A patient develops sinus bradycardia at a rate of 32 ...

[Bernana]

A patient develops sinus bradycardia at a rate of 32 beats/minute, has a blood pressure (BP) of 80/42 mm Hg, and is complaining of feeling faint. Which actions should the nurse take next?
 
  a. Recheck the heart rhythm and BP in 5 minutes.
  b. Have the patient perform the Valsalva maneuver.
  c. Give the scheduled dose of diltiazem (Cardizem).
  d. Apply the transcutaneous pacemaker (TCP) pads.

Question 2

A patient's cardiac monitor shows sinus rhythm, rate 64. The P-R interval is 0.18 seconds at 1:00 AM, 0.22 seconds at 2:30 PM, and 0.28 seconds at 4:00 PM. Which action should the nurse take next?
 
  a. Place the transcutaneous pacemaker pads on the patient.
  b. Administer atropine sulfate 1 mg IV per agency dysrhythmia protocol.
  c. Document the patient's rhythm and assess the patient's response to the rhythm.
  d. Call the health care provider before giving the next dose of metoprolol (Lopressor).

[debra928]

Answer to Question 1

ANS: D
The patient is experiencing symptomatic bradycardia, and treatment with TCP is appropriate. Continued monitoring of the rhythm and BP is an inadequate response. Calcium channel blockers will further decrease the heart rate, and the diltiazem should be held. The Valsalva maneuver will further decrease the rate.

Answer to Question 2

ANS: D
The patient has progressive first-degree atrioventricular (AV) block, and the -blocker should be held until discussing the medication with the health care provider. Documentation and assessment are appropriate but not fully adequate responses. The patient with first-degree AV block usually is asymptomatic, and a pacemaker is not indicated. Atropine is sometimes used for symptomatic bradycardia, but there is no indication that this patient is symptomatic.

[Bernana]

Excellent

[ghepp]

TYSM