A nurse is analyzing a client's electrocardiogram strip and identifies the following information: Heart rate: 92/min, Rhythm: Irregular, P wave: Unable to identify, PR interval: Unable to measure, QRS duration: 0.10 seconds.
Based upon this information, the nurse should interpret the client's rhythm as indicating which of the following?

First-degree heart block.

Supraventricular tachycardia.

Sinus bradycardia.

Atrial fibrillation.

Answer and Explanation

The Correct Answer is D

Choice A rationale

First-degree heart block is characterized by a prolonged PR interval (greater than 0.20 seconds) due to a delay in the conduction of the electrical impulse from the atria to the ventricles. The ECG strip described lacks identifiable P waves and a measurable PR interval, thus ruling out first-degree heart block. The QRS duration is within the normal range (0.06-0.10 seconds), which is also inconsistent with higher-degree AV blocks that might show a widened QRS complex if a ventricular escape rhythm is present.

Choice B rationale

Supraventricular tachycardia (SVT) is characterized by a rapid heart rate (typically greater than 150 beats per minute) originating above the ventricles. While the rhythm might be regular or slightly irregular depending on the specific type of SVT, P waves are usually present, although they may be abnormal in morphology or hidden within the T wave. The ECG description indicates an irregular rhythm and the absence of identifiable P waves, making SVT an unlikely diagnosis.

Choice C rationale

Sinus bradycardia is defined by a slow heart rate (less than 60 beats per minute) originating from the sinoatrial (SA) node. The rhythm is regular, and P waves are present, preceding each QRS complex with a normal PR interval (0.12-0.20 seconds). The client's heart rate is 92 beats per minute, which is within the normal range (60-100 beats per minute), and the rhythm is irregular with no discernible P waves, thus excluding sinus bradycardia.

Choice D rationale

Atrial fibrillation (A-fib) is a common arrhythmia characterized by rapid, disorganized electrical activity in the atria, leading to an irregularly irregular ventricular response. The ECG findings of an irregular rhythm, the absence of identifiable P waves (replaced by fibrillatory waves, which are not explicitly mentioned but implied by the lack of P waves), and a normal QRS duration (indicating normal ventricular depolarization) are classic characteristics of atrial fibrillation. The heart rate can vary in A-fib; a rate of 92 beats per minute falls within a controlled ventricular response in the context of this arrhythmia.

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Correct Answer is C

Explanation

Choice A rationale

Bumetanide is a loop diuretic commonly used in acute heart failure to reduce fluid overload. A 1 mg IV bolus every 12 hours is a typical dose for diuresis in this setting.

Choice B rationale

Morphine sulfate is an opioid analgesic that can be used to relieve pain and anxiety associated with myocardial infarction. A 2 mg IV bolus every 2 hours PRN for pain is a reasonable prescription for pain management.

Choice C rationale

Administering 0.9% normal saline IV at 100 mL/hr continuous in a client with acute heart failure following an MI requires clarification. In heart failure, the heart's ability to pump blood effectively is compromised, and administering a continuous infusion of isotonic fluid can exacerbate fluid overload, leading to worsening pulmonary congestion and edema. The priority in heart failure is often fluid restriction, not fluid administration.

Choice D rationale

Laboratory testing of serum potassium upon admission is a standard practice in clients with acute heart failure, especially after an MI. Electrolyte imbalances, particularly potassium, can occur due to the stress of the MI, medication use (like diuretics), and can significantly impact cardiac function and increase the risk of arrhythmias. Normal serum potassium levels are typically 3.5-5.0 mEq/L. .

A. Plasma low-density lipoproteins (LDL). B. Myoglobin. C. Creatine kinase-MB (CK-MB). D. Troponin I. E. Troponin T.

Correct Answer is ["B","C","D","E"]

Explanation

Choice A rationale

Plasma low-density lipoproteins (LDL) are a measure of cholesterol levels and are primarily used to assess the risk of developing atherosclerosis, a long-term process that can contribute to myocardial infarction. However, LDL levels do not acutely rise in response to an MI and are not used for immediate diagnosis. Normal LDL levels are generally below 100 mg/dL.

Choice B rationale

Myoglobin is a heme protein found in cardiac and skeletal muscle. It is released into the bloodstream relatively quickly (within 1-3 hours) after myocardial injury. Elevated myoglobin levels can indicate muscle damage, but it lacks cardiac specificity as skeletal muscle injury can also cause its release. Normal myoglobin levels are typically less than 90 mcg/L.

Choice C rationale

Creatine kinase-MB (CK-MB) is an isoenzyme of creatine kinase that is more specific to cardiac muscle. CK-MB levels rise within 3-6 hours after the onset of myocardial infarction, peak at 12-24 hours, and return to normal within 2-3 days. An elevated CK-MB level supports the diagnosis of MI. Normal CK-MB levels are typically 0-3 ng/mL.

Choice D rationale

Troponin I is a cardiac-specific regulatory protein that is released into the bloodstream when myocardial damage occurs. Troponin I levels become elevated within 3-12 hours after the onset of MI, peak at 24-48 hours, and can remain elevated for 5-14 days. Troponin I is highly sensitive and specific for myocardial injury. Normal Troponin I levels are typically less than 0.04 ng/mL.

Choice E rationale

Troponin T is another cardiac-specific regulatory protein that is released into the bloodstream following myocardial infarction. Similar to Troponin I, Troponin T levels rise within 3-12 hours, peak at 12-48 hours, and can remain elevated for up to 14 days. Elevated Troponin T levels are a sensitive and specific marker for cardiac muscle damage. Normal Troponin T levels are typically less than 0.1 ng/mL.

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Naxlex Comprehensive Predictor Exams

A nurse is admitting a client who has acute heart failure following myocardial infarction (MI). The nurse recognizes that which of the following prescriptions by the provider requires clarification?

Correct Answer is C

Explanation

A nurse in an emergency department is caring for a client who reports substernal chest pain and dyspnea.The client is vomiting and is diaphoretic.Which of the following laboratory tests are used to diagnose a myocardial infarction?

Correct Answer is ["B","C","D","E"]

Explanation

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