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The nurse is caring for a patient who has been experiencing dizziness and shortness of breath for several days. During cardiac monitoring in the emergency department (ED), the nurse obtains the following electrocardiographic tracing. Which of the following cardiac rhythms should the nurse identify?
- A. Sinus rhythm with premature ventricular contractions (PVCs)
- B. Junctional escape rhythm
- C. Third-degree atrioventricular (AV) block
- D. Sinus rhythm with premature atrial contractions (PACs)
Correct Answer: C
Rationale: The inconsistency between the atrial and ventricular rates and the variable P-R interval indicate that the rhythm is third-degree AV block. Sinus rhythm with PACs or PVCs will have a normal rate and consistent P-R intervals with occasional PACs or PVCs. A junctional escape rhythm will not have P waves.
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The nurse has received change-of-shift report about the following patients on the telemetry unit. Which of the following patients should the nurse see first?
- A. A patient with atrial fibrillation, rate 88, who has a new order for warfarin
- B. A patient with type 1 second-degree atrioventricular (AV) block, rate 60, who is dizzy when ambulating
- C. A patient who is in a sinus rhythm, rate 98, after having electrical cardioversion 2 hours ago
- D. A patient whose implantable cardioverter-defibrillator (ICD) fired three times today who has a dose of amiodarone due
Correct Answer: D
Rationale: The frequent firing of the ICD indicates that the patient's ventricles are very irritable, and the priority is to assess the patient and administer the amiodarone. The other patients may be seen after the amiodarone is administered.
The nurse is interpreting an ECG strip to determine whether there is a delay in impulse conduction above the ventricles. Which of the following components of an ECG strip should the nurse measure?
- A. P-wave
- B. P-R interval
- C. Q-T interval
- D. QRS complex
Correct Answer: B
Rationale: The P-R interval represents depolarization of the atria, atrioventricular (AV) node, bundle of His, bundle branches, and the Purkinje fibres. The QRS represents ventricular depolarization. The Q-T interval represents depolarization and repolarization of the entire conduction system.
The nurse is analyzing an electrocardiogram rhythm strip of a patient with a regular cardiac rhythm and finds there are 25 small blocks from one R wave to the next. The nurse calculates the patient's heart rate as beats per minute.
Correct Answer: 60
Rationale: There are 1500 small blocks in a minute, and the nurse will divide 1500 by 25 to calculate the heart rate, resulting in 60 beats per minute.
The nurse is caring for a patient who has a normal cardiac rhythm and a heart rate of 72 beats/minute, except that the P-R interval is 0.24 seconds. Which of the following actions should the nurse implement?
- A. Notify the patient's health care provider immediately.
- B. Administer atropine per agency bradycardia protocol.
- C. Prepare the patient for temporary pacemaker insertion.
- D. Document the finding and continue to monitor the patient.
Correct Answer: D
Rationale: First-degree atrioventricular (AV) block is asymptomatic and requires ongoing monitoring because it may progress to more serious forms of heart block. The rate is normal, so there is no indication that atropine is needed. Immediate notification of the health care provider about an asymptomatic rhythm is not necessary.
Which of the following actions by a new nurse who is caring for a patient who has just had an implantable cardioverter-defibrillator (ICD) inserted indicates a need for more education about care of patients with ICDs?
- A. The nurse assists the patient to do active range-of-motion exercises for all extremities.
- B. The nurse assists the patient to fill out the application for obtaining a Medic Alert ID and bracelet.
- C. The nurse gives atenolol to the patient without consulting first with the health care provider.
- D. The nurse teaches the patient that sexual activity usually can be resumed once the surgical incision is healed.
Correct Answer: A
Rationale: The patient should avoid moving the arm on the ICD insertion site until healing has occurred in order to prevent displacement of the ICD leads. The other actions by the new nurse are appropriate for this patient.