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 A

Explanation

Choice A rationale

Nausea, vomiting, and weakness are potential signs of digoxin toxicity, especially when coupled with a refusal to eat, which could indicate electrolyte imbalances exacerbating the toxicity. Digoxin has a narrow therapeutic index (0.5-2.0 ng/mL), and these symptoms warrant immediate notification of the provider for potential medication adjustment and further evaluation, including checking digoxin levels and electrolytes.

Choice B rationale

Checking vital signs is a necessary step in assessing the client's overall condition. However, in the context of potential digoxin toxicity, this action alone does not address the underlying concern. Notifying the provider to order relevant tests and potential medication changes takes priority.

Choice C rationale

Suggesting rest before eating does not address the potential underlying cause of the nausea and weakness, which could be digoxin toxicity. Delaying appropriate intervention could lead to worsening toxicity and adverse effects.

Choice D rationale

Requesting an order for an antiemetic might alleviate the nausea, but it does not address the potential digoxin toxicity causing the symptom. Masking the symptom without identifying and treating the underlying cause could be harmful. .

A. Troponin T test. B. Creatine kinase (CK) test. C. Brain natriuretic peptide (BNP) test. D. Creatine kinase-myocardial band (CK-MB) test.

Correct Answer is A

Explanation

Choice A rationale

Troponin T is a cardiac-specific protein that is released into the bloodstream when myocardial damage occurs. It is highly sensitive and specific for cardiac injury, becoming elevated within 3 to 12 hours after the onset of myocardial infarction, peaking at 12 to 48 hours, and remaining elevated for 5 to 14 days. Normal values for Troponin T are typically less than 0.1 ng/mL, although reference ranges can vary slightly between laboratories. Its early elevation makes it a key indicator of recent cardiac muscle injury.

Choice B rationale

Creatine kinase (CK) is an enzyme found in various tissues, including the heart, skeletal muscle, and brain. While CK levels rise with myocardial infarction, they are less specific than troponin because elevations can also occur due to skeletal muscle injury. CK levels typically begin to rise 3 to 12 hours after the onset of chest pain, peak at 24 hours, and return to normal within 2 to 3 days. Normal total CK ranges from 55 to 170 U/L for men and 30 to 135 U/L for women.

Choice C rationale

Brain natriuretic peptide (BNP) is a hormone released primarily from the ventricles in response to increased ventricular volume and pressure. While BNP is a useful marker for heart failure and can be elevated after a myocardial infarction due to ventricular remodeling, it is not a primary indicator of early cardiac muscle injury. Normal BNP levels are generally less than 100 pg/mL, but values increase with age.

Choice D rationale

Creatine kinase-myocardial band (CK-MB) is an isoenzyme of CK that is more specific to cardiac muscle than total CK. CK-MB levels rise within 3 to 12 hours after myocardial infarction, peak at 18 to 24 hours, and return to normal within 2 to 3 days. While more specific to the heart than total CK, troponin is considered a more sensitive and specific marker for early myocardial injury. Normal CK-MB levels are typically less than 3-5% of total CK or less than 25 U/L.

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Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has congestive heart failure and is taking digoxin daily.The client refused breakfast and is complaining of nausea and weakness.Which of the following actions should the nurse take first?

Correct Answer is A

Explanation

A nurse is providing care for a client who experienced a myocardial infarction prior to a cardiac arrest.Which of the following laboratory tests will identify early injury to the cardiac muscle?

Correct Answer is A

Explanation

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