Quiz 76: Cardiac Care
Perry et al.: Clinical Nursing Skills & Techniques, 9th Edition
Instructor Verified Answers Included
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1. Proper placement of the ECG electrodes is essential for which reason?
a. To ensure real-time detection of arrhythmias
b. To prevent painful removal of the electrodes
c. To facilitate capture of all leads
d. To reduce ventricular arrhythmias
2. When applying ECG electrodes to a woman, it is important to give special consideration to which of the following objectives?
a. Place the electrode as close to the chest wall as possible, close to the breast tissue.
b. Place the electrode away from the chest wall, close to the breast tissue.
c. Place the electrode as close to the chest wall as possible, avoiding the breast tissue.
d. Place the electrode away from the chest way, avoiding the breast tissue.
3. Identify the first step toward establishing appropriate alarms and response expectations.
a. Instructing the patient and immediate family members about the necessity of the alarms
b. Obtaining a physician’s order for ECG monitoring
c. Adjusting the volume of the alarms so the primary nurse can hear them
d. Determining which patients require ECG monitoring
4. 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?
a. Patient refusal
b. The patient is receiving chemotherapy.
c. The patient is ordered to have nothing by mouth (NPO).
d. The patient has just been medicated for a pain level of 8 on a scale of 1 to 10.
5. 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?
a. 3 minutes
b. 5 minutes
c. 8 minutes
d. 10 minutes
6. 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?
a. Administrative secretary
b. Registered nurse who is covering for lunch breaks
c. Nursing assistive personnel (NAP) who has been specifically trained to obtain the measurement
d. ECG technician from the vascular lab
7. 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?
a. American Nurses Association
b. The Joint Commission
c. The National Hospital Association for Patient Safety
d. Magnet Credentialing
8. 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?
a. Cleansing and preparing the isolated electrode area with soap and water
b. Wiping the area with a rough cloth or gauze to gently scrape the area
c. Clipping the excessive hair from the electrode area
d. Using alcohol to cleanse the electrode area
9. 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?
a. V1—Fourth intercostal space at the right sternal angle
b. V2—Fourth intercostal space at the right sternal border
c. V4—Fifth intercostal space at the midclavicular line
d. V6—Left midaxillary line at the level of V4 horizontally
10. 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?
a. The 12-lead ECG must be held until the pain is relieved and continued as soon as it passes.
b. The physician will order a follow-up ECG exactly 5 minutes post the last episode of chest pain.
c. It helps to correlate the ECG changes to symptoms of chest pain.
d. The ECG tracing must be stopped immediately.
11. 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?
a. Can you tell me why you need this test?
b. Did you experience pain during the test?
c. Can you tell me when the test results will be shared with you?
d. Can you give me your name and date of birth?
12. 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?
a. Unplugs the battery-operated equipment in the room one item at a time.
b. Reapplies the electrodes to ensure proper connection with the skin.
c. Adjusts the extremity electrodes on the wrists and ankles.
d. Asks the patient to hold his breath to see if the tracing improves.
13. 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?
a. Changing the electrodes more often than 24 hours can result in skin breakdown.
b. It is not necessary to change the electrodes daily.
c. It was not documented that the electrodes were changed.
d. Changing the electrodes daily will decrease the number of false alarms.
14. 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?
a. Cleanse and prepare the chest area for electrode placement with chlorhexidine.
b. Use a blanket to cover the patient’s abdomen while the limb electrodes are being placed.
c. Scrape the area to roughen the dermis layer of skin to allow electrical signals to travel more easily.
d. Place the patient in a supine position.
15. 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?
a. White is negative.
b. Black is neutral.
c. Red is the ground lead.
d. Brown is positive.
16. 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?
a. Sinus bradycardia
b. Sinus tachycardia
c. Premature bradycardia
d. Normal sinus rhythm
17. 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?
a. The position of the green lead can be changed to mirror one of the precordial lead positions.
b. The standard placement for V1 is at the fifth intercostal space, right sternal border.
c. The standard placement for V1 is at the fourth intercostal space, left sternal border.
d. In general, mechanisms of dysrhythmias are the same in children as they are in adults.
18. Reduction of alarm fatigue is an important nursing practice. The nurse addresses this concern when which of the following actions is implemented?
a. Change the electrodes once per shift.
b. Provide initial and ongoing education about the intravenous pumps.
c. Monitor all patients diagnosed with cancer on continuous cardiac monitoring.
d. Set the parameters for the pulse oximetry machine within the standard normal range.
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?
a. Decreased cardiac output
20. 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?
b. Ventricular fibrillation
c. Ventricular tachycardia
d. Sinus bradycardia
21. When describing the rationale for connecting electrodes to each limb and around the heart, the nurse shares with the patient which appropriate explanation?
a. The leads view a specific portion of the heart’s surface to help determine which part has sustained damage.
b. Multiple leads are necessary to provide a three-dimensional view of the heart.
c. The electrodes are necessary to provide a shock to the heart if needed during cardiac conversion.
d. The limb electrodes are required to provide a backup study in the event of artifact.
22. The nurse is obtaining a 12-lead ECG on a patient with syncope. Which of the following actions, if taken by the nurse, are effective at reducing the presence of artifact in the ECG tracing?
a. Instruct the patient to stop talking.
b. Turn the ECG machine on after all the electrodes are applied.
c. Position the patient in semi-Fowler’s position.
d. Maintain the gown on the patient to provide privacy.
23. After obtaining a 12-lead ECG, the nurse records the date and time the ECG was obtained, the reason for obtaining the ECG, and who the ECG was given to for interpretation in the patient’s chart. After this documentation, what is the appropriate action of the nurse?
a. Immediately report any unexpected outcomes.
b. Reposition the patient to a position of comfort.
c. Report to the nursing assistive personnel that the 12-lead ECG is completed.
d. Invite the family caregivers to visit at the bedside.
1. The nurse is assessing if the patient needs a 12-lead ECG. Which of the following indications, if identified, indicates that a 12-lead ECG should be obtained? (Select all that apply.)
a. Suspected acute coronary syndromes including myocardial infarction
b. History of smoking 2 packs per day for 30 years
c. Evaluation of syncope
d. Disorders of the cardiac rhythm
2. The nurse is reviewing the patient’s medications and recognizes that which of the following medications can cause dysrhythmias? (Select all that apply.)
3. The nurse identifies the appropriate equipment necessary to obtain a 12-lead ECG and gathers the following supplies. (Select all that apply.)
a. 12-Lead ECG machine
b. Clean, dry towel
c. Hair clippers
d. Betadine cleanser
4. The nurse is obtaining a 12-lead ECG on a patient and notices that the ECG cannot be interpreted. Which of the following interventions are appropriate for the nurse to take? (Select all that apply.)
a. Inspect the electrodes for secure placement.
b. Reposition any wires that move as a result of patient breathing or movement.
c. Reposition electrodes that are in the correct position.
d. Remind the patient to remain still in order to obtain a good tracing.
5. The nurse is caring for a patient who has chest discomfort. While obtaining the 12-lead ECG, the patient complains of feeling very anxious. Which of the following interventions should the nurse take in caring for the patient’s anxiety? (Select all that apply.)
a. Continue to monitor the patient.
b. Reassess factors contributing to anxiety or distress.
c. Ask the family caregiver to leave the room.
d. Notify the health care provider.
6. A patient is being monitored on a continuous cardiac monitor. The nurse directs the nursing assistive personnel (NAP) to immediately report which of the following patient findings? (Select all that apply.)
a. Patient complaints of pain
b. Shortness of breath
d. Patient’s request to use the bedside commode
7. The nurse is caring for a patient on continuous cardiac monitoring who is experiencing occasional premature ventricular contractions. Which of the following actions demonstrate appropriate protocol? (Select all that apply.)
a. Review alarm trends and waveforms at least once per shift.
b. Review alarm trends and waveforms upon report of an alarm.
c. Record at least one rhythm strip per shift to the patient’s medical record.
d. Report any unexpected outcomes to the health care provider at the end of the shift.
8. The nurse recognizes the following indications as appropriate for continuous cardiac monitoring. (Select all that apply.)
a. Postresuscitation patients
b. Patients with heart failure
c. Patients over the age of 75 years
d. Diagnosis of dysrhythmias in children
1. Some patients may have allergies, or more commonly, sensitivities to the adhesive used to affix the leads. In these cases, _____________ are available from various manufacturers.
2. When preparing the skin before ECG electrode placement, clipping the hair in the electrode area is preferred over shaving due to risk of _________________.
3. ECG tracings that cannot be interpreted are known as _________________.
4. _______________ develops when a person is exposed to an excessive number of alarms.