A nurse is collecting data from a client who is receiving continuous cardiac monitoring that is indicating premature ventricular contractions (PVCs). Which of the following findings should the nurse expect when assessing the client?
S3 heart sounds
Increase in point of maximum impulse (PMI)
Irregular pulsations
Bradycardia
The Correct Answer is C
A. S3 heart sounds. An S3 sound is more indicative of heart failure rather than PVCs specifically.
B. Increase in point of maximum impulse (PMI). PMI is typically displaced in conditions like ventricular hypertrophy or heart failure, not PVCs.
C. Irregular pulsations. PVCs are extra beats that interrupt the heart’s normal rhythm, leading to irregular pulsations on palpation.
D. Bradycardia. PVCs usually occur in the context of normal or elevated heart rates rather than bradycardia.
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Correct Answer is D
Explanation
A. Depression: While propranolol can sometimes worsen symptoms of depression, this is not as critical as the impact on conditions like heart failure.
B. Glaucoma: Propranolol does not typically affect glaucoma; however, some beta-blockers are used to treat glaucoma.
C. Migraine: Propranolol is sometimes used to prevent migraines, so a history of migraines would not require discontinuation.
D. Heart failure: Propranolol can exacerbate heart failure by reducing myocardial contractility. Clients with heart failure require careful monitoring or an alternative medication.
Correct Answer is D
Explanation
A. Schedule deep tissue massage with physical therapy. Massaging the area is contraindicated in cases of suspected deep vein thrombosis (DVT), as it can dislodge the clot, leading to a pulmonary embolism.
B. Monitor Homan's sign. Homan’s sign (pain in the calf upon dorsiflexion) is no longer considered a reliable or safe assessment for DVT due to the risk of dislodging a clot.
C. Obtain platelet aggregation studies. Platelet aggregation studies are not specific to diagnosing a DVT; instead, imaging is preferred.
D. Arrange for a venous duplex ultrasound. A venous duplex ultrasound is a non-invasive test that can confirm the presence of a DVT in the affected extremity.