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When analyzing the waveforms of a patient's electrocardiogram (ECG), the nurse will need to investigate further upon assessing which of the following findings?
- A. T wave of 0.16 second
- B. P-R interval of 0.18 second
- C. Q-T interval of 0.34 second
- D. QRS interval of 0.14 second
Correct Answer: D
Rationale: Because the normal QRS interval is 0.04-0.10 seconds, the patient's QRS interval of 0.14 seconds indicates that the conduction through the ventricular conduction system is prolonged. The P-R interval, Q-T interval, and T-wave interval are within the normal range.
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The nurse is caring for a patient who develops sinus bradycardia at a rate of 32 beats/minute, has a BP of 80/36 mm Hg, and symptoms of feeling faint. Which of the following actions should the nurse take?
- A. Continue to monitor the rhythm and BP
- B. Apply the transcutaneous pacemaker (TCP).
- C. Have the patient perform the Valsalva manoeuvre.
- D. Give the scheduled dose of diltiazem.
Correct Answer: B
Rationale: The patient is experiencing symptomatic bradycardia, and treatment with TCP is appropriate. Continued monitoring of the rhythm and BP is an inadequate response. Calcium channel blockers will further decrease the heart rate, and the diltiazem should be held. The Valsalva manoeuvre will further decrease the rate.
Which of the following information will the nurse include when teaching a patient who is scheduled to have a permanent pacemaker inserted for treatment of chronic atrial fibrillation with slow ventricular response?
- A. The pacemaker prevents or minimizes ventricular irritability.
- B. The pacemaker paces the atria at rates up to 500 impulses/minute.
- C. The pacemaker discharges if ventricular fibrillation and cardiac arrest occur.
- D. The pacemaker stimulates a heartbeat if the patient's heart rate drops too low.
Correct Answer: D
Rationale: The permanent pacemaker will discharge when the ventricular rate drops below the set rate. The pacemaker will not decrease ventricular irritability or discharge if the patient develops ventricular fibrillation. Since the patient has a slow ventricular rate, overdrive pacing will not be used.
The nurse is caring for a patient whose cardiac monitor shows sinus rhythm, rate 60-70. The P-R interval is 0.18 seconds at 1:00 A.M., 0.20 seconds at 2:30 P.M., and 0.23 seconds at 4:00 P.M. Which of the following actions should the nurse take at this time?
- A. Prepare for possible temporary pacemaker insertion.
- B. Administer atropine sulphate 1 mg IV per agency protocol.
- C. Document the patient's rhythm and assess the patient's response to the rhythm.
- D. Hold the dose of metoprolol and call the health care provider.
Correct Answer: D
Rationale: The patient has progressive first-degree atrioventricular (AV) block, and the β-blocker should be held until discussing the medication with the health care provider. Documentation and assessment are appropriate but not fully adequate responses. The patient with first-degree AV block usually is asymptomatic, and a pacemaker is not indicated. Atropine is sometimes used for symptomatic bradycardia, but there is no indication that this patient is symptomatic.
The nurse is caring for a young adult patient who had a mandatory electrocardiogram (ECG) before participating on a college swim team and is found to have sinus bradycardia, rate 52. BP is 114/54 mm Hg, and the student denies any health problems. Which of the following actions by the nurse is best?
- A. Allow the student to participate on the swim team.
- B. Refer the student to a cardiologist for further assessment.
- C. Obtain more detailed information about the student's health history.
- D. Tell the student to stop swimming immediately if any dyspnea occurs.
Correct Answer: A
Rationale: In an aerobically trained individual, sinus bradycardia is normal. The student's normal BP and negative health history indicate that there is no need for a cardiology referral or for more detailed information about the health history. Dyspnea during an aerobic activity such as swimming is normal.
The nurse obtains a monitor strip on a patient who has had a myocardial infarction and makes the following analysis. P wave not apparent, ventricular rate 162, R-R interval regular, P-R interval not measurable, and QRS complex wide and distorted, QRS duration 0.18 second. Which of the following cardiac rhythms should the nurse interpret from these findings?
- A. Atrial fibrillation
- B. Sinus tachycardia
- C. Ventricular fibrillation
- D. Ventricular tachycardia
Correct Answer: D
Rationale: The absence of P waves, wide QRS, rate >150, and the regularity of the rhythm indicate ventricular tachycardia. Atrial fibrillation is grossly irregular, has a narrow QRS configuration, and has fibrillatory atrial activity. Sinus tachycardia has P waves. Ventricular fibrillation is irregular and does not have a consistent QRS duration.