The client arrives to the emergency department with syncope. After placing the telemetry monitor on the client, the nurse sees this rhythm. How should the nurse interpret this rhythm?

Complete (third-degree) heart block

Pacemaker rhythm

Sinus bradycardia

First-degree heart block

Answer and Explanation

The Correct Answer is B

A. Complete (third-degree) heart block: This rhythm is characterized by a lack of relationship between P waves and QRS complexes, indicating a complete dissociation between atrial and ventricular activity.

B. A pacemaker rhythm on an ECG is characterized by the presence of pacing spikes followed by P waves or QRS complexes, depending on whether the pacemaker is pacing the atrium or the ventricle. If the pacemaker is pacing the ventricle, the pacing spike will be followed by a QRS complex. The QRS complexes in a paced rhythm are often wider than normal.

C. Sinus bradycardia: Sinus bradycardia is a slow but regular rhythm originating from the sinus node, with normal P waves and QRS complexes.

D. First-degree heart block: First-degree heart block is characterized by a prolonged PR interval (greater than 0.20 seconds) but with all P waves followed by QRS complexes, differing from third-degree heart block.

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Correct Answer is B

Explanation

A. To increase hydration: This is not a priority in terminal care. In fact, increasing hydration can be uncomfortable for dying patients who are often unable to process fluids effectively.

B. To control symptoms: The primary focus in end-of-life care is to manage symptoms, such as pain, difficulty breathing, and anxiety, to ensure the patient is as comfortable as possible.

C. To promote nutrition: At the end of life, promoting nutrition is usually not the priority, as the client may no longer desire food and may be unable to tolerate it.

D. To limit environmental hazards: While important, it is not the priority in terminal care. The focus should be on comfort and symptom control.

A. Decerebrate posturing B. Decorticate posturing C. Flexion withdrawal D. Localization of pain

Correct Answer is B

Explanation

A. Decerebrate posturing: This involves extension and outward rotation of the arms, which is not observed here.

B. Decorticate posturing: Internal rotation, adduction, and flexion of the arms are characteristic of decorticate posturing, indicating damage to the corticospinal tract.

C. Flexion withdrawal: This refers to pulling away from a painful stimulus and does not involve the described pattern of movement.

D. Localization of pain: This is an intentional movement toward the source of pain, which is not demonstrated in this scenario.

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The client arrives to the emergency department with syncope. After placing the telemetry monitor on the client, the nurse sees this rhythm. How should the nurse interpret this rhythm?

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