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CCRN Practice – Cardiac Conduction and EKG Interpretation Part 2

Biology41 CardsCreated 4 months ago

This flashcard set focuses on interpreting EKG findings and understanding coronary artery involvement in cardiac conduction. It reinforces knowledge of lead placement, ST segment changes, and their correlation to affected conduction system structures.

If a murmur is audible at the same time that the carotid pulse is felt, the murmur is:

A. systolic.
B. diastolic.
C. always normal.
D. always pathologic.

A. systolic

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Key Terms

Term
Definition

If a murmur is audible at the same time that the carotid pulse is felt, the murmur is:

A. systolic.
B. diastolic.
C. always normal.
D. always pathologic.

A. systolic

Which drug has Class II and Class III properties?

A. Verapamil (Calan)
B. Propranolol (Inderal)
C. Sotalol (Betapace)
D. Tocainide (Tonocard)

C. Sotalol (Betapace)

The skin changes associated with chronic peripheral arterial disease are:

A. thickened with brownish discoloration at the ankles.
B. pale and shiny.
C. ulcerations at the sides of the ankles.
D. rubor when in dependent position.

B. pale and shiny.

If the air fluid meniscus of the zero reference port of the transducer of a pressure monitoring system is 2 inches below the phlebostatic axis, what effect would it have on pressure measurements?

A. The pressures recorded would be falsely high by about 2 mm Hg.
B. The pressures recorded would be falsely low by about 2 mm Hg.
C. The pressures recorded would be falsely high by about 4 mm Hg.
D. The pressures recorded would be falsely low by about 4 mm Hg.

C. The pressures recorded would be falsely high by about 4 mm Hg.

A patient is admitted to the coronary care unit in third-degree AV heart block with syncopal episodes. Which of the following defines syncope?

A. Dizziness
B. Ataxia
C. Vertigo
D. Transient loss of consciousness

D. Transient loss of consciousness

Clinical indications of a right tension pneumothorax include which of the following?

A. Tracheal shift toward the right with diminished or absent breath sounds on the left
B. Tracheal shift toward the left with diminished or absent breath sounds on the right
C. Tracheal shift toward the left with diminished or absent breath sounds on the left
D. Tracheal shift toward the right with diminished or absent breath sounds on the right

B. Tracheal shift toward the left with diminished or absent breath sounds on the right

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TermDefinition

If a murmur is audible at the same time that the carotid pulse is felt, the murmur is:

A. systolic.
B. diastolic.
C. always normal.
D. always pathologic.

A. systolic

Which drug has Class II and Class III properties?

A. Verapamil (Calan)
B. Propranolol (Inderal)
C. Sotalol (Betapace)
D. Tocainide (Tonocard)

C. Sotalol (Betapace)

The skin changes associated with chronic peripheral arterial disease are:

A. thickened with brownish discoloration at the ankles.
B. pale and shiny.
C. ulcerations at the sides of the ankles.
D. rubor when in dependent position.

B. pale and shiny.

If the air fluid meniscus of the zero reference port of the transducer of a pressure monitoring system is 2 inches below the phlebostatic axis, what effect would it have on pressure measurements?

A. The pressures recorded would be falsely high by about 2 mm Hg.
B. The pressures recorded would be falsely low by about 2 mm Hg.
C. The pressures recorded would be falsely high by about 4 mm Hg.
D. The pressures recorded would be falsely low by about 4 mm Hg.

C. The pressures recorded would be falsely high by about 4 mm Hg.

A patient is admitted to the coronary care unit in third-degree AV heart block with syncopal episodes. Which of the following defines syncope?

A. Dizziness
B. Ataxia
C. Vertigo
D. Transient loss of consciousness

D. Transient loss of consciousness

Clinical indications of a right tension pneumothorax include which of the following?

A. Tracheal shift toward the right with diminished or absent breath sounds on the left
B. Tracheal shift toward the left with diminished or absent breath sounds on the right
C. Tracheal shift toward the left with diminished or absent breath sounds on the left
D. Tracheal shift toward the right with diminished or absent breath sounds on the right

B. Tracheal shift toward the left with diminished or absent breath sounds on the right

A 70-year-old woman, weighing 50 kg, comes to the ED complaining of chest pain and shortness of breath. EKG shows ventricular tachycardia HR 150. Which treatment is appropriate in this situation?

A. Amiodarone (Cordarone) IV
B. Verapamil HCl (Calan) IV
C. Defibrillation beginning at 200 J
D. Synchronized cardioversion beginning at 100 J

D.
Synchronized cardioversion beginning at 100 J

A patient is admitted to the coronary care unit with third-degree AV heart block, and a transvenous temporary ventricular pacemaker is inserted. Four hours later the patient complains of dizziness while lying in bed. The monitor shows third-degree AV heart block with a ventricular rate of 52 beats/min and no pacing spikes. This indicates failure to pace, and the patient is taken to surgery for insertion of a DVI permanent pacemaker. Which of the following describes the function of a DVI pacemaker?

A. Senses atrium and ventricle; paces ventricle; inhibited by QRS complex
B. Senses atrium and ventricle; paces ventricle; triggered by QRS complex
C. Paces atrium and ventricle; senses ventricle; inhibited by the QRS complex
D. Paces and senses atrium and ventricle; inhibited by the P wave

C. Paces atrium and ventricle; senses ventricle; inhibited by the QRS complex

Shortly after returning from PCI, a patient begins to complain of chest pain similar in intensity and character to the pre-PCI pain. The pain is unresponsive to nitroglycerin infusion titration. The patient should be prepared for:

A. return to cardiac catheterization for an additional procedure.
B. emergency coronary artery bypass grafting.
C. intraaortic balloon pump therapy.
D. a catheterization of the right side of the heart.

A. return to cardiac catheterization for an additional procedure.

Which of the following would not be associated with a false-positive result for an acute MI using the total creatine kinase (CK)?

A. Hypothyroidism
B. Hemorrhagic stroke
C. Cardioversion
D. Ulcerative colitis

D. Ulcerative colitis

While auscultating the patient's heart, an S3 is noted. What does this heart sound indicate?

A. Atrial contraction and propulsion of blood into a noncompliant ventricle
B. Inflammation of the pericardium
C. Opening of a defective semilunar valve
D. Rapid ventricular filling into an already distended ventricle

D. Rapid ventricular filling into an already distended ventricle

Which of the following is the best hemodynamic parameter for assessing LV function?

A. Pulmonary artery occlusive pressure (PAOP)
B. Pulmonary artery diastolic pressure (PAd)
C. Cardiac index (CI)
D. Pulmonary artery systolic pressure (PAs

A. PAOP

Which of the following are therapeutic goals for drug therapy for dilated cardiomyopathy?

A. Decreasing contractility, decreasing afterload and preload
B. Decreasing contractility, increasing afterload and preload
C. Increasing contractility, decreasing afterload and preload
D. Increasing contractility, increasing afterload and preload

C. Increasing contractility, decreasing afterload and preload

A 65-year-old black man comes to the ER with complaints of headache. His admission BP 220/150. A nitroprusside (Nipride) drip is initiated. Which of the following would not be an important aspect of care for a patient receiving nitroprusside?

A. Closely assessing the patient for clinical indications of hypoxia
B. Monitoring the patient's blood pressure every 1-2 minutes until it stabilizes and dosage is established
C. Checking the patient's serum glucose every 6 hours
D. Monitoring the patient for signs of thiocyanate poisoning

C. Checking the patient's serum glucose every 6 hours

A patient has just arrived in the ED with severe dyspnea. His history includes an inferior MI approximately 1 week ago. Physical assessment reveals a loud, blowing holosystolic murmur that is loudest at the apex and radiates to the axilla. Crackles are audible throughout the lung fields, and pulse oximetry reveals hypoxemia. What is the most likely cause of the patient's deterioration?

A. Ruptured ventricular septum
B. Acute left ventricular failure
C. Reinfarction
D. Ruptured papillary muscle

D. Ruptured papillary muscle

A patient has developed a 2:1 AV block. Which of the following two factors would be helpful in deciding that it is most likely type II second-degree AV block?

A. The QRS complex is 0.1 second wide, and the patient has had an anterior myocardial infarction (MI).
B. The QRS complex is 0.14 second wide, and the patient has had an anterior MI.
C. The QRS complex is 0.1 second wide, and the patient has had an inferior MI.
D. The QRS complex is 0.14 second wide, and the patient has had an inferior MI.

B. The QRS complex is 0.14 second wide, and the patient has had an anterior MI.

Occlusion of the RCA would cause ST elevation in which leads?

A. I, aVL
B. II, III, aVF
C. V1, V2
D. V5, V6

B. II, III, aVF

Which of the following correlates with brain natriuretic peptide (BNP) levels?

A. Venous oxygen saturation
B. Pulmonary artery pressure
C. Pulmonary artery occlusive pressure (PAOP)
D. Systemic vascular resistance

C. Pulmonary artery occlusive pressure (PAOP)

A patient is receiving low-molecular-weight dextran after an aortofemoral bypass graft. What is the purpose of this therapy for this patient?

A. Increase circulating volume
B. Increase blood thrombogenicity
C. Decrease platelet aggregation
D. Decrease inflammation

C. Decrease platelet aggregation

Which of the following findings would occur in dilated cardiomyopathy?

A. Murmur of mitral regurgitation
B. Hypertension
C. Elevated sedimentation rate
D. Syncope

A. Murmur of mitral regurgitation

Which of the following would be contraindicated in a patient with Wolff-Parkinson-White (WPW) syndrome?

A. Amiodarone (Cordarone)
B. Lidocaine (Xylocaine)
C. Adenosine (Adenocard)
D. Verapamil (Calan)

D. Verapamil (Calan)

A 67-year-old woman with unstable angina is admitted to the cardiac unit. She has a history of DM and reports having had chest pain intermittently for 4 days. The EKG shows nonspecific ST changes. Which of the following studies is most diagnostic in identifying a MI in this patient?

A. Elevated creatine kinase-myocardial bound (CK-MB)
B. Elevated creatine kinase-muscle type (CK-MM)
C. Elevated troponin I
D. Lactate dehydrogenase 1 (LDH-1) greater than LDH-2

C. Elevated troponin I

A patient is in cardiogenic shock and requires careful volume titration to enhance contractility. Which of the following ranges describes the most likely optimal PAOP in this patient?

A. 0-5 mm Hg
B. 10-15 mm Hg
C. 15-20 mm Hg
D. 20-25 mm Hg

C. 15-20 mm Hg

Which of the following drugs prescribed for a patient with stable angina does not decrease myocardial oxygen consumption?

A. Beta-blocker
B. Calcium channel blocker
C. Nitrate
D. Aspirin

D. Aspirin

Which of the following is the most common complication of infective endocarditis?

A. Heart failure
B. Emboli
C. Myocarditis
D. Pericarditis

B. Emboli

Which of the following is likely to correlate most directly with the need for electrical cardioversion for a tachydysrhythmia?

A. Degree of instability
B. Presence of heart failure
C. Heart rate
D. Origin of the rhythm

A. Degree of instability

What is the most frequently identified primary mechanism of cardiac arrest?

A. Asystole
B. Ventricular tachycardia
C. Third-degree atrioventricular block
D. Ventricular fibrillation

D. Ventricular fibrillation

Which are the two most common dysrhythmias associated with Wolff-Parkinson-White syndrome?

A. Atrial fibrillation and supraventricular tachycardia
B. Atrial fibrillation and ventricular tachycardia
C. Supraventricular and ventricular tachycardia
D. Atrioventricular nodal blocks and ventricular fibrillation

A. Atrial fibrillation and supraventricular tachycardia

patient in ED with complaints of severe headache. She states that she has been out of her BP pills for 3 weeks and cannot afford to buy more. BP ranges from 250/128 to 200/110. Nitroprusside (Nipride) is being titrated, and the patient is on O2 by NC. In considering the risk for cardiac failure and pulmonary edema, consideration should be made to the physiologic principle that the majority of myocardial oxygen consumption occurs during which phase of the cardiac cycle?

A. Ventricular ejection
B. Isovolumetric contraction
C. Ventricular filling
D. Isovolumetric relaxation

B. Isovolumetric contraction

A postoperative cardiac surgery patient's blood pressure suddenly drops to 70 mm Hg palpable, with a loss of the a wave in the PAOP waveform. What change in his cardiac rhythm would cause this change in his PAOP waveform?

A. Sinus tachycardia
B. Sinus dysrhythmia
C. Atrial tachycardia
D. Atrial fibrillation

D. afib

A 40-year-old patient has been admitted to the critical care unit after sustaining multiple injuries from a cave-in accident this morning. X-ray confirm multiple fractures, including the left femur. During the afternoon he was taken to surgery for internal fixation of the left femur. It is now 10 pm, and the patient is complaining of severe throbbing pain in his thigh. The patient received 5 mg of morphine sulfate IV 30 minutes ago. The anterior left thigh is firm to touch, and the pain increases when the patient flexes his left leg. The nurse should suspect which of the following?

A. Normal pain related to fractured femur
B. Abnormal pain related to compartment syndrome
C. Abnormal pain related to infection
D. Abnormal pain related to lumbosacral plexus injury

B. Abnormal pain related to compartment syndrome

Which of the following medications is associated with thiocyanate toxicity?

A. Nicardipine (Cardene)
B. Captopril (Capoten)
C. Metoprolol (Lopressor)
D. Nitroprusside (Nipride)

D. Nitroprusside (Nipride)

patient is in cardiac and respiratory arrest. The selection of medications to reestablish cardiac function would stimulate the sympathetic nervous system beta1 receptors. This stimulation would result in increased automaticity and which of the following?

A. Increased myocardial contractility
B. Decreased left ventricular stroke work
C. Decreased myocardial oxygen consumption
D. Increased left ventricular afterload

A. Increased myocardial contractility

A 55-year-old man had a heart transplant 10 hours ago. Present assessment includes cold, clammy skin, jugular venous distention, bilateral crackles, and tachycardia. Vital signs are temperature 98.6° F, BP 80/60, HR 120 and RR 24 . Mediastinal tube drainage is approximately 50 mL/hr. He is diagnosed with decreased cardiac contractility. Which of the following would be an appropriate treatment for this patient?

A. Beta-adrenergic stimulant (e.g., dobutamine)
B. Diuretic (e.g., furosemide)
C. Normal saline bolus
D. Antibiotics

A. Beta-adrenergic stimulant (e.g., dobutamine)

Which vessel is used as a graft when the minimally invasive direct coronary artery bypass grafting (MIDCABG) procedure is performed?

A. Internal thoracic artery
B. Radial artery
C. Gastroepiploic artery
D. Saphenous vein

A. Internal thoracic artery

Which of the following may be useful in systolic dysfunction but may be detrimental in diastolic dysfunction?

A. Beta-blockers
B. Angiotensin-converting enzyme inhibitors
C. Aldosterone antagonists
D. Vasodilators

D. Vasodilators

A 90-year-old patient is admitted with acute respiratory distress. Vital signs are blood pressure 92/66 mm Hg, heart rate 132 beats/min and regular rhythm, and respiratory rate 36 breaths/min and labored. Auscultation of breath sounds reveals crackles to the scapular level bilaterally. Which of the following is the most likely pathophysiologic problem in this patient?

A. Acute myocardial infarction
B. Mild heart failure
C. Massive pulmonary embolus
D. Acute pulmonary edema

D. Acute pulmonary edema

Which of the following are two significant adverse effects of angiotensin-converting enzyme (ACE) inhibitors (e.g., captopril [Capoten])?

A. Heart failure and hypokalemia
B. Proteinuria and hyperkalemia
C. Thrombocytopenia and hepatotoxicity
D. Dysrhythmias and hyponatremia

B. Proteinuria and hyperkalemia

A patient has just returned to the critical care unit from the operating room. He has a VDD pacemaker. Which of the following is an accurate description of this type of pacemaker?

A. atrium and ventricle are paced and sensed, atrial pacing can be inhibited by an intrinsic atrial impulse, and ventricular pacing can be triggered by an intrinsic atrial impulse or inhibited by an intrinsic ventricular impulse.

B. ventricle is paced in response to a sensed intrinsic atrial impulse.

C. atrium and ventricle are paced, but only ventricular pacing can be inhibited by a sensed intrinsic ventricular impulse.

D. ventricle is paced in response to a sensed intrinsic atrial impulse or inhibited by a sensed intrinsic ventricular impulse.

D. The ventricle is paced in response to a sensed intrinsic atrial impulse or inhibited by a sensed intrinsic ventricular impulse

While placing a patient on the monitor during admission, a wide-notched P wave is noted in lead II. What does this most likely indicate?

A. Chronic obstructive pulmonary disease (COPD)
B. Myocardial infarction
C. Pulmonary embolism
D. Mitral valve disease

D. Mitral valve disease

When pulmonary arterial diastolic pressure (PAd) is more than 5 mm Hg higher than pulmonary artery occlusive pressure (PAOP), it signals which abnormal condition?

A.Right ventricular failure
B.Left ventricular failure
C.Pulmonary hypertension
D.Systemic hypertension

C. Pulmonary HTN
*When the PAd is more than 5 mm Hg higher than the PAOP, it is an indication of pulmonary hypertension. Possible causes of pulmonary hypertension are passive (e.g., mitral valve disease) or active (e.g., causes of hypoxemic pulmonary vasoconstriction such as acute respiratory distress syndrome, chronic obstructive pulmonary disease, or pulmonary embolism). Pulmonary embolism causes pulmonary hypertension by mechanical obstruction and by hypoxemic pulmonary vasoconstriction.