A patient's heart monitor shows HR 78 with progressive lengthening of the PR interval over time. What is the most appropriate action for the nurse to take next?
Notify the healthcare provider about the changes in PR interval.
increase the patient's activity level to stimulate heart rate.
Administer metoprolol as scheduled.
initiate atropine administration to increase heart rate.
The Correct Answer is A
Rationale:
A. Progressive lengthening of the PR interval indicates a first-degree or potentially worsening second-degree AV block. Notifying the provider is essential to prevent further conduction deterioration and potential progression to complete heart block, which can be life-threatening.
B. Increasing activity could exacerbate bradycardia or AV block symptoms (e.g., dizziness, syncope) and is unsafe in this context.
C. Beta-blockers like metoprolol can further slow AV conduction, potentially worsening the block, so giving it without provider consultation is unsafe.
D. Atropine is indicated for symptomatic bradycardia, but this patient currently has a normal HR (78) and is asymptomatic. Immediate administration is not warranted; the priority is assessment and provider notification.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Rationale:
A. PT measures the extrinsic and common coagulation pathways, which are affected by warfarin therapy. Warfarin inhibits vitamin K–dependent clotting factors (II, VII, IX, X), prolonging PT. Nurses also often monitor the international normalized ratio (INR), which standardizes PT results to guide therapeutic dosing. For clients with an artificial heart valve, the therapeutic INR range is usually 2.5–3.5.
B. aPTT measures the intrinsic coagulation pathway and is primarily used to monitor heparin therapy, not warfarin. It does not reflect the anticoagulant effect of warfarin.
C. Hemoglobin measures the oxygen-carrying capacity of the blood and can indicate anemia, but it does not provide information about coagulation or warfarin effectiveness.
D. Bleeding time evaluates platelet function, not the effect of anticoagulants like warfarin. Warfarin primarily affects clotting factor synthesis, not platelet function.
Correct Answer is A
Explanation
Rationale:
A. Percutaneous transluminal balloon valvuloplasty (PTBV) is a minimally invasive procedure that dilates the stenotic mitral valve without replacing it. Since no prosthetic valve is implanted, clients typically do not require lifelong anticoagulation, which is a major advantage over mechanical valve replacement.
B. While PTBV is less invasive than open surgery, it usually requires moderate sedation or general anesthesia for patient comfort and safety. Local anesthesia alone is rarely sufficient.
C. PTBV improves valve opening temporarily, but valve restenosis can occur over time, so the correction is not necessarily permanent. Valve replacement provides a more long-term solution.
D. While PTBV avoids prosthetic material and thus may reduce some infection risks, infection is generally not the primary concern with valve replacement, and the overall difference in infection risk is not a primary advantage cited for PTBV.
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