A nurse is monitoring a client who is on telemetry. Which of the following findings on the ECG strip should the nurse recognize as normal sinus rhythm?

The T wave is in the inverted position.

The P wave falls before the QRS complex.

The QRS duration is 0.20 seconds.

The P-R interval measures 0.22 seconds.

Answer and Explanation

The Correct Answer is B

A. The T wave in the inverted position can indicate ischemia or electrolyte imbalances but does not define normal sinus rhythm.
B. The P wave falling before the QRS complex is characteristic of normal sinus rhythm.
C. A QRS duration of 0.20 seconds is within the normal range and does not specifically define normal sinus rhythm.
D. The P-R interval typically ranges from 0.12 to 0.20 seconds, and a slightly prolonged interval here wouldn't necessarily exclude normal sinus rhythm.

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Correct Answer is C

Explanation

A. Antidiuretic hormone (ADH) levels are not typically affected by alcohol or acetaminophen use.
B. Amylase levels are related to pancreatic function and are not specifically affected by alcohol or acetaminophen use.
C. Aspartate aminotransferase (AST) is a liver enzyme that can be elevated in alcohol-induced liver damage and acetaminophen toxicity.
D. Creatinine levels assess kidney function and are not typically affected by alcohol or acetaminophen use to the extent that AST levels are.

A. (Select all that apply.) B. Low back pain C. Urine color D. Blood pressure E. Respiratory rate

Correct Answer is ["C","D"]

Explanation

A. While low back pain can be concerning, it's not an immediate priority compared to the vital sign changes. However, the nurse should document the pain and ask about its characteristics.
B. Brown-colored urine can sometimes indicate dehydration or certain medical conditions, requiring follow-up.
C. A significant drop in blood pressure (74/50 mmHg) indicates hypotension and requires immediate attention.
D. An increase in respiratory rate (28 breaths/min) suggests the client may be experiencing respiratory distress and needs evaluation.
E. The client’s oxygen saturation is 95% on room air which is normal.

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A nurse is monitoring a client who is on telemetry. Which of the following findings on the ECG strip should the nurse recognize as normal sinus rhythm?

Nursing Test Bank

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