LIPPINCOT EXERCISE 4

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Electrocardiogram (ECG), right chest lead: Results How should you position the patient for an ECG?
  Sims'
  Supine
  Side-lying
  Prone
Rationale: You should have the patient lie supine in the center of the bed with his arms at his sides. You may raise the head of the bed to promote comfort.


To which standard paper speed should you set the ECG machine?
  10 mm/sec
  25 mm/sec
  30 mm/sec
  15 mm/sec
Rationale: Check to see that the paper speed selector is set to the standard 25 mm/second and that the machine is set to full voltage.


Where should you place lead V1R?
  On the right side of the sternum in the fourth intercostal space
  On the sternum in the fourth intercostal space
  On the left side of the sternum in the fourth intercostal space
  At the midclavicular line
Rationale: You should start at the second intercostal space on the left (the notch felt at the top of the sternum, where the manubrium joins the body of the sternum) and count down two spaces to the fourth intercostal space, and then apply a disposable electrode to the site and attach lead wire V1R to that electrode.


For best results, on what area of the limbs should you place the limb electrodes?
  Over hairy areas
  Over flat, fleshy areas
  Over muscular areas
  Over bony areas
Rationale: You should select flat, fleshy areas to place the limb lead electrodes for best results.


What is right-sided ECG used to evaluate?
  Right atrial function
  Left ventricular function
  Left atrial function
  Right ventricular function
Rationale: A right chest lead ECG reflects right ventricular function and provides clues to damage or dysfunction in this chamber.


Where should you place lead V2R?
  Fourth intercostal space on the right side of the sternum
  Sixth intercostal space on the right side of the sternum
  Second intercostal space on the right side of the sternum
  Third intercostal space on the right side of the sternum
Rationale: You should move your fingers across the sternum to the fourth intercostal space on the right side of the sternum and apply a disposable electrode to that site and attach lead V2R.


What should you do if you must take more than one right chest lead ECG?
  Mark the sites of the electrodes with a marker.
  Leave the patient connected to the machine.
  Reapply the leads in approximately the same position each time you perform a right-sided ECG.
  Leave the electrodes in place.
Rationale: Marking the sites of the electrodes with a marker permits accurate comparisons for future tracings.


Which type of myocardial infarction (MI) does a right chest lead ECG assess?
  Anterior wall MI
  Lateral wall MI
  Inferior wall MI
  Superior wall MI
Rationale: You might need to perform a right chest lead ECG for a patient with an inferior wall MI and suspected right ventricular involvement.


What step should you take to differentiate between the right and standard ECG?
  Label the tracing "RIGHT CHEST ECG."
  Write an order.
  Document in the nurse's notes.
  Make a note in the patient's medical record.
Rationale: Label the tracing "RIGHT CHEST ECG" to ensure that those who are reading the tracing know what they're looking at.


Where should you place lead V5R?
  At the midpoint between V4R and V6R, on the same horizontal line
  Under V4R and V6R
  To the left of V4R and the right of V6R
  Below V4R and above V6R
Rationale: You should attach lead V5R on the same horizontal line at the midpoint between V4R and V6R.


Electrocardiogram (ECG), posterior chest lead: Results When doing a right posterior ECG, mark the leads as:
  VR7, VR8, VR9.
  V7L, V8L, V9L.
  V7R,V8R, V9R.
  V7, V8, V9.
Rationale: Marking the leads as V7R, V8R, and V9R will distinguish right posterior ECG from left posterior ECG.


What are the landmarks when placing the V9 lead?
  Right of the spinal column, fourth intercostal space
  Left of the spinal column, fourth intercostal space
  Left of the spinal column, paraspinal line at the same level as V7
  Fourth intercostal space, midclavicular line
Rationale: The lead is placed left of the spinal column, paraspinal line at the same level as V7.


Where should you attach the electrode for V7?
  Left posterior axillary line, fifth intercostal space
  Left midscapular, fourth intercostal space
  Right posterior axillary line, fourth intercostal space
  Left spinal column, fifth intercostal space
Rationale: Attaching the electrode at the left posterior axillary line, fifth intercostal space allows viewing of the posterior of the heart.


What should you do before placing the posterior chest electrodes?
  Clean the area with alcohol.
  Clip the patient's back hair.
  Place leads over the patient's hair.
  Shave the patient's back hair.
Rationale: Clipping the hair on the patient's back helps ensure better contact between the electrode and the skin.


Which leads are posterior leads?
  V1, V2, V3
  V4, V5, V6
  V7, V8, V9
  I, II, III
Rationale: Leads V7, V8, and V9 are posterior leads.


Place the posterior V8 lead halfway between:
  V7 and V9.
  V6 and V7.
  V5 and V6.
  V9 and V6.
Rationale: The V8 lead goes in between V7 and V9.


If the ECG machine doesn't produce a tracing, attach leads:
  V1, V2, V3, and limb leads.
  V4, V5, V6, and limb leads.
  V7, V8, V9, and limb leads.
  RA, LA, LL, V4, V5, and V6.
Rationale: Some ECG machines will not produce a tracing unless all leads, including V1, V2, V3 and limb leads, are placed.


How should you position a patient to place the leads for a right posterior ECG?
  On his right side
  On his left side
  Supine with his legs crossed
  On his stomach
Rationale: Place the patient on his left side to locate where to place leads on the right side of his back.


After turning on the ECG machine, you should set the speed at:
  20 mm/second.
  25 mm/second.
  50 mm/second.
  30 mm/second.
Rationale: A speed of 25 mm/second allows the heart rhythm to be recorded for distinction of rhythm.


What should you do when the ECG is complete?
  Chart the patient's tolerance.
  Retake the ECG.
  Take the patient's vital signs.
  Mark lead placement with a marking pen.
Rationale: Mark lead placement with a marking pen. This will be a reference point if another ECG is needed.


Which leadwire should you attach to the V7 electrode?
  V3
  V5
  V6
  V4
Rationale: Attach the V4 lead wire to the V7 electrode.


15-lead electrocardiogram (ECG): Results The 15-lead ECG is helpful in determining whether a patient is experiencing which condition?
  Right ventricular infarction
  Ejection fraction
  Congestive heart failure
  Cardiac output
Rationale: A 15-lead ECG is helpful in determining whether the patient is experiencing right ventricular ischemia, injury, or infarction.


Correct placement of V9 is over the:
  fifth intercostal space, immediately left of the vertebral column.
  fifth intercostal space at the left midclavicular line.
  fifth intercostal space at the right midclavicular line.
  fifth intercostal space on the left midscapular line.
Rationale: Proper placement of V9 is over the fifth intercostal space, immediately left of the vertebral column.


When connecting the lead wire to V9, you should use which lead wire?
  V6
  V5
  V3
  V2
Rationale: Lead wire V6 should be connected to V9 for the ECG reading.


During the ECG recording, the patient must:
  stand up.
  hold his breath.
  breathe deeply.
  remain still.
Rationale: To prevent artifact from occurring, the patient must remain still while the ECG is recording the waveform.


The 15-lead ECG is used to:
  predict patient outcome.
  evaluate fluid status.
  evaluate heart rhythm.
  enhance the 12-lead ECG.
Rationale: The 15-lead ECG is used to enhance the 12-lead ECG.


Which lead views the right ventricle?
  V3
  V2
  V4R
  V6
Rationale: V4R views the right ventricle to determine infarction, injury, or ischemia.


Where should the V4R lead be placed?
  Fifth intercostal space, immediately left of the vertebral column
  Fifth intercostal space at the right midclavicular line
  Fifth intercostal space at the left midclavicular line
  Fifth intercostal space on the left midscapular line
Rationale: V4R is placed over the fifth intercostal space at the right midclavicular line.


When connecting the lead wire for V4R, you should use which lead wire?
  V5
  V4
  V2
  V3
Rationale: Lead wire V4 should be connected to V4R for the ECG reading.


Correct placement of V8 is over the:
  fifth intercostal space at the left midclavicular line.
  fifth intercostal space on the left midscapular line.
  fifth intercostal space at the right midclavicular line.
  fifth intercostal space, immediately left of the vertebral column.
Rationale: Proper placement of V8 is over the fifth intercostal space on the midscapular line.


When connecting the lead wire for V8 , you should use which lead wire?
  V5
  V3
  V2
  V4

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