A nurse is caring for a client with a ventricular pacemaker who is on ECG monitoring. The nurse understands that the pacemaker is functioning properly when which of the following appears on the monitor strip?
Pacemaker spikes before each QRS complex
Pacemaker spikes after each QRS complex
Pacemaker spikes before each P wave
Pacemaker spikes with each T wave
The Correct Answer is A
A. Pacemaker spikes before each QRS complex: This is the correct answer. In a client with a ventricular pacemaker, the pacemaker spikes should precede each QRS complex on the ECG strip. This indicates that the pacemaker is appropriately stimulating the ventricles to depolarize and initiate a heartbeat. The
presence of pacemaker spikes before each QRS complex signifies that the pacemaker is functioning properly and effectively pacing the ventricles.
B. Pacemaker spikes occurring after each QRS complex would suggest a malfunction or inappropriate timing of the pacemaker. In this scenario, the pacemaker would not be pacing the ventricles as intended. This would be an abnormal finding and would require further assessment and intervention.
C. Pacemaker spikes preceding each P wave would suggest pacing of the atria rather than the ventricles. This would indicate a different type of pacemaker (atrial pacemaker) or inappropriate pacing settings for a ventricular pacemaker. In either case, it would be considered abnormal for a ventricular pacemaker and would require evaluation and possibly reprogramming of the pacemaker.
D. Pacemaker spikes occurring with each T wave would be an abnormal finding and would suggest interference or oversensing by the pacemaker. This could lead to inappropriate pacing or dysrhythmias. It would require further investigation and correction to ensure proper pacemaker function.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
C. Amiodarone is a Class III antiarrhythmic medication commonly used for the acute management of atrial fibrillation with a rapid ventricular rate. It works by blocking multiple ion channels, prolonging the action potential duration, and slowing conduction in the atria and ventricles. Amiodarone is often used when other interventions such as vagal maneuvers or beta blockers are ineffective or contraindicated. In this scenario, where the patient is hypotensive and symptomatic, intravenous amiodarone may be administered to control the ventricular rate and stabilize hemodynamics
A. Bearing down, or the Valsalva maneuver, is a vagal maneuver that can sometimes help slow the heart rate in certain arrhythmias by increasing parasympathetic tone. However, it may not be effective or safe in all situations, especially if the patient is hypotensive or confused. In this scenario, immediate pharmacological intervention is likely needed to control the heart rate and stabilize hemodynamics.
B. Lidocaine is not typically used to treat atrial fibrillation with a rapid ventricular rate. Lidocaine is a Class IB antiarrhythmic medication primarily used for the treatment of ventricular arrhythmias, such as ventricular tachycardia and ventricular fibrillation. It is not considered a first-line agent for atrial fibrillation and may not effectively control the ventricular rate in this situation.
D. While beta blockers are commonly used for rate control in atrial fibrillation, they may not be the best choice in this scenario where the patient is hypotensive and symptomatic. Beta blockers can further decrease blood pressure and exacerbate hypotension, especially in patients with compromised hemodynamics. In such cases, other rate-controlling agents like calcium channel blockers or amiodarone may be preferred.
Correct Answer is A
Explanation
A. Atropine is commonly used in the treatment of symptomatic bradycardia. It works by blocking vagal stimulation, leading to increased heart rate. Atropine is typically administered in doses of 0.5 to 1 mg every 3 to 5 minutes, up to a total dose of 3 mg, in patients with symptomatic bradycardia.
B. Sodium bicarbonate is not indicated for symptomatic bradycardia. It is primarily used in the management of metabolic acidosis, hyperkalemia, and certain drug overdoses. While sodium bicarbonate may be administered in specific situations during cardiopulmonary resuscitation (CPR), it is not the first-line treatment for symptomatic bradycardia.
C. Magnesium sulfate is used in the treatment of certain arrhythmias, such as torsades de pointes and refractory ventricular fibrillation or ventricular tachycardia associated with hypomagnesemia. However, it is not the first-line treatment for symptomatic bradycardia. Magnesium sulfate may be considered if there are specific indications such as torsades de pointes or suspected hypomagnesemia.
D. Epinephrine is commonly used in advanced cardiac life support (ACLS) protocols for cardiac arrest. It is not the first-line treatment for symptomatic bradycardia. Epinephrine is primarily used during CPR to improve coronary and cerebral perfusion by increasing systemic vascular resistance and heart rate.
However, in the case of symptomatic bradycardia, atropine is typically preferred as the initial medication.
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