Identify the telemetry strip below.

Choice A rationale

A ventricular pacemaker is designed to pace the ventricles, not the atria. Therefore, a pacemaker spike appearing before each P wave would indicate atrial pacing, which is not the primary function of a ventricular pacemaker. P waves represent atrial depolarization, and a ventricular pacemaker's stimulus is delivered to the ventricles to initiate a QRS complex.

Choice B rationale

A pacemaker spike appearing after each QRS complex suggests either oversensing, undersensing with competitive rhythms, or a malfunction. The purpose of a pacemaker spike is to *initiate* depolarization, not to follow it. If the spike occurs after the QRS, it indicates that the ventricle has already depolarized, and the spike is not contributing to ventricular contraction.

Choice C rationale

A pacemaker spike appearing with each T wave would be inappropriate and potentially dangerous. The T wave represents ventricular repolarization, a vulnerable period during which an electrical stimulus can induce life-threatening arrhythmias like ventricular fibrillation (R-on-T phenomenon). Pacing should occur before ventricular depolarization, not during repolarization.

Choice D rationale

A ventricular pacemaker functions by delivering an electrical impulse to the ventricle when its intrinsic rate falls below a programmed threshold. This impulse, seen as a pacemaker spike on the ECG, should precede ventricular depolarization, thus initiating a QRS complex. This indicates that the pacemaker is effectively stimulating ventricular contraction at the appropriate time.

Choice A rationale

A blood pressure of 124/79 mm Hg is not within the expected reference range for normotension. The expected reference range for normal blood pressure is typically defined as systolic blood pressure less than 120 mm Hg AND diastolic blood pressure less than 80 mm Hg, reflecting optimal cardiovascular health and minimal risk.

Choice B rationale

Stage 1 hypertension is defined by a systolic blood pressure between 130-139 mm Hg OR a diastolic blood pressure between 80-89 mm Hg. The client's blood pressure of 124/79 mm Hg does not meet these criteria, as both values are below the threshold for stage 1 hypertension.

Choice C rationale

A blood pressure of 124/79 mm Hg falls into the category of "elevated blood pressure.”. This classification is defined by a systolic blood pressure between 120-129 mm Hg AND a diastolic blood pressure less than 80 mm Hg, indicating a higher risk for developing hypertension.

Choice D rationale

Stage 2 hypertension is characterized by a systolic blood pressure of 140 mm Hg or higher OR a diastolic blood pressure of 90 mm Hg or higher. The client's blood pressure of 124/79 mm Hg is significantly below these thresholds, thus ruling out a diagnosis of stage 2 hypertension.