Dysrhythmia ReviewBy Don Frasco, RN

After the blood returns from the body it passes through the superior and inferior vena cava into what chamber?

A. Left atriumB. Right ventricleC. Left ventricle D. Right atrium

What valve sits between the left atrium and the left ventricle?

A. Tricuspid valveB. Valsalvic valveC. Bicuspid (Mitral) valveD. Pulmonic valve

Complete the sentence: “Pulmonary arteries carry _________ blood.”

A. Type AB. OxygenatedC. Type BD. Deoxygenated

From the right atrium, the blood flows past the tricuspid valve into the _______

A. Left atriumB. Right ventricleC. Left ventricleD. Right atrium

True or False

The Right Ventricle is the chamber that pumps blood into the lungs.

Answer: True

The amount of fluid prior to contraction, best describes

A. Cardiac OutputB. Starlings Law C. PreloadD. Stroke Volume

Heart Rate x Stroke Volume = ________A. Cardiac OutputB. Starlings LawC. PreloadD. Stroke Volume

The ________ is the chamber that pumps blood to the body.

A. Left atriumB. Right ventricleC. Left VentricleD. Right Atrium

Name all the components of the conduction pathway in order.• His-Purkinje system in Ventricles• Internodal & Interatrial Pathways• Left & Right Bundle Branches• Bundle of His• Atrioventricular (AV) Node• Sinoatrial Node (SA) Node

Name all the components of the conduction pathway in order.• Sinoatrial Node (SA) Node• Internodal & Interatrial Pathways• Atrioventricular (AV) Node• Bundle of His• Left & Right Bundle Branches• His-Purkinje system in Ventricles

The electrical current generated by ventricular depolarization is recorded as the

A. P waveB. QRS complexC. Atrial T waveD. T wave

The electrical current generated by ventricular repolarization is recorded as the

A. P waveB. T wave C. QRS complexD. Atrial T wave

Causes of artifacts on an EKG tracing include: A. Muscle tremorB. Poor electrode contact with the skinC. External chest compressionD. All of the above

The normal PR interval is between: A. 0.8 and 0.24 seconds B. 0.8 and 0.16 seconds C. 0.12 and 0.20 seconds D. 0.10 and 0.24 seconds

Myocardial Ischemia, Acute MI, and excess serum potassium can cause an abnormal __________ on the EKG

A. P waveB. QRS complex C. T wave D. U wave

Identify this Rhythm

Sinus Bradycardia with Peak P waves, ST Elevation, Tall and Peak T waves

The EKG change that may be noted after a completed acute STEMI myocardial infarction is

A. Absence of “P” wavesB. Tall, Peaked “T” waves C. Pathological Q wave D. Inverted “P” waves

In an acute MI, elevation of the ST segment represents:

A. Ischemia B. Injury C. NecrosisD. Tissue regeneration

In the presence of an Acute MI, a “Q” wave of more than 25% the amplitude of the R wave and wider than 0.04 seconds indicates:

A. Bundle branch block B. Improvement in condition C. Infarction (death of tissue) necrosisD. Injury

Identify the Abnormalities

Bundle Branch Block, ST Depression, Inverted T waves

The heart rate can be determined by A. The six second strip method B. The large box method C. The small box method D. All of the above

An arrhythmia originating in an escape pacemaker in the AV junction with a rate of 61 to 100 beats per minute is called a(n):

A. Agonal rhythm B. Junctional Escape Rhythm C. Accelerated Junctional Rhythm D. Junctional Tachycardia

Identify This Rhythm

Junctional Bradycardia

1500 ÷ 38 = 39

If the QRS complexes are < 0.12 seconds in duration, the electrical impulses responsible for the QRS complexes most likely have originated in the:

A. SA nodeB. Atrial sitesC. AV junction D. All of the above

A PR interval of less than 0.12 seconds indicates that the pacemaker site of the P wave is in the:

A. AV junctionB. Lower right atrium near the AV nodeC. Upper right atrium with an accessory AV

pathway present WPWD. All of the above

Identify This Rhythm

Sinus Arrhythmia

If there are 20 small squares between the peaks of two consecutive R waves, in a regular rhythm, the heart rate is _________ beats per minute

A. 50B. 75C. 100D. 150

Formula: 1500 ÷ 20 = 75

Identify This Rhythm

Sinus Rhythm

Two PVC’s in a row are called A. TrigeminyB. Couplet or a Pair C. Bigeminy D. Run or Burst

Identify This Rhythm

Sinus BradycardiaWith Bigeminal Unifocal PVCs

The QRS complex of a PAC usually resembles that of:

A. The underlying rhythmB. A premature ventricular complexC. A right bundle branch block D. A left bundle branch block

Identify The Ectopic

Premature Atrial Complex (PAC)

Atrial flutter is characterized by A. An atrial rate slower than the ventricular

rateB. Waves with a saw tooth or picket fence

pattern C. An atrial rate between 160 and 220 beats

per minute D. All of the above

Identify This Rhythm

Atrial Flutter with 4:1 block

P P P P

R

The reduction in cardiac output accompanying SVT can cause:

A. Syncope B. Lightheadedness C. DizzinessD. All of the above

Identify This Rhythm

Supraventricular Tachycardia (SVT)

A Non-conducted or Blocked PAC is A. Only found in bradycardic arrhythmias B. A premature P wave that is not followed

by a QRS complex C. Never symptomatic in patients D. A P wave with a dropped or blocked QRS

Identify This Rhythm

Sinus Bradycardia

Junctional type P waves are “_________” before, during or after the QRS.

A. Notched/FlatB. Biphasic/MonophasicC. Inverted/retrogradeD. Saw toothed/Picket Fence

An early beat that originates in an ectopic pacemaker, in the AV junction, occurring before the next expected beat of the underlying rhythm, is called:

A. A premature atrial contractionB. A premature junctional contraction C. A premature ventricular contraction D. None of the above

The QRS complex of a PJC:A. Resembles a premature ventricular

contraction B. Is usually wider than .12C. Resembles that of the underlying rhythm D. All of the above

Identify The Ectopic

Premature Junctional Complex (PJC)

Identical PVCs that originate from a single ectopic pacemaker site are called;

A. Multifocal B. UnifocalC. Polymorphic D. Monomorphic

An early beat consisting of an abnormally wide and bizarre QRS complex, originating in an ectopic pacemaker in the ventricles is called a

A. PAC B. PJCC. PVCD. QVC

A PVC may:A. Trigger ventricular fibrillation if it occurs

on the “T” wave B. Often be a precursor to V-Tach C. All of the aboveD. None of the above

Groups of 3 PVCs are called: A. Triplets B. Trigeminy C. Short run of VT or SalvoD. All of the above

Identify The Ectopic

Premature Ventricular Complex (PVC)

An arrhythmia characterized by multiple dissimilar, small atrial waves occurring at 400 or more beats per minute is:

A. Multifocal Atrial TachycardiaB. Atrial Flutter C. Atrial Fibrillation D. Atrial tachycardia

An arrhythmia originating in pacemakers that shift back and forth between the SA node and an ectopic pacemaker in the atria or AV junction is call a(n):

A. Multifocal Atrial Tachycardia B. Wandering Atrial Pacemaker C. Paroxysmal Supraventricular Tachycardia

(PSVT)D. All of the above

Identify This Rhythm

Wandering Atrial Pacemaker (WAP)

Absent “P” waves in a junctional arrhythmia indicate:

A. Retrograde atrial depolarization occurs at the same time as antegrade ventricular depolarization

B. Atrial depolarization has not occurred because a retrograde AV block

C. Either of the aboveD. None of the above

Identify This Rhythm

Accelerated Junctional Rhythm (AJR)

P

R

T

The number of P waves is: A. The same as that of the number of QRS

complexesB. Sometimes less than the number of the

QRS complexesC. Sometimes greater than the number of

QRS complexesD. All of the above

Identify This Rhythm

2nd degree AV Block Type II, Mobitz II with 2:1 block

P P P P P P P P

R R R

An arrhythmia in which there is a progressive delay following each P wave in the conduction of electrical impulses through the AV node until the conduction of electrical impulses is completely blocked is called a:

A. First degree AV block B. Second degree, Type I AV block (Wenckebach) C. Second degree, Type II AV block D. Third degree AV block

Identify This Rhythm

2nd degree AV block Type I,Wenckebach, Mobitz I

Second degree, type two AV Block, should be monitored and observed because

A. It can progress to a third degree, complete AV heart block

B. It can progress to ventricular tachycardia C. It is symptomatic D. None of the above

Identify This Rhythm

3rd degree AV blockComplete Heart Block

An arrhythmia originating in the ventricular pacemaker with a rate of 20-40 bpm is call a(n)

A. Ventricular escape rhythm (VER or IVR)B. Ventricular tachycardia C. Agonal ventricular rhythm D. Accelerated ventricular rhythm

Identify This Rhythm

Accelerated Ventricular Rhythm (AVR)Accelerated Idioventricular Rhythm (AIVR)

Rhythm that originates in the ventricles, which may produce a pulse.

A. AsystoleB. Agonal C. Ventricular TachycardiaD. Ventricular Fibrillation

Identify This Rhythm

Monomorphic Ventricular Tachycardia

Identify This Rhythm

Polymorphic Ventricular TachycardiaTorsades de Pointes

Identify This Rhythm

Ventricular Fibrillation

Identify This Rhythm

2nd degree AV Block Type I

Identify This Rhythm

2nd degree AV Block Type II

Identify This Rhythm

3rd degree AV Block

Identify This Rhythm

Ventricular Pacemaker

Identify This Rhythm

Atrial and Ventricular (AV) Pacemaker

Identify This Rhythm

Asystole

Which rhythm may have a pulse if palpated?

A.)

B.)

C.)

D.) None of the above

Always check lead placement

Questions?