Pacemaker Interpretation: Master EKGs with Pacemakers

Question 1

A spike on an EKG preceding every QRS complex represents the activity of which structure?

Accepted Answer

Pacemaker

Answer

Atrioventricular node

Answer

Bundle of His

Answer

Left bundle branch

Question 2

An EKG pattern of equally spaced, tall, narrow spikes followed by QRS complexes indicates what condition?

Accepted Answer

Pacemaker with fixed-rate mode

Answer

Sinus bradycardia

Answer

Ventricular tachycardia

Answer

Atrial flutter

Question 3

What is the key difference between a VVI and a DDD pacemaker?

Accepted Answer

Response to atrial depolarization

Answer

Presence of a ventricular sensing function

Answer

Pacing rate

Answer

Mode of capture

Question 4

A suppressed QRS complex immediately following a pacemaker spike on an EKG suggests what?

Accepted Answer

Proper pacemaker function

Answer

Pacemaker malfunction

Answer

Electrode displacement

Answer

Ventricular asystole

Question 5

Which factor does NOT affect pacemaker spike morphology?

Accepted Answer

Patient's body habitus

Answer

Electrode placement

Answer

Capture threshold

Answer

Pacemaker output voltage

Question 6

A series of inverted QRS complexes following pacemaker spikes on an EKG may indicate:

Accepted Answer

Ventricular capture

Answer

Atrial capture

Answer

Pacemaker undersensing

Answer

Electrode malfunction

Question 7

What is the term for the distinctive spike on an EKG representing a pacemaker firing?

Accepted Answer

Pacemaker spike

Answer

P wave

Answer

Q wave

Answer

R wave

Question 8

The primary indicator of a malfunctioning pacemaker is:

Accepted Answer

Irregular heart rhythm

Answer

Chest pain

Answer

Shortness of breath

Answer

Fatigue

Question 9

What is the primary purpose of a pacemaker lead?

Accepted Answer

To connect the pacemaker to the heart

Answer

To provide power to the pacemaker

Answer

To monitor the heart's electrical activity

Answer

To anchor the pacemaker in place

Question 10

The primary function of a pacemaker is to regulate ____________.

Accepted Answer

Heart rate

Answer

Blood pressure

Answer

Breathing

Answer

Blood sugar levels

Question 11

Which EKG waveform component represents the electrical impulse generated by the pacemaker?

Accepted Answer

Pacemaker spike

Answer

P wave

Answer

QRS complex

Answer

T wave

Question 12

The pacemaker sensitivity setting determines ____________.

Accepted Answer

The threshold at which the pacemaker fires

Answer

The heart rate

Answer

The pacing mode

Answer

The amplitude of the pacemaker spike

Question 13

The period of time between the pacemaker spike and the QRS complex is known as the ____________.

Accepted Answer

AV delay

Answer

PR interval

Answer

QT interval

Answer

Ventricular refractory period

Question 14

Which type of pacemaker provides pacing for both the atria and ventricles?

Accepted Answer

Dual-chamber pacemaker

Answer

Single-chamber pacemaker

Answer

Biventricular pacemaker

Answer

Rate-adaptive pacemaker

Question 15

The anti-tachycardia pacing feature in pacemakers is designed to prevent ____________.

Accepted Answer

Excessively fast heart rates

Answer

Slow heart rates

Answer

Irregular heartbeats

Answer

Heart attacks

Question 16

On an EKG, which electrical spike represents the pacemaker firing?

Accepted Answer

Pacemaker spike

Answer

P wave

Answer

QRS complex

Answer

T wave

Question 17

In pacemaker interpretation, what does the term "atrioventricular synchrony" refer to?

Accepted Answer

Coordination between atrial and ventricular pacing spikes

Answer

Lack of coordination between atrial and ventricular pacing spikes

Answer

Synchronization of pacemaker spikes with the patient's native heart rhythm

Answer

Synchronization of the pacemaker spike with the patient's respiratory rate

Question 18

Which type of pacemaker allows the pacemaker to sense and respond to the heart's intrinsic rhythm when present?

Accepted Answer

Demand pacing

Answer

Fixed-rate pacing

Answer

External pacing

Answer

Burst pacing

Question 19

What is the primary purpose of a rate-responsive pacemaker?

Accepted Answer

To increase the heart rate during periods of increased physical activity

Answer

To decrease the heart rate during periods of decreased physical activity

Answer

To maintain a consistent heart rate regardless of activity level

Answer

To prevent dangerous heart rhythms

Question 20

Which device is used to adjust pacemaker settings and programming?

Accepted Answer

Programmer

Answer

Monitor

Answer

ECG machine

Answer

Defibrillator

Question 21

Which of the following is NOT a standard type of pacemaker mode?

Accepted Answer

SFI

Answer

AAI

Answer

VVI

Answer

DDD

Question 22

What does the letter 'A' in a pacemaker mode code represent?

Accepted Answer

Atrial pacing

Answer

Ventricular pacing

Answer

Dual pacing

Answer

Sensing

Question 23

Which type of pacemaker spike indicates successful capture of the atrium?

Accepted Answer

Positive spike preceding the P wave

Answer

Negative spike following the P wave

Answer

Inverted T wave

Answer

QRS complex with a prolonged PR interval

Question 24

Differentiate ventricular overdrive pacing from ventricular escape pacing.

Accepted Answer

Overdrive pacing occurs when the pacemaker overrides the patient's intrinsic rhythm, while escape pacing occurs when the pacemaker takes over in the absence of intrinsic activity.

Answer

Overdrive pacing occurs when the pacemaker senses intrinsic ventricular activity, while escape pacing occurs when no intrinsic activity is detected.

Answer

Overdrive pacing uses a higher pacing rate than escape pacing.

Answer

There is no difference between overdrive pacing and escape pacing.

Question 25

What is the most common cause of pacemaker battery depletion?

Accepted Answer

Excessive pacing

Answer

Electrolyte imbalance

Answer

Mechanical failure

Answer

Infection

Question 26

Which type of pacemaker lead is used to pace the right atrium?

Accepted Answer

Atrial unipolar lead

Answer

Ventricular bipolar lead

Answer

Epicardial lead

Answer

Subcutaneous lead

Question 27

How do capture modes affect the EKG appearance of paced beats?

Accepted Answer

Capture modes influence the timing and shape of paced beats on the EKG.

Answer

Capture modes determine the pacemaker's ability to sense the heart's natural electrical activity.

Answer

Capture modes do not impact the EKG interpretation of paced beats.

Question 28

In the event of a suspected pacemaker-related EKG abnormality, what should be the initial troubleshooting step?

Accepted Answer

Inspect the pacemaker leads for integrity

Answer

Replace the pacemaker battery

Answer

Modify the pacemaker settings

Question 29

What is the primary purpose of a cardiac pacemaker?

Accepted Answer

To regulate the heart rate and rhythm

Answer

To increase the blood pressure

Answer

To transport oxygen to the heart

Answer

To prevent blood clots

Question 30

In an EKG, how do you identify a pacemaker spike?

Accepted Answer

As a sharp, upward deflection

Answer

As a downward deflection followed by an upward deflection

Answer

As a series of small, regular deflections

Answer

As a flattening of the P wave

Question 31

Which capture mode indicates that the pacemaker is controlling the heartbeat?

Accepted Answer

VVIR

Answer

AAV

Answer

AAI

Answer

VVI

Question 32

What is the significance of a pacing artifact in an EKG tracing?

Accepted Answer

It can interfere with the interpretation of the EKG

Answer

It indicates a problem with the pacemaker

Answer

It is a normal finding in patients with pacemakers

Answer

It has no clinical significance

Question 33

Which pacemaker mode allows the heart to beat at its natural rhythm unless it falls below a preset rate?

Accepted Answer

Demand pacing mode

Answer

Fixed-rate pacing mode

Answer

Synchronous pacing mode

Answer

Asynchronous pacing mode

Question 34

What does the term "ventricular tracking" refer to in pacemaker interpretation?

Accepted Answer

The pacemaker's ability to sense the patient's natural heart rhythm

Answer

The pacemaker's ability to deliver electrical impulses at a consistent rate

Answer

The pacemaker's ability to adjust its pacing to the patient's activity level

Answer

The pacemaker's ability to prevent ventricular tachycardia

Question 35

Identify the purpose of the ventricular sense (S) wave in a pacemaker EKG:

Accepted Answer

To trigger the pacemaker to fire a ventricular pacing pulse if the patient's intrinsic heart rate falls below the set rate.

Answer

To inhibit the pacemaker from firing a ventricular pacing pulse if the patient's intrinsic heart rate exceeds the set rate.

Answer

To synchronize the pacemaker's firing with the patient's intrinsic P wave.

Question 36

Select the correct interpretation for an EKG showing regular P waves preceding QRS complexes with no pacemaker spikes:

Accepted Answer

Underlying sinus rhythm

Answer

Atrial pacing with ventricular capture

Answer

Ventricular pacing with retrograde conduction

Question 37

What does the presence of a fusion beat indicate on an EKG with pacemaker activity?

Accepted Answer

Partial capture of the heart by the pacemaker pulse.

Answer

Absence of ventricular pacing

Answer

Complete failure of the pacemaker to capture the heart

Question 38

Identify the term for a situation where the pacemaker fires and captures the heart, but the ventricular depolarization is delayed and widened:

Accepted Answer

Pseudofusion

Answer

Wenckebach phenomenon

Answer

Alternating bundle branch block

Answer

Ventricular escape beat

Question 39

Select the appropriate initial management step when a patient with a pacemaker experiences syncope:

Accepted Answer

Check the pacemaker function and battery status immediately.

Answer

Perform a comprehensive physical exam

Answer

Administer antiarrhythmic medication

Question 40

Identify the lead configuration that provides both atrial and ventricular pacing and sensing:

Accepted Answer

Dual-chamber pacing

Answer

Single-chamber atrial pacing

Answer

Single-chamber ventricular pacing

Answer

Biventricular pacing