Exam (elaborations)
NUR 213 Exam Elaborations – Questions & Answers
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NUR 213 Exam Elaborations – Questions & AnswersWhat is the inherent pacemaker of the heart? Right Ans - SA node (sino-
atrial node) 60-100 per minute is normal pace
What does the P wave indicate? Right Ans - Atrial depolarization, we
cannot for sure say that the atria contracted because you can have the
electricity without the pump (is there a pulse with that rhythm?)
What does the QRS wave indicate? Right Ans - Ventricular depolarization,
at the same time the atria is re-polarizing. We cannot for sure say that the
ventricle contracted because you can have the electricity without the pump (is
there a pulse with that rhythm?)
What does the T wave indicate? Right Ans - Ventricular re-polarization
What is the appropriate time measurement for the PR interval? Right Ans -
0.12-0.2 seconds, 3-5 small boxes on graph paper
What is the appropriate time measurement for the QRS
interval? Right Ans - Less than 0.12 seconds
What is the resting state for an ECG? Right Ans - Isoelectric line
When you are feeling a pulse what are you feeling? Right Ans - The QRS,
which is the ventricle depolarizing. You cannot feel the atria depolarize
because it doesn't have a strong enough beat
How long is each small box? Right Ans - 0.04 seconds
What is the time measurement of one LARGE box on the EKG paper? Right
Ans - 0.2 seconds
How do you calculate heart rate? Right Ans - Feel patients pulse, count the
R's in a six second strip and multiply by 10
,What are the RULES for Normal Sinus Rhythm? Right Ans - Rhythm needs
to be regular (measured R to R) and is either regular or irregular, then Rate
(60-100), then P-waves (do we have one for every QRS and is their
morphology the same and are they upright), PR interval (measure from where
the P wave leaves the isoelectric line and stop measuring at the beginning of
the QRS complex) it should be 0.12-0.2 seconds, then look at QRS and it should
be less than 0.12
ECG labeled Right Ans -
Positive deflection, negative deflection and biphasic deflection Right Ans -
Measurements for ECG Right Ans - PR interval - .12 - .20 sec.
QRS complex - less than .10 seconds
P - P - Regular
R - R - Regular
Analyzing a rhythm strip step-by-step Right Ans - 1. Determine the
regularity of R waves
2. Calculate the heart rate
3. Identify and examine P waves
4. Measure the PR Interval
5. Measure the QRS complex
Precise rate calculation for HR Right Ans - Precise rate calculation
Count the number of small squares between two consecutive R waves
Divide the number of small squares into 1500 or use a conversion chart
Only accurate for regular rhythms
Identifying and examine P waves Right Ans - One P wave preceding each
QRS
All P waves identical in shape, size, and position
P to P interval should be regular
Examine the ST segment Right Ans - Normal ST segment is flat and at the
isoelectric line
Elevation or depression measuring 1mm above or below is abnormal
Elevation = acute myocardial injury
Depression = myocardial ischemia, hypokalemia, digitalis
,Assess the patient when using an ECG Right Ans - Is there a PULSE with
that Rhythm???!!!
ALWAYS take a pulse before you treat a high or low alarm
False high alarms
False low alarms
Artifact- junk
Normal Sinus Rhythm (NSR) Right Ans - Rhythm: Regular
Rate: 60 - 100
P waves: 1 P wave before each QRS, Normal in appearance
PR: .12 - .20 seconds
QRS: < .12 seconds
Sinus Tachycardia (ST) Right Ans - Rhythm: Regular
Rate: 100 - 160
P waves: 1 P wave before each QRS, Normal in appearance
PR: .12 seconds - .20 seconds
QRS: < .12 seconds
Sinus Bradycardia (SB) Right Ans - Rhythm: Regular
Rate: 40 - 60
P waves: 1 P wave before each QRS, Normal in appearance
PR: .12 seconds - .20 seconds
QRS: < .10 seconds
Sinus Arrhythmia Right Ans - Rhythm: Irregular
Rate: 60 - 100
P waves: 1 P wave for each QRS, Normal in appearance
PR: .12 seconds - .20 seconds
QRS: < .10 seconds
Seen a lot in pediatric patients (called a respiratory variance because when
they breathe in and out their HR changes, this is normal for kids)
Premature Atrial Contractions (PAC) Right Ans - Rhythm: Underlying
rhythm regular, Irregular with PAC
Rate: Rate of underlying Rhythm
, P waves: PAC P Wave is premature, Abnormal in size, shape or direction, May
be hidden
PR: .12 seconds - .20 seconds (may be prolonged
QRS: < .10 seconds
When you see a PAC it is superimposed on another rhythm, usually normal
sinus rhythm
Atrial Tachycardia (PAT) Right Ans - Rhythm: Regular
Rate:140-250
P waves: Hidden in preceding T wave
PR: Not measurable
QRS: < .10 seconds
-When these happen the body tries to fix it by making you cough or bear down
to get you to have a vagal response to slow the HR
-This is not a sustainable rhythm because the ventricle doesn't have enough
time to re-fill so they are not getting good output
-Anxiety is the brain telling us that they are not getting enough oxygenation
(sometimes)
Atrial flutter Right Ans - Rhythm: Regular or irregular
Rate: Atrial rate 250 - 400
Ventricular rate varies depending on AV node conduction
P wave: Absent, Flutter waves present
PR: Not measurable
QRS: < .10 seconds
-Typically a rhythm seen post cardiac event, like MI, surgery or heart cath
-will go away and become either AFIB or NSR usually
-AV node is the gatekeeper and stops some of these electrical charges from
going through until the ventricle is ready for another contraction because
otherwise the ventricles just cannot keep up
-No P wave because atria is not repolarizing and depolarizing its fluttering
-Extremely routine rhythm in the flutter, nothing else marches out like that
-Has a sawtooth pattern
-If the ventricular rate is over 100 then we say it is uncontrolled because the
AV node is not controlling the rate well, then we have to control it
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