Heart Anatomy & Electrical Conduction Structure at a glance - 4 chambers: right atrium, right ventricle, left atrium, left ventricle - 4 valves: tricuspid, pulmonic, mitral, aortic - Flow: SVC/IVC to RA to tricuspid to RV to pulmonic to lungs to LA to mitral to LV to aortic to body
Conduction pathway SA node to AV node to Bundle of His to Right & Left bundle branches to Purkinje fibers - SA node = intrinsic pacemaker (60–100 bpm) - AV node delay allows atrial kick before ventricular contraction - Purkinje fibers depolarize ventricles from apex up
ECG landmarks | Wave | Represents | | P | Atrial depolarization | | QRS | Ventricular depolarization | | T | Ventricular repolarization | | PR interval | 0.12–0.20 s | | QRS | < 0.12 s |
High-yield NCLEX points - Loss of P waves + irregularly irregular rhythm to atrial fibrillation to anticoagulate to prevent stroke. - Prolonged PR (>0.20 s) to 1st-degree AV block. - Wide QRS to ventricular origin — always assess perfusion first (LOC, BP, pulse). - Right-sided heart failure to peripheral edema, JVD, hepatomegaly. Left-sided to pulmonary crackles, orthopnea, pink frothy sputum.
Apply the lesson: original practice questions 1. A nurse notes an irregularly irregular rhythm with no discernible P waves on the client's cardiac monitor. Which action is the nurse's priority? A. Prepare to defibrillate the client immediately. B. Assess the client's level of consciousness, blood pressure, and pulse. C. Administer a 500 mL IV fluid bolus. D. Notify the rapid response team.
2. Which findings are expected in a client with left-sided heart failure? Select all that apply. A. Bilateral crackles B. Jugular venous distention C. Orthopnea D. Peripheral pitting edema E. Pink frothy sputum
3. Which structure is the intrinsic pacemaker of the heart? A. AV node B. Bundle of His C. SA node D. Purkinje fibers
4. A PR interval of 0.28 seconds indicates: A. Normal conduction B. First-degree AV block C. Third-degree AV block D. Ventricular tachycardia
5. Blood returning from the body enters the heart through the: A. Left atrium B. Right ventricle C. Right atrium D. Pulmonary vein
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