DC Quality Assurance & Standards 3 — Questions and Answers
Question 1: Which electrode placement error is most likely to produce an artifactual wide QRS mimicking ventricular tachycardia on a 12-lead ECG?
- Limb lead reversal (e.g., RA and LA switched) (Correct answer)
- Using disposable vs. reusable electrodes
- Applying electrodes over bony prominences
- Running the ECG at 50 mm/sec instead of 25 mm/sec
Correct answer: Limb lead reversal (e.g., RA and LA switched)
Limb lead reversal (especially RA-LA swap) distorts axis and morphology, producing patterns that can falsely resemble wide-complex tachycardias.
Question 2: In a performance improvement cycle for dysrhythmia monitoring, which step follows data collection and analysis?
- Implement targeted interventions and re-measure outcomes (Correct answer)
- Publish findings in a medical journal
- Notify regulatory agencies of deficiencies
- Discontinue monitoring for stable patients
Correct answer: Implement targeted interventions and re-measure outcomes
The Plan-Do-Study-Act (PDSA) model requires implementing evidence-based interventions after analysis and then reassessing to confirm improvement.
Question 3: What does a sensitivity setting of 10 mm/mV on an ECG tracing indicate?
- Standard sensitivity where 1 mV of electrical signal produces a 10 mm deflection (Correct answer)
- The paper speed is set at 10 mm per second
- The high-frequency filter is activated
- The ECG is recording at double standard speed
Correct answer: Standard sensitivity where 1 mV of electrical signal produces a 10 mm deflection
10 mm/mV is the internationally accepted standard sensitivity for ECG recording, allowing consistent amplitude measurements across institutions.
Question 4: A quality review reveals technicians are inconsistently applying the V4 precordial electrode. What is the correct landmark?
- 5th intercostal space at the midclavicular line (Correct answer)
- 4th intercostal space at the left sternal border
- 5th intercostal space at the anterior axillary line
- 4th intercostal space at the midclavicular line
Correct answer: 5th intercostal space at the midclavicular line
V4 is placed at the 5th intercostal space at the midclavicular line, a standard landmark critical for accurate precordial lead placement.
Question 5: Which AACN practice alert guides monitoring frequency reassessment for patients on telemetry?
- AACN Practice Alert on Alarm Management recommends reassessing monitoring need and alarm settings every 12 hours (Correct answer)
- AACN mandates continuous 72-hour monitoring for all cardiac patients
- AACN requires physician re-order every 6 hours for telemetry continuation
- AACN defers all monitoring protocols to individual hospital IT departments
Correct answer: AACN Practice Alert on Alarm Management recommends reassessing monitoring need and alarm settings every 12 hours
AACN's Alarm Management Practice Alert calls for reassessing the necessity of monitoring and alarm thresholds at least every 12 hours to reduce alarm fatigue.
Question 6: A Holter monitor report shows 3% artifact throughout a 24-hour recording. What QA action is most appropriate?
- Review electrode application technique with the technician and check skin preparation protocol (Correct answer)
- Discard the recording and repeat the study immediately
- Report the patient for non-compliance without investigation
- Accept the recording as within normal quality limits
Correct answer: Review electrode application technique with the technician and check skin preparation protocol
Even modest artifact rates warrant review of skin preparation (cleaning, abrading) and electrode application technique to improve future recording quality.
Question 7: What is the primary reason dysrhythmia competency validation must be repeated periodically (e.g., annually) in most hospital programs?
- To ensure staff maintain current knowledge as clinical guidelines and technology evolve (Correct answer)
- Because regulatory agencies require daily competency testing
- To fulfill billing requirements for telemetry charges
- Because rhythm interpretation skills deteriorate within 30 days
Correct answer: To ensure staff maintain current knowledge as clinical guidelines and technology evolve
Annual competency validation ensures staff keep pace with updated guidelines, new dysrhythmia classifications, and evolving monitoring technology.
DC Quality Assurance & Standards 3
Which electrode placement error is most likely to produce an artifactual wide QRS mimicking ventricular tachycardia on a 12-lead ECG?