The nurse is attempting to determine the ventricular rate and rhythm of a patient's telemetry strip. What should the nurse examine to determine this part of the analysis?
RR Interval
QT interval
PP interval
PR interval
The Correct Answer is A
A. RR Interval:
The RR interval is the time between two consecutive R waves on an electrocardiogram (ECG) strip. It is primarily used to determine the ventricular rate and rhythm of the heart. A regular RR interval suggests a regular heart rhythm, while irregular intervals may indicate arrhythmias or other cardiac abnormalities. Calculating the RR interval can help determine the heart rate (ventricular rate) by dividing 60 seconds by the RR interval in seconds (e.g., if the RR interval is 0.8 seconds, the heart rate would be approximately 75 beats per minute).
B. QT Interval:
The QT interval represents the time from the start of the Q wave to the end of the T wave on an ECG. It reflects the time it takes for the ventricles to depolarize and repolarize. Prolongation or shortening of the QT interval can indicate certain cardiac conditions or medication effects, including an increased risk of arrhythmias such as torsades de pointes. However, it is not directly used to determine ventricular rate and rhythm as the RR interval is.
C. PP Interval:
The PP interval is the time between two consecutive P waves on an ECG strip. It is primarily used to assess the atrial rate and rhythm. Regular PP intervals indicate a regular atrial rhythm, while irregular intervals may suggest atrial arrhythmias such as atrial fibrillation or atrial flutter. The PP interval is not directly used to determine ventricular rate and rhythm.
D. PR Interval:
The PR interval is the time from the start of the P wave to the start of the QRS complex on an ECG strip. It represents the time it takes for the electrical impulse to travel from the atria to the ventricles. A normal PR interval is typically between 0.12 to 0.20 seconds. Prolongation or shortening of the PR interval can indicate certain cardiac conduction abnormalities.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","C","D","E","F"]
Explanation
A. Numbness in extremities: Numbness in extremities is not a common adverse effect of digoxin. The focus of digoxin monitoring is primarily on cardiovascular and gastrointestinal effects.
B. Fatigue: Fatigue is a common adverse effect of digoxin and can indicate toxicity or overdose. Clients taking digoxin should be monitored for increased fatigue or weakness.
C. Shortness of breath: Shortness of breath can occur as an adverse effect of digoxin toxicity, particularly if it leads to pulmonary congestion or heart failure exacerbation.
D. Anorexia: Anorexia, or loss of appetite, can be a gastrointestinal adverse effect of digoxin. Clients may experience nausea, vomiting, or anorexia, which can contribute to weight loss and electrolyte imbalances.
E. Chest pain: Chest pain can be a sign of digoxin toxicity, especially if it is associated with other symptoms such as shortness of breath or palpitations. It is essential to evaluate any chest pain in a client taking digoxin.
F. Confusion: Confusion or changes in mental status can occur with digoxin toxicity, particularly in older adults. Clients should be monitored for signs of confusion, delirium, or other cognitive changes.
Correct Answer is C
Explanation
A. Weigh yourself once a week:
This is an important part of heart failure management as weight gain can indicate fluid retention, a common symptom of heart failure. The nurse should instruct the client to weigh themselves at the same time of day, using the same scale, and wearing similar clothing each time. Any sudden weight gain should be reported to the healthcare provider promptly.
B. Drink 3 liters of fluid per day:
This option is not appropriate for most heart failure patients, especially those with fluid retention issues. Fluid intake should be monitored and restricted based on the individual's condition and healthcare provider's recommendations. Consuming too much fluid can exacerbate fluid retention and worsen heart failure symptoms.
C. Engage in exercise daily:
Exercise is generally recommended for heart failure patients, but the type, intensity, and frequency of exercise should be tailored to the individual's condition. The nurse should encourage the client to engage in regular physical activity as tolerated, following a structured exercise plan approved by their healthcare provider. Activities like walking, cycling, or water aerobics can be beneficial for heart health.
D. Restrict dietary potassium:
This option is not typically included in lifestyle modifications for heart failure unless the client has specific potassium-related issues or is taking medications that require potassium restriction. Potassium is an important electrolyte for heart function, and most heart failure patients are advised to consume a balanced diet with moderate potassium intake, unless otherwise directed by their healthcare provider.
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