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ATI MED SURG CARDIOVASCULAR.
EXAM QUESTIONS WITH 100% CORRECT ANSWERS
"A nurse is providing discharge teaching to an adult female client who has infective endocarditis about how to prevent recurrence. Which of the following statements by the client indicates an understanding of the teaching? A. "I will ask my provider to change my contraception to an intrauterine device." B. "I will notify my doctor before I have dental procedures." C. "I will avoid using antiseptic mouthwash for oral care."
D. "I will wear a mask when I go out in public." - CORRECT ANSWER B. "I will notify my doctor
before I have dental procedures."" "A nurse is providing teaching about lifestyle changes to a client who experienced a myocardial infarction and has a new prescription for a beta blocker. Which of the following client statements indicates an understanding of the teaching? A. "I should eat foods that are high in saturated fat." B. "Before taking my medication, I will count my radial pulse rate." C. "I will exercise once a week for an hour at the health club."
D. "I will stop taking my medication when my blood pressure is within a normal range." -
CORRECT ANSWER B. "Before taking my medication, I will count my radial pulse rate.""
"A nurse is reviewing the laboratory findings of a client who has protein-calorie malnutrition. Which of the following findings should the nurse expect? A. Decreased albumin B. Elevated hemoglobin C. Elevated lymphocytes
D. Decreased cortisol - CORRECT ANSWER A. Decreased albumin"
"A nurse is teaching a client with heart disease about a low-cholesterol diet. Which of the following client statements indicates the teaching was effective? A. "I should remove the skin from poultry before eating it." B. "I will eat seafood once per week." C. "I should use margarine when preparing meals."
D. "I can use whole milk in my oatmeal." - CORRECT ANSWER A. "I should remove the skin
from poultry before eating it.""
"A nurse is preparing an automated external defibrillator (AED) for a client receiving CPR after a cardiac arrest. Which of the following actions should the nurse perform first? A. Press the analyze button on the machine B. Stop CPR and move away from the client C. Push the charge button to prepare to shock
D. Apply the defibrillator pads to the client's chest - CORRECT ANSWER D. Apply the
defibrillator pads to the client's chest" "A nurse is assessing a client who has heart failure and is taking daily furosemide. The client's apical pulse is weak and irregular. The nurse should identify these findings as manifestations of which of the following electrolyte imbalances? A. Hypokalemia B. Hypophosphatemia C. Hypercalcemia
D. Hypermagnesemia - CORRECT ANSWER A. Hypokalemia"
"A nurse is caring for a client who has an abdominal aortic aneurysm and is scheduled for surgery. The client's vital signs are blood pressure 160/98 mmHg, heart rate 102/min, respirations 22/min, and SpO2 95%. Which of the following actions should the nurse take? A. Administer antihypertensive medication for blood pressure B. Monitor to ensure the client's urinary output is 20 mL/hr C. Withhold pain medication to prepare the client for surgery
D. Take the client's vital signs every 2 hr - CORRECT ANSWER A. Administer antihypertensive
medication for blood pressure" "A nurse is completing a medication history for a client who reports using fish oil as a dietary supplement. Which of the following substances in fish oil should the nurse recognize as a health benefit to the client? A. Omega-3 fatty acids B. Antioxidants C. Vitamins A, D, and C
D. Beta-carotene - CORRECT ANSWER A. Omega-3 fatty acids"
"A nurse is teaching about a low-cholesterol diet to a client who had a myocardial infarction. Which of the following meal selections by the client indicates an understanding of the teaching? A. Chicken breast and corn on the cob B. Shrimp and rice C. Cheese omelet and turkey bacon
D. Ample hydration - CORRECT ANSWER D. Ample hydration"
"A nurse is teaching a 70-year-old client about risk factors for heart failure. The client has mild asthma, diabetes mellitus, and coronary artery disease. Which of the following statements by the client indicates an understanding of the teaching? A. "My diabetes will not increase my risk of heart failure." B. "My asthma makes it more likely for me to have heart failure." C. "My age does not increase my risk of heart failure."
D. "My coronary artery disease is a risk factor for heart failure." - CORRECT ANSWER D. "My
coronary artery disease is a risk factor for heart failure."" "A nurse is reviewing the laboratory results of a client who has end-stage renal disease and reports fatigue. The client's hemoglobin level is 8 g/dL. The nurse should expect a prescription for which of the following medications? A. Erythropoietin B. Erythromycin C. Filgrastim
D. Calcitriol - CORRECT ANSWER A. Erythropoietin"
"A nurse is showing a client who has right-sided heart failure an illustration of the heart. Which of the following blood vessels carry deoxygenated blood to the right atrium? A. Right coronary artery B. Left carotid artery C. Aorta
D. Superior vena cava - CORRECT ANSWER D. Superior vena cava"
"A nurse is planning care for a client who has acute myelogenous leukemia and a platelet count of 48,000/mm^3. Which of the following interventions should the nurse include? A. Avoid IM injections B. Assess the client for ecchymosis once per shift C. Do not allow the client to have visitors
D. Encourage daily flossing between teeth - CORRECT ANSWER A. Avoid IM injections"
"A nurse is preparing to transfuse a unit of packed red blood cells (RBCs) for a client who has anemia. Which of the following actions should the nurse take first? A. Hang an IV infusion of 0.9% sodium chloride with the blood B. Compare the client's identification number with the number on the blood C. Witness the informed consent document
D. Obtain pretransfusion vital signs - CORRECT ANSWER C. Witness the informed consent
document" "A nurse is caring for a client who has a demand pacemaker inserted with a set rate of 72/min. Which of the following findings should the nurse expect? A. Telemetry monitoring showing QRS complexes occurring at a rate of 74/min with no pacing spikes B. Premature ventricular complexes at 12/min C. Telemetry monitoring showing pacing spikes with no QRS complexes
D. Hiccups - CORRECT ANSWER A. Telemetry monitoring showing QRS complexes occurring at
a rate of 74/min with no pacing spikes" "A nurse is caring for a client following a stroke. Which of the following actions should the nurse take first? A. Obtain coagulation laboratory studies from the client B. Apply pneumatic compression boots to the client C. Request a referral for a speech-language pathologist
D. Keep the client NPO - CORRECT ANSWER D. Keep the client NPO"
"A nurse is monitoring a client who had a myocardial infarction. For which of the following complications should the nurse monitor in the first 24 hr? A. Infective endocarditis B. Pericarditis C. Ventricular dysrhythmias
D. Pulmonary emboli - CORRECT ANSWER C. Ventricular dysrhythmias"
"While participating in a community health fair, a nurse is providing information to a client who has a blood pressure of 150/90 mmHg during screening. Which of the following actions should the nurse take? A. Give the client a written record of his BP to bring to his provider B. Encourage the client to go to the nearest emergency department C. Instruct the client to follow-up with a provider within 6 months
D. Explain to the client that he is not at risk unless he has manifestations of hypertension -
CORRECT ANSWER A. Give the client a written record of his BP to bring to his provider"
". A nurse is preparing to transfuse 250 mL of packed red blood cells (RBCs) to a client over 4 hr. A blood administration set is available that delivers 10 gtt/mL. The nurse should set the manual blood transfusion to deliver how many gtt/min? (Fill in the blank with the numeric value only,
A. P waves occurring at 0.16 seconds before each QRS complex B. Atrial rate of 300/min with QRS complex of 80/min C. Ventricular rate of 82/min with an atrial rate of 80/min
D. Irregular ventricular rate of 125/min with a wide QRS pattern - CORRECT ANSWER B. Atrial
rate of 300/min with QRS complex of 80/min" "A nurse in a clinic is assessing the lower extremities and ankles of a client who has a history of peripheral arterial disease. Which of the following findings should the nurse expect? A. Pitting edema B. Areas of reddish-brown pigmentation C. Dry, pale skin with minimal body hair
D. Sunburned appearance with desquamation - CORRECT ANSWER C. Dry, pale skin with
minimal body hair" "A nurse completing an assessment on a client. Which of the following findings should the nurse identify as a risk factor for coronary artery disease? (Select all that apply.) A. Hypothyroidism B. Hypertension C. Diabetes mellitus D. Hyperlipidemia
E. Tobacco smoking - CORRECT ANSWER B. Hypertension
C. Diabetes mellitus D. Hyperlipidemia E. Tobacco smoking" "A nurse is assessing a client who is receiving a unit of whole blood. Which of the following findings should the nurse identify as a manifestation of a hemolytic transfusion reaction? A. Bradycardia B. Paresthesia C. Hypertension
D. Low back pain - CORRECT ANSWER D. Low back pain"
"A nurse is caring for a client who has scurvy. Which of the following vitamin deficiencies should the nurse identify as the cause of this disease? A. Vitamin A B. Vitamin B C. Vitamin C
D. Vitamin D - CORRECT ANSWER C. Vitamin C"
"A nurse is caring for a client who has a new diagnosis of pernicious anemia. The nurse should expect the client's provider to prescribe which of the following medications for this client? A. Ferrous sulfate B. Epoetin alfa C. Vitamin B
D. Folic acid - CORRECT ANSWER C. Vitamin B12"
"A nurse is reviewing the progress notes for a client who has heart failure. The provider noted some improvement in the client's cardiac output. The nurse should understand that cardiac output reflects which of the following physiologic parameters? A. The percentage of blood the ventricles pump during each beat B. The amount of blood the left ventricle pumps during each beat C. The amount of blood in the left ventricle at the end of diastole
D. The heart rate times the stroke volume - CORRECT ANSWER D. The heart rate times the
stroke volume" "A nurse is monitoring a client who has heart failure related to mitral stenosis. The client reports shortness of breath on exertion. Which of the following conditions should the nurse expect? A. Increased cardiac output B. Increased pulmonary congestion C. Decreased left atrial pressure
D. Decreased pulmonary artery pressure - CORRECT ANSWER B. Increased pulmonary
congestion" "A nurse is assessing a client who has an abdominal aortic aneurysm. Which of the following manifestations should the nurse expect? A. Midsternal chest pain B. Thrill C. Pitting edema in lower extremities
D. Lower back discomfort - CORRECT ANSWER D. Lower back discomfort"
"A nurse is assessing the hematologic system of an older adult client. The nurse should report which of the following findings to the provider as a possible indication of a hematologic disorder? A. Pallor B. Jaundice C. Absence of hair on the legs
D. Poor nailbed capillary refill - CORRECT ANSWER C. Absence of hair on the legs"
D. Tissue hypoxia - CORRECT ANSWER D. Tissue hypoxia"
"A nurse is providing discharge teaching to a client who has a new permanent pacemaker. Which of the following statements by the client indicates an understanding of the teaching? A. "I should check my heart rate at the same time each day." B. "I don't have to take my antihypertensive medications now that I have a pacemaker." C. "I should keep a pressure dressing over the generator until the incision is healed."
D. "I cannot stand in front of our new microwave oven when it is on." - CORRECT ANSWER A.
"I should check my heart rate at the same time each day."" "A nurse is assessing a client who has pernicious anemia. Which of the following findings should the nurse expect? A. Thick, white coating on the client's tongue B. Decreased pulse rate C. Paresthesias in the hands and feet
D. Joint pain in the extremities - CORRECT ANSWER C. Paresthesias in the hands and feet"
"A nurse is preparing an in-service presentation about assessing clients who are having an acute myocardial infarction (MI). What is the most common assessment finding with acute MI? A. Dyspnea B. Pain in the shoulder and left arm C. Substernal chest pain
D. Palpitations - CORRECT ANSWER C. Substernal chest pain"
"A nurse is reviewing a client's repeat laboratory results 4 hr after administering fresh frozen plasma (FFP). Which of the following laboratory results should the nurse review? A. Prothrombin time B. WBC count C. Platelet count
D. Hematocrit - CORRECT ANSWER A. Prothrombin time"
"A nurse is checking paradoxical blood pressure of a client who has a possible cardiac tamponade. In what order should the nurse complete the following steps? (Move the steps into the box on the
right, placing them in the order of performance. Use all the steps.) - CORRECT ANSWER
Palpate the blood pressure and inflate the cuff above the systolic pressure. Deflate the cuff slowly and listen for the first audible sounds. Identify the first BP sounds audible on expiration and then on inspiration. Subtract the inspiratory pressure from the expiratory pressure.
Inspect for jugular venous distention and notify the provider." "A nurse is teaching a client who has iron-deficiency anemia. The nurse should encourage the client to increase her consumption of which of the following foods? A. Lentils B. Avocados C. Cabbage
D. Broccoli - CORRECT ANSWER A. Lentils"
"A nurse is caring for a client who is undergoing conservative treatment for deep-vein thrombosis. The client asks the nurse what will happen to the clot. Which of the following responses should the nurse make? A. "Your body has a process called fibrinolysis that will eventually dissolve the clot." B. "Your body has a mechanism that will keep the clot stable in its present location." C. "The clot will break into tiny fragments and float harmlessly in your bloodstream."
D. "Treatment with heparin will dissolve the clot and keep other clots from forming." - CORRECT
ANSWER A. "Your body has a process called fibrinolysis that will eventually dissolve the clot.""
"A nurse is preparing a client for cardiac catheterization. Which of the following pieces of information should the nurse give the client before the procedure? (Select all that apply.) A. "You'll have to lie flat for several hours after the procedure." B. "You'll receive medication to relax you before the procedure." C. "You'll feel a cool sensation after the injection of the dye." D. "You'll have to keep your leg straight after the procedure."
E. "You'll have to limit the amount of fluid you drink for the first 24 hr." - CORRECT ANSWER A.
"You'll have to lie flat for several hours after the procedure." B. "You'll receive medication to relax you before the procedure." D. "You'll have to keep your leg straight after the procedure."" "A nurse is completing dietary teaching with a client who has heart failure and is prescribed a 2 g sodium diet. Which of the following statements by the client indicates an understanding of the teaching? A. "I should use salt sparingly while cooking." B. "I can have yogurt as a dessert." C. "I should use baking soda when I bake."
D. "I should use canned vegetables instead of frozen." - CORRECT ANSWER B. "I can have
yogurt as a dessert.""
"A nurse is providing discharge teaching for a client who has a newly inserted permanent pacemaker. Which of the following instructions should the nurse include in the teaching? A. "Request a provider's prescription when traveling to alert airport security." B. "Stand at least 3 feet away while using a microwave." C. "Keep your cell phone 6 inches away from your pacemaker when making a call."
D. "Avoid showering for the first 2 weeks following surgery." - CORRECT ANSWER C. "Keep
your cell phone 6 inches away from your pacemaker when making a call."" "A nurse is assessing a client who has pericarditis. Which of the following manifestations should the nurse expect? A. Bradycardia with ST-segment depression B. Relief of chest pain with deep inspiration C. Dyspnea with hiccups
D. Chest pain that increases when sitting upright - CORRECT ANSWER C. Dyspnea with
hiccups" "A nurse is preparing an in-service presentation about the management of myocardial infarction (MI). Death following MI is often a result of which of the following complications? A. Cardiogenic shock B. Dysrhythmias C. Heart failure
D. Pulmonary edema - CORRECT ANSWER B. Dysrhythmias"
"A nurse is preparing to administer packed RBCs to a client who is anemic. Which of the following actions should the nurse take? (Select all that apply.) A. Insert a 23-gauge angiocatheter with an IV adaptor B. Check to determine the packed RBCs are less than 1 week old C. Administer the packed RBCs over a 6-hr period D. Ask another nurse to check the packed RBCs' label against the medical record
E. Prime the transfusion tubing with 0.9% sodium chloride - CORRECT ANSWER "
“A nurse is planning care for a client who is having a percutaneous transluminal coronary angioplasty (PTCA) with stent placement. Which of the following actions should the nurse anticipate in the post-procedure plan of care? A. Instruct the client about a long-term cardiac conditioning program B. Administer scheduled doses of acetaminophen C. Check for peak laboratory markers of myocardial damage
D. Monitor for bleeding - CORRECT ANSWER D. Monitor for bleeding"
"A nurse is planning care for a client during a sickle cell crisis. Which of the following interventions should the nurse include in the client's plan of care?
A. Maintain the client's knees and hips in a flexed position B. Apply cold compresses to painful joints C. Withhold opioids until the crisis is resolved
D. Encourage increased fluid intake - CORRECT ANSWER D. Encourage increased fluid intake"
"A nurse is teaching a client who has iron-deficiency anemia. The nurse should encourage the client to increase consumption of which of the following foods? A. Beef liver B. Oranges C. Turnips
D. Whole milk - CORRECT ANSWER A. Beef liver"
"A nurse is teaching a client about dietary modifications to control blood pressure. Which of the following food choices should the nurse identify as an indication that the client understands the instructions? A. Onion soup and salad B. Vegetarian wrap with potato chips C. Grilled chicken salad with fresh tomatoes
D. Chicken bouillon and crackers - CORRECT ANSWER C. Grilled chicken salad with fresh
tomatoes" "A nurse is caring for a client who has peripheral vascular disease (PVD) and ulcers on the toes. Which of the following findings of PVD is a risk factor for ulceration of the extremities? A. Insufficient skin care B. Dehydration C. Immobility
D. Impaired circulation - CORRECT ANSWER D. Impaired circulation"
"A nurse is caring for a client who is receiving IV ampicillin and develops urticaria and dyspnea. Which of the following actions should the nurse take first? A. Elevate the client's feet and legs B. Administer epinephrine C. Infuse 0.9% sodium chloride
D. Stop the medication infusion - CORRECT ANSWER D. Stop the medication infusion"
"A nurse is caring for a client with heart failure whose telemetry reading displays a flattening of the T wave. Which of the following laboratory results should the nurse anticipate as the cause of this ECG change? A. Potassium 2.8 mEq/L B. Digoxin level 0.7 ng/mL C. Hemoglobin 9.8 g/dL
D. Calcium 8.0 mg - CORRECT ANSWER A. Potassium 2.8 mEq/L"
A. Magnesium 2.0 mEq/L B. Hgb 6.5 g/dL C. WBC count 9.6/mm
D. Creatinine 0.8 mg/dL - CORRECT ANSWER B. Hgb 6.5 g/dL"
"A nurse is caring for a client who has pernicious anemia. Which of the following factors should the nurse identify with this condition? A. Iron deficiency B. Hemolytic blood loss C. Folic acid deficiency
D. Vitamin B12 deficiency - CORRECT ANSWER D. Vitamin B12 deficiency"
"A nurse is assessing a client who has fluid volume overload from a cardiovascular disorder. Which of the following manifestations should the nurse expect? (Select all that apply.) A. Jugular vein distension B. Moist crackles C. Postural hypotension D. Increased heart rate
E. Fever - CORRECT ANSWER A. Jugular vein distension
B. Moist crackles D. Increased heart rate" "A nurse is providing discharge teaching for a client who had a bone marrow transplant and has thrombocytopenia. Which of the following statements indicates that the client understands the precautions he must take at home? A. "I'll stick with soft foods for now." B. "My family will be bringing me fresh flowers today." C. "I'll use a new disposable razor each day."
D. "I'll blow my nose more often to avoid nosebleeds." - CORRECT ANSWER A. "I'll stick with
soft foods for now."" "A nurse is assessing a client who is 85 years old. Which of the following findings should the nurse identify as a manifestation of myocardial infarction? A. Sudden hemoptysis B. Acute diarrhea C. Frontal headache
D. Acute confusion - CORRECT ANSWER D. Acute confusion"
"A nurse is assessing a client who has late-stage heart failure and is experiencing fluid volume overload. Which of the following findings should the nurse expect? A. Weight gain of 1 kg (2.2 lb) in 1 day B. Pitting edema +
C. Client report of a nocturnal cough
D. B-type natriuretic peptide (BNP) level of 100 pg/mL - CORRECT ANSWER A. Weight gain of
1 kg (2.2 lb) in 1 day" "A nurse is caring for a client who has femoral thrombophlebitis and a prescription for enoxaparin. Which of the following actions should the nurse take? A. Elevate the affected leg B. Place the client on bed rest C. Massage the affected leg
D. Administer aspirin for discomfort - CORRECT ANSWER A. Elevate the affected leg"
"A nurse is reviewing laboratory values for an adult client who has sickle cell anemia and a history of receiving blood transfusions. For which of the following complications should the nurse monitor? A. Hypokalemia B. Lead poisoning C. Hypercalcemia
D. Iron toxicity - CORRECT ANSWER D. Iron toxicity"
"A nurse is caring for a client who has emphysema and chronic respiratory acidosis. The nurse should monitor the client for which of the following electrolyte imbalances? A. Hyperkalemia B. Hyponatremia C. Hypercalcemia
D. Hypomagnesemia - CORRECT ANSWER A. Hyperkalemia"
"A nurse is caring for a client who is in hypovolemic shock. While waiting for a unit of blood, the nurse should administer which of the following IV solutions? A. 0.45% sodium chloride B. Dextrose 5% in 0.9% sodium chloride C. Dextrose 10% in water
D. 0.9% sodium chloride - CORRECT ANSWER D. 0.9% sodium chloride"
"A client who has thrombocytopenia asks the nurse why platelets are so important. Which of the following responses should the nurse make? A. "Platelets help the body fight infection." B. "Platelets help break down clots in the body." C. "Platelets plug breaks in blood vessels."
D. "Platelets produce the molecules that carry oxygen." - CORRECT ANSWER C. "Platelets plug
breaks in blood vessels.""
C. Verify with another nurse the blood type and Rh of the packed RBCs E. Change IV tubing to a set that has a filter" "A nurse is assessing a client for manifestations of aplastic anemia. Which of the following findings should the nurse expect? A. Plethoric appearance of facial skin B. Glossitis and weight loss C. Jaundice with an enlarged liver
D. Petechiae and ecchymosis - CORRECT ANSWER D. Petechiae and ecchymosis"
"A nurse is teaching a client who has polycythemia vera about self-care measures. Which of the following interventions should the nurse include? A. "Drink at least 1 liter of fluid each day." B. "Continuously wear support hose." C. "Elevate your legs when sitting."
D. "Use dental floss daily." - CORRECT ANSWER C. "Elevate your legs when sitting.""
"A nurse is teaching a client who has pernicious anemia. The nurse should encourage the client to increase consumption of which of the following foods? A. Eggs B. Squash C. Kale
D. Tofu - CORRECT ANSWER A. Eggs"
"A nurse is monitoring a client for reperfusion following thrombolytic therapy to treat acute myocardial infarction (MI). Which of the following indicators should the nurse identify to confirm reperfusion? A. Ventricular dysrhythmias B. Appearance of Q waves C. Elevated ST segments
D. Recurrence of chest pain - CORRECT ANSWER A. Ventricular dysrhythmias"
"A charge nurse is observing a newly licensed nurse administer an IV medication to a client who has an implanted venous access port. Which of the following observations requires intervention by the charge nurse? A. A dressing is not applied to the port site after use. B. A 22-gauge non-coring needle is used to access the port. C. Blood return is noted prior to administering the medication.
D. A solution of 5 mL heparin 1,000 units/mL has been prepared. - CORRECT ANSWER D. A
solution of 5 mL heparin 1,000 units/mL has been prepared."
"A nurse is preparing a client for a bone-marrow biopsy. Which of the following pieces of information should the nurse include in preoperative teaching? A. "You'll receive heavy sedation, so you might even sleep during the procedure." B. "You'll have to lie on your back throughout the procedure." C. "You'll feel a painful, pulling sensation when the doctor withdraws the marrow."
D. "Expect the procedure to take about an hour." - CORRECT ANSWER C. "You'll feel a painful,
pulling sensation when the doctor withdraws the marrow."" "A nurse is rewarming a client following coronary artery bypass graft (CABG) surgery. For which of the following complications of the rewarming process should the nurse monitor the client? A. Acidosis B. Infection C. Hypertension
D. Cardiac tamponade - CORRECT ANSWER A. Acidosis"
"A nurse is assessing a client who had coronary artery bypass grafts for cardiac tamponade. Which of the following actions should the nurse take? A. Check for hypertension B. Auscultate for loud, bounding heart sounds C. Auscultate blood pressure for pulsus paradoxus
D. Check for a pulse deficit - CORRECT ANSWER C. Auscultate blood pressure for pulsus
paradoxus" "A nurse is assessing for disseminated intravascular coagulation (DIC) in a client who has septic shock secondary to an untreated foot wound. Which of the following findings should the nurse expect? (Select all that apply.) A. Bradycardia B. Bleeding at the venipuncture site C. Petechiae on the chest and arms D. Flushed, dry skin
E. Abdominal distension - CORRECT ANSWER B. Bleeding at the venipuncture site
C. Petechiae on the chest and arms E. Abdominal distension" "A nurse is examining the ECG of a client who has frequent premature ventricular contractions (PVCs). Which of the following QRS changes should the nurse expect to see on the client's ECG? A. Narrower than usual QRS complexes B. Much greater amplitude than the usual QRS complexes C. Same polarity as the usual QRS complexes
D. Immediate resumption of the usual rhythm - CORRECT ANSWER B. Much greater
amplitude than the usual QRS complexes"
