The nurse notes premature ventricular contractions (PVCs) while suctioning a client's endotracheal tube. Which action by the nurse is a priority?

Stop and ventilate the patient with 100% oxygen.

Give antidysrhythmic medications per protocol.

Decrease the suction pressure to 80 mm Hg.

Document the dysrhythmia in the patient's chart.

Answer and Explanation

The Correct Answer is A

A. PVCs during suctioning may indicate hypoxia or irritation; the priority is to stop suctioning and ventilate the patient with 100% oxygen to prevent worsening arrhythmias.
B. Medications may be needed later, but immediate action is oxygenation and stopping suctioning.
C. Adjusting suction pressure is important but secondary to ensuring patient oxygenation.
D. Documentation is necessary but not the priority when PVCs are noted.

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Correct Answer is B

Explanation

A. Fluids are usually encouraged to help flush out contrast dye, so restricting fluid intake is not appropriate.
B. Performing neurovascular checks along with vital signs is essential to monitor for complications such as bleeding, hematoma, or impaired circulation after femoral artery access.
C. Range-of-motion exercises on the affected leg may increase the risk of bleeding or hematoma and are generally avoided initially.
D. Early ambulation (such as within 1 hour) is usually contraindicated; clients are typically kept on bed rest for several hours to prevent bleeding at the catheter site.

A. Atrial rhythm regular, ventricular rhythm irregular B. P:QRS ratio of 1:1 C. P:QRS ratio of 2:1 D. Ventricular and atrial rhythm are irregular

Correct Answer is B

Explanation

A. An atrial rhythm regular and ventricular rhythm irregular would suggest an arrhythmia such as atrial fibrillation or flutter with variable conduction—not sinus tachycardia.
B. In sinus tachycardia, the rhythm is regular, the P:QRS ratio is 1:1, meaning each P wave is followed by a QRS complex, and the origin is from the sinus node.
C. A 2:1 P:QRS ratio is characteristic of certain types of heart block or atrial flutter—not sinus tachycardia.
D. Irregular ventricular and atrial rhythms are seen in atrial fibrillation or other irregular arrhythmias, not sinus tachycardia.

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The nurse notes premature ventricular contractions (PVCs) while suctioning a client's endotracheal tube. Which action by the nurse is a priority?

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