Chapter 33- Disorders of Cardiac Conduction and Rhythm

Porth's Pathophysiology, Concepts of Altered Health States 9th Edition by Sheila Grossman-Carol Mattson Porth

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Chapter 33- Disorders of Cardiac Conduction and Rhythm

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

1. A physician has ordered the measurement of a cardiac patient’s electrolyte levels as part of the client’s morning blood work. Which of the following statements best captures the importance of potassium in the normal electrical function of the patient’s heart?
  A) Potassium catalyzes the metabolism of ATP, producing the gradient that results in electrical stimulation.
  B) Potassium is central to establishing and maintaining the resting membrane potential of cardiac muscle cells.
  C) The impermeability of cardiac cell membranes to potassium allows for action potentials achieved by the flow of sodium ions.
  D) The reciprocal movement of one potassium ion for one sodium ion across the cell membrane results in the production of an action potential.
  Ans: B
  Feedback:
  The selective permeability of cell membranes to potassium, and its near-impermeability to sodium ions, produces the resting membrane potential of cardiac cells. Potassium does not catalyze the metabolism of ATP, and sodium and potassium ions do not move across the cell membrane in a 1:1 ratio.

 

 

2. Which of the following statements describes phase 4 of the action potential of cells in the sinoatrial (SA) node?
  A) A slow depolarization occurs when Na+ is transported out of the cell and K+ moves back in, resulting in resting membrane potential.
  B) The cells are capable of responding to a greater than normal stimulus before the resting membrane potential is reached.
  C) The fast sodium channels in the cellular membranes close, causing an abrupt decrease in intracellular positivity.
  D) Potassium permeability is allowing the cell membrane to remain depolarized, and Ca2+ channel opens moving Ca2+ back into the cell.
  Ans: A
  Feedback:
  During phase 4 in the cells of the SA node, a slow leakage of current through the slow channels of the cellular membrane leads to spontaneous depolarization; this slow response enables pacemaker function. Answer B describes the relative refractory period of the action potential curve, which occurs at the end of phase 3 in cardiac cells, and answer C describes phase 1 of the action potential, which signals the end of depolarization. The sodium–potassium pump transports sodium out of the cell and a smaller amount of potassium into it, contributing to the negative intracellular charge of the resting membrane potential in phase 4.

 

 

3. An ECG technician is placing leads on a patient who has presented to the emergency department with a sudden onset of chest pain. The technician would recognize which of the following facts about the placement of leads and the achievement of a clinically accurate ECG?
  A) The electrical potential recorded by a lead on an extremity will vary significantly depending on where the lead is placed on the extremity.
  B) The chest leads measure electrical activity on the horizontal plane, while limb leads measure it on the vertical plane.
  C) Limb leads measure the electrical activity of the heart indirectly through the activity of adjacent skeletal muscle.
  D) A total of 12 chest leads are necessary to attain the most accurate ECG.
  Ans: B
  Feedback:
  A complete ECG is obtained by combining data from chest leads, which measure activity on the horizontal plane, and limb leads, corresponding to the vertical or frontal plane. The electrical potential recorded by a lead on an extremity should not vary significantly depending on where the lead is placed on the extremity, and limb leads do not measure electrical activity by way of skeletal muscle activity. A total of 12 leads, only six of which are on the chest, are necessary for a complete ECG.

 

 

4. The cardiologist just informed a patient that he has a reentry circuit in the electrical conduction system in his heart. This arrhythmia is called Wolff-Parkinson-White (WPW) syndrome. After the physician has left the room, the patient asks the nurse to explain this to him. Which of the following statements most accurately describes what is happening?
  A) “This means that the SA node (which is the beginning of your heart’s electrical system) has been damaged and is no longer functioning normal.”
  B) “You must have a large clot in one of your arteries that supply oxygenated blood to the special conduction cells in your heart.”
  C) “There is an extra, abnormal electrical pathway in the heart that leads to impulses traveling around the heart very quickly, in a circular pattern, causing the heart to beat too fast.”
  D) “For some reason, your electrical system is not on full charge, so they will have to put in new leads and a pacemaker to make it work better.”
  Ans: C
  Feedback:
  There are several forms of reentry. The first is anatomic reentry. It involves an anatomic obstacle around which the circulating current must pass and results in an excitation wave that travels in a set pathway. Arrhythmias that arise as a result of anatomic reentry are paroxysmal supraventricular tachycardias, as seen in WPW syndrome, atrial fibrillation, atrial flutter, etc. Answer choice A relates to sinus node arrhythmias and SSS. Answer choice B relates to arrhythmias caused by MI. Answer choice D relates to third-degree block or ventricular standstill, for example.

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