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

Answer and Explanation

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.

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Correct Answer is B

Explanation

B. A client who is postoperative with shallow respirations at a rate of 9/min is likely not adequately eliminating carbon dioxide from their body due to hypoventilation. This retention of carbon dioxide can lead to an increase in the partial pressure of CO2 in the blood, causing an acidotic state.

A. Metabolic acidosis results from an accumulation of acids in the body or a loss of bicarbonate. Hypoventilation leading to respiratory acidosis does not directly cause metabolic acidosis.

C. Respiratory alkalosis occurs when there is excessive elimination of CO2 from the body, leading to decreased arterial carbon dioxide levels (hypocapnia) and an increase in pH. Shallow respirations and decreased respiratory rate are more consistent with hypoventilation and respiratory acidosis rather than hyperventilation and respiratory alkalosis.

D. Metabolic alkalosis results from excessive loss of acids or increased bicarbonate levels in the body. Hypoventilation leading to respiratory acidosis does not directly cause metabolic alkalosis.

A. Pulmonary artery wedge pressure (PAWP) is low. B. Systemic vascular resistance (SVR) is elevated. C. Mean arterial pressure (MAP) is 56 mm Hg D. Heart rate is slow at 58 beats/min.

Correct Answer is C

Explanation

C. Mean arterial pressure (MAP) reflects the average pressure in the arteries during one cardiac cycle and is an important indicator of tissue perfusion. A MAP of 56 mm Hg is below the normal range (typically >60 mm Hg) and may indicate inadequate tissue perfusion. While norepinephrine is commonly used to increase blood pressure and improve tissue perfusion in hypotensive patients, a MAP of 56 mm Hg suggests that the current infusion rate may not be sufficient to maintain adequate perfusion, and adjusting the infusion rate may be warranted.

A. Norepinephrine is a vasopressor medication primarily used to increase blood pressure in patients with hypotension or shock. A low pulmonary artery wedge pressure (PAWP) suggests decreased preload, which may indicate hypovolemia or inadequate fluid resuscitation. In this case, adjusting the norepinephrine infusion rate may not be necessary, but rather addressing the underlying cause of hypovolemia or inadequate preload.

B. Systemic vascular resistance (SVR) represents the resistance the heart must overcome to pump blood into the systemic circulation. An elevated SVR may suggest vasoconstriction, which could be a desired effect of norepinephrine infusion to increase blood pressure. Therefore, an elevated SVR may not necessarily indicate a need to adjust the norepinephrine infusion rate, as it may reflect the medication's intended action.

D. Norepinephrine primarily acts on alpha-adrenergic receptors to increase blood pressure by inducing vasoconstriction. While it may cause reflex bradycardia due to increased systemic vascular resistance, a heart rate of 58 beats/min may be within an acceptable range depending on the patient's clinical condition and baseline heart rate. Therefore, a slow heart rate alone may not necessarily indicate a need to adjust the norepinephrine infusion rate unless it is associated with signs of inadequate tissue perfusion or other concerning symptoms.

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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?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is B

Explanation

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Correct Answer is C

Explanation

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