A patient's sinus rhythm rate is 62. The PR interval is 0.18 seconds at 1:00 AM, 0.20 seconds at 12:30 PM, and 0.23 seconds at 4:00 PM. Which action should the nurse take?
Hold the ordered metoprolol (Lopressor) and call the health care provider.
Give the PRN dose of Amiodarone.
Prepare for possible pacemaker insertion.
Document the patient's rhythm and continue to monitor.
The Correct Answer is D
A. Hold the ordered metoprolol (Lopressor) and call the health care provider: The PR interval measurements (0.18–0.23 seconds) are within or just slightly above the upper limit of normal (0.12–0.20 seconds). A minor prolongation without symptoms does not require holding beta-blockers or contacting the provider immediately.
B. Give the PRN dose of Amiodarone: Amiodarone is used for treating significant arrhythmias, such as atrial fibrillation or ventricular tachyarrhythmias. The patient’s sinus rhythm with a mildly prolonged PR interval does not indicate a need for antiarrhythmic therapy at this time.
C. Prepare for possible pacemaker insertion: Pacemaker insertion is reserved for symptomatic bradycardia or high-degree AV block. A PR interval of 0.23 seconds is only a first-degree AV block, which is often asymptomatic and does not necessitate immediate pacemaker placement.
D. Document the patient's rhythm and continue to monitor: The patient’s rhythm is sinus with a slightly prolonged PR interval that remains stable and asymptomatic. The appropriate nursing action is ongoing monitoring and documentation, ensuring that any progression or new symptoms are promptly identified.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. anti-inflammatory: While aspirin has anti-inflammatory properties, the primary reason it is prescribed for a client with a history of myocardial infarction is not to reduce inflammation but to prevent thrombotic events. Anti-inflammatory effects are secondary in this context.
B. analgesic: Aspirin can relieve mild pain, such as headaches or musculoskeletal discomfort. However, in post-MI management, pain relief is not the therapeutic goal; the focus is on preventing further cardiac events.
C. antiplatelet aggregate: Aspirin inhibits platelet aggregation by irreversibly blocking cyclooxygenase-1 (COX-1) and thromboxane A2 formation. This reduces the risk of clot formation in coronary arteries, preventing recurrent myocardial infarction or other thromboembolic events, which is why it is prescribed at this dosage for post-MI patients.
D. antipyretic: Aspirin can lower fever by affecting the hypothalamic thermoregulatory center, but antipyretic effects are not relevant in the management of a patient with a history of myocardial infarction.
Correct Answer is A
Explanation
A. Applying gel pads to the patient's chest: Proper placement of defibrillator pads is essential for effective delivery of the electrical shock. Gel pads or adhesive electrodes reduce chest wall resistance, improve conductivity, and ensure the shock reaches the myocardium efficiently, which is critical for successful defibrillation.
B. Setting the defibrillator to a synchronized mode: Synchronized mode is used for cardioversion, not defibrillation. In defibrillation, the shock is delivered immediately and unsynchronized to terminate life-threatening arrhythmias like ventricular fibrillation or pulseless ventricular tachycardia. Using synchronized mode would delay therapy and reduce effectiveness.
C. Sedating the patient with midazolam (Versed) before defibrillation: Sedation is only considered for elective synchronized cardioversion in conscious patients. In emergency defibrillation of an unresponsive patient, sedation is unnecessary and could delay critical life-saving intervention.
D. Looking for R-wave markers: R-wave markers are used to time synchronized cardioversion to avoid delivering a shock during ventricular repolarization (T wave). In defibrillation for pulseless or chaotic ventricular rhythms, synchronization is not used, so R-wave markers are not relevant.
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