The nurse is caring for a client who is on cardiac telemetry monitoring and notes that the PR interval is 0.16 seconds. Which interpretation is correct for the nurse to make?

It indicates a normal depolarization of the atria.

It provides information about atrial repolarization.

It shows an early indication of first degree heart block.

It reflects a delayed conduction through the atria.

Answer and Explanation

The Correct Answer is A

A. It indicates a normal depolarization of the atria: A PR interval of 0.12–0.20 seconds is within the normal range, representing normal conduction through the atria and AV node.

B. It provides information about atrial repolarization: Atrial repolarization is obscured by the QRS complex and not reflected in the PR interval.

C. It shows an early indication of first-degree heart block: First-degree heart block is indicated by a PR interval longer than 0.20 seconds.

D. It reflects a delayed conduction through the atria: A delay in conduction would result in a prolonged PR interval.

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Correct Answer is C

Explanation

A. Thrombotic stroke. A thrombotic stroke develops more gradually and is not typically associated with such sudden and severe symptoms.

B. Embolic stroke. An embolic stroke is often associated with a known embolic source, such as a clot from the heart, and can present more suddenly, but without all the symptoms seen here.

C. Hemorrhagic stroke: Hemorrhagic strokes often present with a sudden, severe headache, vomiting, seizure activity, and high blood pressure. A fever may also develop due to increased intracranial pressure.

D. Transient ischemic attack (TIA). TIAs are brief and resolve within minutes to hours and do not typically cause seizures.

A. Apply warm compresses to site of the client's pacemaker insertion B. Teach the client to avoid being near any type of household microwave oven C. Ambulate the client as soon as possible to evaluate function of pacemaker. D. Instruct client to limit movement of arm on side where pacemaker inserted.

Correct Answer is D

Explanation

A. Apply warm compresses to site of the client's pacemaker insertion: Heat application is contraindicated as it may increase swelling or risk infection.

B. Teach the client to avoid being near any type of household microwave oven: Modern pacemakers are shielded, so microwaves do not interfere with their function.

C. Ambulate the client as soon as possible to evaluate pacemaker function: While early ambulation is encouraged, pacemaker function is not evaluated through ambulation.

D. Instruct client to limit movement of the arm on side where pacemaker was inserted: Limiting arm movement prevents dislodging the pacemaker leads during the healing phase.

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The nurse is caring for a client who is on cardiac telemetry monitoring and notes that the PR interval is 0.16 seconds. Which interpretation is correct for the nurse to make?

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Correct Answer is C

Explanation

The nurse is caring for a client who has just had a pacemaker inserted. Which action should the nurse include in the initial plan of care?

Correct Answer is D

Explanation

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