EKG Summer 23

A client has just undergone an electrocardiogram (ECG), the nurse notes that the QRS complex is measured to be 0.09 seconds. What is the first action the nurse should take?

• Place on a cardiac monitor to check for arrhythmias

• Administer dopamine

• Document this finding

• Call the physician

• Administer 

  oxygen 

Answer explanation

This is a normal finding, the QRS should have a duration between 0.6-0.12 seconds. 

A nurse notices frequent artifact on the ECG monitor for a client whose leads are connected by cable to a console at the bedside.  The nurse examines the client to determine the cause.  Which of the following items is unlikely to be responsible for the artifact?

• Leads applied over hairy areas

• Leads applied to the limbs

• Frequent movement of the client

• Tightly secured cable connections

Answer explanation

Tightly secured cable connections. Motion artifact, or “noise,” can be caused by frequent client movement, electrode placement on limbs, and insufficient adhesion to the skin, such as placing electrodes over hairy areas of the skin. Electrode placement over bony prominence's also should be avoided. Signal interference can also occur with electrode removal and cable disconnection.

The nurse works in the emergency department and assesses a patient who is complaining of mid-sternal chest pain. What is the nurse’s first action?

• Notify the physician

• Examine the patient's chest and auscultate

• Assess the patient's vital signs

• Order an ekg

• Obtain a complete history

Answer explanation

The first nursing action for a patient arriving in distress to the emergency department is always to begin with priority assessments including vital signs. It provides a baseline for the healthcare team to use when further assessment and treatment is implemented. An electrocardiogram may be used later but is not a priority action, and is ordered by the primary care provider and not the nurse. A thorough medical history and physical assessment will be useful but is not the first action the nurse must take. The physician should be notified but the nurse must assess vital signs first.

You are taking care of an elderly patient who is hospitalized for sudden onset of severe, diffuse abdominal pain out of proportion to the patient's abdominal physical exam that is also accompanied by rectal bleeding and palpitations. You obtain an ECG and notice a tachycardic, irregularly irregular rhythm without any distinct P waves. Which of the following is the most likely cardiac rhythm seen on this patient's ECG?

• Atrial flutter

• Atrial fibrillation (A-fib)

• Complete heart block

• Sick sinus syndrome

• Paroxysmal Atrial Tachycardia

Answer explanation

Atrial fibrillation is a tachyarrhythmia that is characterized on ECG by absence of distinct P waves, oscillating "f" waves that cause an irregular baseline rhythm, and abnormal, inconsistent R-R intervals that produce an irregularly irregular rhythm.

When a patient is in atrial fibrillation, the patient may be asymptomatic, but at other times, the patient may complain of a rapid heartbeat, or a feeling of uneasiness. The clues in this case that the patient is in atrial fibrillation are that the ECG shows the characteristic irregularly irregular rhythm, with an absence of any distinct P waves.

A client has developed atrial fibrillation with a ventricular rate of 150 beats per minute.  The nurse assesses the client for:

• Nausea and vomiting

• Flat neck veins

• Hypertension and headache

• Hypotension and dizziness

Answer explanation

The client with uncontrolled atrial fibrillation with a ventricular rate more than 150 beats a minute is at risk for low cardiac output because of loss of atrial kick. The nurse assesses the client for palpitations, chest pain or discomfort, hypotension, pulse deficit, fatigue, weakness, dizziness, syncope, shortness of breath, and distended neck veins.