Chapter 49
Electrocardiography and Pulmonary Function Testing
Multiple Choice Questions
1. | Which of the following is the process by which a graphic pattern is created from the electrical impulses generated in the heart as it pumps?
A. | Electroencephalography |
|
2. | Which of the following measures and evaluates a patient's lung capacity and volume?
B. | Pulmonary function test |
|
3. | Where does the transmission of electrical impulses in the heart begin?
|
4. | Which of the following is the primary pacemaker of the heart?
|
5. | Which of the following delays the electrical impulse for muscle contraction, giving the atria time to contract completely and fill the ventricles with blood?
|
6. | Which of the following is the electrical impulse that initiates a chain reaction resulting in contraction?
|
7. | Which of the following is a record of the waves of electrical impulses responsible for the cardiac cycle?
|
8. | The instrument that measures and displays the electrical impulses responsible for the cardiac cycle is a(n) ____.
|
9. | The electrical impulses responsible for the cardiac cycle that appear on an electrocardiogram as peaks and valleys are called ____.
|
10. | The different views recorded on an electrocardiogram that are produced by the electrical activity of the heart are ____.
|
11. | Which of the following is a pen-like instrument that records impulse movement on the ECG paper?
|
12. | Which of the following is an erroneous mark or defect that may appear on an ECG strip?
|
13. | Which of the following is appropriate when preparing the room and equipment for an electrocardiogram?
A. | Select a room in which all electrical equipment is turned off |
B. | Perform the procedure in an X-ray department |
C. | Place the patient on a metal table |
D. | Set the room's temperature control to a very cool setting |
E. | Check the ECG paper after preparing the patient |
|
14. | Which communication would alleviate a patient’s anxiety about having an electrocardiography?
A. | Tell the patient that the procedure will last 1 hour |
B. | Explain to the patient that a small amount of electricity passes through the body |
C. | Describe to the patient what disease or abnormality the physician is looking for |
D. | Encourage the patient to ask questions and verbalize her concerns |
E. | Tell the patient that although ECGs are unpleasant, they are necessary |
|
15. | Possible causes for a wandering baseline are ____.
A. | the use of paper clips, wet hands, or improper mounting |
B. | loose wires or a short circuit in the wires |
C. | improper grounding or cardiac arrest |
D. | poor skin preparation, dangling wire, or breathing movement |
E. | wrong selector switch setting or crossed wires |
|
16. | Which precordial electrode is located by counting to the fourth intercostal space to the right of the sternum?
|
17. | Which precordial electrode is placed in the fourth intercostal space to the left of the sternum?
|
18. | Which precordial electrode is placed in the fifth intercostal space, where it intersects an imaginary line drawn straight down the middle of the clavicle?
|
19. | Which precordial electrode is placed in the fifth intercostal space, directly below the middle of the armpit?
|
20. | If a lead does not appear on an ECG tracing, what step should be taken before repeating the tracing?
B. | Set the sensitivity selector to 2 |
D. | Increase the paper speed to 50 mm per second |
E. | Move the ECG table away from the wall |
|
21. | Which test is utilized to measure the heart’s conduction system during exercise, when the demand for oxygen is increased?
C. | Pulmonary function test |
|
22. | Which of the following is used to assess the electrical activity of a patient's heart over a 24-hour period of normal activity?
B. | Pulmonary function testing |
|
23. | Which of the following would be included in the patient’s instructions regarding a Holter monitor test?
A. | Encourage the patient to shower while the device is in place |
B. | Tell the patient that using an electrical blanket is permissible |
C. | Instruct the patient to record all activities, emotions, symptoms, and medications taken |
D. | Tell the patient to wear tight-fitting clothing to keep the monitor in place |
E. | Instruct the patient to remove any electrodes that seem loose |
|
24. | Which of the following results in a flat line on the ECG tracing?
E. | Electrical interference |
|
25. | The greatest volume of air that can be expelled when a person performs a rapid, forced expiration is the ____.
C. | peak expiratory flow rate |
|
26. | Which of the following is a measurement taken to determine the amount of air that can be quickly forced from the lungs?
A. | Maximal voluntary ventilation |
D. | Peak expiratory flow rate |
|
27. | Which of the following would you include in patient preparation for a pulmonary function test?
A. | Tell the patient that eating and smoking are permitted up until the time of the test |
B. | Instruct the patient to sit in a chair with legs crossed |
C. | Instruct the patient to slightly elevate the chin and slightly extend the neck |
D. | Tell the patient to bite down firmly on the mouthpiece |
E. | Encourage the patient to perform the test even if he has a viral infection |
|
28. | An instrument used to measure the air taken in by and expelled from the lungs is the ____.
|
29. | Pulmonary function tests are useful in monitoring which condition?
B. | Chronic obstructive pulmonary disease |
E. | Congestive heart failure |
|
30. | Electrical impulse sensors used to obtain an electrocardiogram are called ____.
|
31. | The deflections that occur on an ECG are labeled with the letters ____.
|
32. | Which of the following is a small upward curve that represents the sinoatrial node impulse, wave of depolarization through the atria, and resultant contraction?
|
33. | Which of the following represents the time it takes for the ventricles to contract and recover, or repolarize?
|
34. | Which of the following represents the time between contraction of the ventricles and recovery?
|
35. | The time it takes for electrical impulses to travel from the SA node to the AV node is the ____.
|
36. | Which of the following refers to the contraction of the ventricles following depolarization?
|
37. | The impulse that travels through both ventricles is the ____.
|
38. | When pressed, which of the following should cause the stylus to move up 10mm (10 small squares) and remain there for 0.08 second (2 small squares or 2 mm)?
B. | Standardization control |
E. | Stylus temperature control |
|
39. | Which control is used to adjust the position of the stylus on the ECG?
D. | Standardization control |
E. | Stylus temperature control |
|
40. | Which of the following is a correct statement about the stylus temperature control?
A. | A lower temperature produces a heavier line. |
B. | It has no effect on the ECG tracing. |
C. | A higher temperature produces a heavier line. |
D. | Lower temperatures cause smearing. |
E. | A higher temperature produces a thinner line. |
|
41. | Electrodes for limb leads should be attached to ____.
A. | a bony area on each limb |
B. | a highly vascular area |
C. | fleshy portions of the limbs |
|
42. | If a patient is uncomfortable lying flat on the examining table for an ECG test, he can be placed in the ____.
|
|  |
43. | After preparing the ECG machine, you explained the procedure to Mrs. Thomas, connected the electrodes, and began the tracing, as shown in the picture. You rechecked the electrodes and they are all placed correctly. None of the wires are loose. However, you notice that Mrs. Thomas's skin smells fragrant, as though she has used a body lotion recently. Which of the following describes the problem, its possible cause, and the correct solution?
A. | Extraneous marks caused by paper clips; remove the paper clips |
B. | Somatic interference caused by patient shivering; offer a warm blanket |
C. | Wandering baseline caused by lotion on the skin; re-prep the skin with isopropyl alcohol |
D. | AC interference caused by nearby equipment; turn equipment off |
E. | Flat line caused by crossed wires; reconnect the wires correctly |
|
|  |
44. | The urgent care center where you work is being remodeled, and the room usually used for obtaining ECGs is currently unavailable. The ECG equipment has been moved around the corner to the room next to the X-ray room. When you begin your first patient ECG of the day, the tracing looks as shown in the figure. What problem is present and how can you fix it?
A. | Extraneous marks; avoid using paper clips on the graph paper |
B. | Somatic interference; ask the patient to be very still while you record the ECG |
C. | Wandering baseline; check and reconnect loose leads |
D. | Flat line; check for crossed wires or loose leads |
E. | AC interference; move the ECG equipment to a room farther from other electric equipment |
|
|  |
45. | You are attempting to record an ECG for Mr. Potter, a 72-year-old patient who has Parkinson's disease. Knowing this, you automatically place the limb electrodes close to the trunk. However, the tracing looks as shown in the picture. What artifact is present and what can you do to fix it?
A. | Extraneous marks; avoid using paper clips on the graph paper |
B. | Somatic interference; wait until Mr. Potter's tremors subside |
C. | wandering baseline; check for loose electrodes |
D. | AC interference; turn off nearby electrical equipment |
E. | Flat line; check pulse and respiration, then begin CPR |
|
|  |
46. | Gillian is a cheerful, active teenager who is having an ECG as part of a physical required by her school to participate in cheerleading activities. You explain that she needs to remain very still while you record the ECG. You begin the tracing, as shown in the picture. Although Gillian remains still, when she sees the look on your face, she asks, "What's wrong?" What abnormality is visible in lead V6, and what is your best choice of action?
A. | Somatic interference; ask Gillian again to remain still |
B. | Wandering baseline; check for loose electrodes |
C. | AC interference; turn off nearby electrical equipment |
D. | Flat line; check pulse and respirations and begin CPR |
E. | Flat line; look for loose or disconnected wires |
|
47. | Which of the following can prevent a wandering baseline?
A. | Avoid the use of paper clips on the tracing |
B. | Make sure all the leads are connected properly |
C. | Eliminate other sources of electricity in the room |
D. | Be sure the skin is prepared adequately |
E. | Make sure the temperature of the room is comfortable |
|
48. | AC interference can be prevented by ____.
A. | keeping the patient warm to prevent shivering |
B. | making sure lead wires are not crossed and following the contour of the body |
C. | making certain that a lead has not been disconnected from the electrode |
D. | preparing the patient's skin adequately |
E. | avoiding the use of paper clips |
|
49. | How is somatic interference on an ECG tracing prevented?
A. | Make sure lead wires follow the contour of the body |
C. | Prepare the skin properly |
D. | Remind the patient to lie still and to refrain from talking |
E. | Unplug other electrical devices in the room |
|
50. | How is the heart rate from a regular ECG tracing determined?
A. | Count the number of ST segments in a 60-second strip |
B. | Multiply the number of QRS complexes in a 6-second strip by 10 |
C. | Multiply the number of QRS complexes in a 10-second strip by 10 |
D. | Count the P waves in a 20-second strip |
E. | Count the number of QRS complexes in a 30-second strip |
|
51. | What is the arrhythmia pictured here?
C. | Ventricular fibrillation |
|
52. | The arrhythmia pictured here is ____.
C. | ventricular fibrillation |
|
53. | What is the arrhythmia pictured here?
C. | Ventricular fibrillation |
|
54. | The ____ send(s) out electrical impulses to initiate depolarization.
|
55. | Which of the following is a life-threatening dysrhythmia that results in no cardiac output?
C. | Ventricular fibrillation |
E. | Ventricular tachycardia |
|
56. | Which of the following dysrhythmias is due to a heartbeat originating in the ventricles that occurs early in the cycle and is followed by a pause before the next cycle?
C. | Ventricular fibrillation |
E. | Ventricular tachycardia |
|
57. | The dysrhythmia in which P waves cannot be identified because of rapid multiple electrical signals that fire from areas of the atria other than the SA node is known as ____.
C. | ventricular fibrillation |
E. | ventricular tachycardia |
|
58. | Which of the following delays the electrical impulse to give time for the atria to complete contraction and the ventricles to fill?
|
59. | Which of the following measures the patient's response to a constant or increasing workload?
E. | Peak expiratory flow rate |
|
60. | How do you prepare patients for spirometry?
A. | Tell them to wear tight clothing |
B. | Have them stand for the test |
C. | Have them wear a nose clip |
D. | Have them bite down on the mouthpiece |
E. | Have them eat a light meal immediately before the test |
|
61. | Which of these is a component of an acceptable maneuver for spirometry?
|
62. | Which peak flow zone indicates that large airways are beginning to narrow?
|
63. | The peak flow zone that requires immediate medical treatment is the ____.
|
64. | If the patient has good control of her asthma, her peak flow rate is in the ____,
|
65. | When using pulse oximetry long-term, you should move the sensor to a new site every ____.
|
Fill in the Blank Questions
66. | Calibration of a spirometer requires the use of a standardized measuring instrument called a(n) calibration ________ and should provide a reading on the spirometer within 3% of the stated volume.
________________________________________ |
67. | The cardiac ________ is regulated by specialized tissues in the heart wall that transmit electrical impulses and cause the heart muscle to contract and relax.
________________________________________ |
68. | Electrical impulses of the cardiac cycle produce a series of waves with peaks and valleys on an electrocardiogram that are called ________.
________________________________________ |
69. | The electrical impulse that initiates a chain reaction resulting in contraction is ________.
________________________________________ |
70. | A(n) ________ is the tracing made by an electrocardiograph.
________________________________________ |
71. | Electrical impulse sensors placed on the body that detect and record the electrical activity of the heart are ________.
________________________________________ |
72. | An electrocardiography device that includes a small cassette or microchip recorder and records the heart rhythm over a 24-hour period is a(n) ________ monitor.
________________________________________ |
73. | The impulses received through various combinations of electrodes constitute different ________, or views of the electrical activity of the heart, that are recorded on the ECG.
________________________________________ |
74. | The condition of having two separate poles, one positive and the other negative, is called ________.
________________________________________ |
75. | A licensed practitioner will order a(n) ________ function test to evaluate a patient’s lung volume and capacity.
________________________________________ |
76. | A test used to measure breathing capacity is called ________.
________________________________________ |
77. | An instrument called a(n) ________ measures the air taken in by and expelled from the lungs.
________________________________________ |
78. | The _________ is a pen-like instrument that records the electrical impulses on the ECG paper.
________________________________________ |
79. | The artifact pictured here is ________.
________________________________________ |
80. | This artifact is caused by ________.
________________________________________ |
81. | An ECG tracing for a patient who is shivering may have ________ interference, as shown in this tracing.
________________________________________ |
82. | This arrhythmia is ________.
________________________________________ |
83. | This arrhythmia is ________ and is caused by rapid, multiple electrical signals that fire from areas in the atria other than the SA node.
________________________________________ |
84. | The ________ conduct electrical impulses down both sides of the interventricular septum.
________________________________________ |
85. | A(n) ________ is a beat that originates from the ventricles of the heart, occurs early in the cycle, and is followed by a pause before the next cycle.
________________________________________ |
86. | The process of using ultrasound to view the heart in motion is called ________.
________________________________________ |
87. | In ________ echocardiography, an ultrasound transducer is moved around the patient's chest or abdomen to produce heart images.
________________________________________ |
88. | The type of echocardiography in which the speed and direction of blood flow through the heart can be assessed is ________ echocardiography.
________________________________________ |
89. | Pulse oximetry can be used to help diagnose ________, in which breathing pauses during sleep.
________________________________________ |
90. | A pulse oximeter reading of less than 95% indicates low blood oxygen, or ________.
________________________________________ |
Multiple Choice Questions
91. | When a PVC appears on the ECG, which wave is missing?
|
Fill in the Blank Questions
92. | Irregularities in heart rhythm are called _______, also known as arrhythmias.
________________________________________ |
93. | The medical assistant performs a pulse oximetry on a patient that results in a low blood oxygen reading. The term that the medical assistant will document in the patient’s record for this low blood oxygen is ________.
________________________________________ |
94. | A somatic interference artifact is caused by ______ movement.
________________________________________ |
