80mg PO daily Diagnostic Studies: CXR: reveals a right lower lobe pleural effusion. Labs: Na 137, K 3.8, BUN and Creatinine normal. EKG rhythm strip:

1. Identify the dysrhythmia � Atrial flutter � Ventricular fibrillation � Sinus arrest � Atrial fibrillation


2. What might be an appropriate medical treatment for Jessica? � IV digoxin and lasix � Defibrillation � Temporary pacing � Magnesium sulfate 3. Which are appropriate nursing interventions? � Teach Jessica the importance of taking her medications as prescribed. � Describe the actions of Jessica’s medications to her. � Encourage Jessica to continue her diet and exercise routine. � All of the above. 4. The "hallmark" of the dysrhythmia is: � Regularity � Wavy baseline � Wide, bizarre QRS complexes � Irregularly irregular rhythm 5. The PR interval in the dysrhythmia is: � Prolonged � Normal � Not measurable � Shortened

3. Mr. Terry, a 62 year old male, is admitted to the ER complaining of chest pain. At this moment he is pain free. Physical Assessment: Neuro: Sleepy, but rouses easily to voice. Ox3. Exhibits equal strength in all extremities. CVS: Heart sounds normal with S1 and S2 present. Nail beds pink with good capillary refill. Resp: Lungs are clear. Resp. even and unlabored. Mr. Terry is on O2 via nasal cannula at 2L/min. GI: Bowel sounds normal, abdomen soft and non-tender. GU: Voiding clear yellow urine without problems. CVS: Heart sounds normal with S1 and S2 present. Nail beds pink with good capillary refill. Denies chest pain at this moment. Vitals: HR: 60, BP 102/55, Resp. 16, Temp. 36.2C, Height 6’0", Weight 95 kg.


History: Mr. Terry is a construction worker and states he is active and normally healthy. He has been having episodes of chest pain for the past 3 months, but thought it was just "gas" and didn’t go his physician. Mr. Terry is a past smoker and has been cigarette free for the past 12 months. He states he had "a few beers with his buddies after work". Medications: Tums 2 tabs prn prior to this admission. Diagnostic Studies: CXR normal, Coronary angiogram shows a lesion in the left coronary artery. Labs: CK, troponin levels are elevated, K+ 3.6, Na+ 145, BUN and Creatinine are normal. Cholesterol 250. EKG rhythm strip:

1. What is the above rhythm? � 1st degree AV block � 2nd degree AV block type I � 2nd degree AV block type II � 3rd degree AV block


2. Medical treatment for Mr. Terry might include; � Emergent pacemaker � Lidocaine � Nitroglycerine � None of the above 3. This rhythm is caused by which of the following? � Some impulses do not induce a ventricular response. � All atrial impulses are blocked. � The heart can't repolarize � The ventricles aren't fully contracting. 4. This rhythm is: � Always fatal � Normal � Often accompanies inferior MI � Requires a pacemaker 5. Nursing care for Mr. Terry includes: � ECG monitoring � Treating his chest pain � Relieving his anxiety � All of the above

4. Jian, 19 year male, is admitted to your unit for complaints of palpitations and dizziness. On admission he had no symptoms complaints, but right after your shift starts he calls and tells you his palpitations are starting again. He is very anxious. Physical Assessment: Neuro: Alert, Ox3, perrla, exhibits restlessness and complains of anxiety. CVS: Heart sounds rapid S1S2, good capillary refill, peripheral pulses 2+, complains of palpitations. Resp: Lungs clear to auscultation in all lobes. Respiratory rate rapid. GI: BS active x 4 quadrants, abdomen soft and non tender. GU: Voiding clear yellow urine in adequate amounts. Vital signs: Pulse 160, BP 100/64, Resp. rate 22, temp 36.0C


History: Jian is a normally healthy teenager. He is active in track sports and does not smoke or consume alcohol. He states that the palpitations and dizziness started about a month ago and he experiences episodes once or twice per week. Diagnostic studies: Na+ 140, K+ 3.4, BUN and creat normal, Cardiac markers all normal. EKG rhythm strip:

1. What rhythm is this? � Ventricular tachycardia � PSVT � Normal sinus rhythm � Atrial fibrillation 2. Which of the following medications would be appropriate for this dysrhythmia? � Atropine � Beta blocker � ACE inhibitor � Potassium 3. Signs and symptoms associated with this dysrhythmia may include � Palpitations, shortness of breath, syncope � Chest discomfort, palpitations, edema � Syncope, hypertension, fatigue � Generally asymptomatic except for palpitations


4. Nursing care for Jian would include? � Frequent CV assessment � Psychological support � Education for Jian and his family � All of the above 5. An interventional technique to eliminate this dysrhythmia is: � Ablation � Cardiac stenting � Thrombolysis � Coronary artery bypass grafts

ECG Interpretation Review 2014ECG Interpretation Review...

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