You are observing cardiac rhythms for patients in the coronary care unit. Which of these patients will need immediate intervention?
A patient admitted with heart failure who has atrial fibrillation with a rate of 88 bpm while at rest.
A patient with a newly implanted demand ventricular pacemaker, who has sinus rhythm, rate 90 to 100 bpm.
A patient who has just arrived on the unit with an acute MI and has sinus rhythm, rate 76 bpm, with frequent premature ventricular contractions.
A patient who recently started taking atenolol (Tenormin) and has a first-degree heart block, rate 58 bpm.
The Correct Answer is C
A. A patient admitted with heart failure who has atrial fibrillation with a rate of 88 bpm while at rest: Atrial fibrillation with a controlled ventricular rate (typically <100 bpm) is generally stable. While the patient requires monitoring for thromboembolism and rate control, this rhythm does not necessitate immediate intervention.
B. A patient with a newly implanted demand ventricular pacemaker, who has sinus rhythm, rate 90 to 100 bpm: The pacemaker appears to be functioning appropriately, and the patient’s heart rate is within normal limits. No urgent intervention is required, though routine monitoring of pacemaker function should continue.
C. A patient who has just arrived on the unit with an acute MI and has sinus rhythm, rate 76 bpm, with frequent premature ventricular contractions: Frequent PVCs in the setting of an acute myocardial infarction can indicate myocardial irritability and an increased risk of life-threatening arrhythmias, such as ventricular tachycardia or fibrillation. This patient requires immediate close monitoring, assessment, and potential intervention.
D. A patient who recently started taking atenolol (Tenormin) and has a first-degree heart block, rate 58 bpm: First-degree AV block with a slightly low heart rate while on a beta-blocker is usually stable and asymptomatic. The patient should be monitored, but immediate intervention is not typically necessary unless symptoms like syncope or hypotension develop.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. The P-R interval measures 0.22 seconds: A normal PR interval ranges from 0.12 to 0.20 seconds. A measurement of 0.22 seconds indicates a first-degree AV block, which is not considered normal sinus rhythm.
B. The QRS duration is 0.20 seconds: Normal QRS duration is 0.06–0.10 seconds. A QRS of 0.20 seconds is prolonged, suggesting a bundle branch block or ventricular conduction delay, which deviates from normal sinus rhythm.
C. The P wave falls before the QRS complex: In normal sinus rhythm, the electrical impulse originates in the SA node, producing a P wave before each QRS complex. This indicates normal atrial depolarization followed by ventricular depolarization and is the hallmark of NSR.
D. The T wave is in the inverted position: T wave inversion is abnormal and may indicate myocardial ischemia, ventricular strain, or other pathology. Normal sinus rhythm is characterized by upright T waves in most leads.
Correct Answer is B
Explanation
A. Adenosine: Adenosine is used to terminate paroxysmal supraventricular tachycardia (PSVT) by transiently blocking AV nodal conduction. It is not effective for atrial fibrillation because AF originates in the atria with multiple ectopic foci, so adenosine cannot restore sinus rhythm in this arrhythmia.
B. Verapamil: Verapamil is a calcium channel blocker that slows conduction through the AV node and can be used for rate control in atrial fibrillation. While not typically first-line for rhythm conversion, it is sometimes employed in chemical cardioversion strategies to control ventricular response or assist with cardioversion in select patients.
C. Lidocaine: Lidocaine is an antiarrhythmic primarily used for ventricular arrhythmias, such as ventricular tachycardia or ventricular fibrillation. It does not effectively convert atrial fibrillation to sinus rhythm and is therefore not indicated for chemical cardioversion in AF.
D. Epinephrine: Epinephrine is a sympathomimetic used in cardiac arrest or severe bradycardia to increase cardiac output and perfusion. It is not used for chemical cardioversion of atrial fibrillation and could potentially exacerbate arrhythmias if administered inappropriately.
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