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 A
Explanation
A. Obtain a pair of slipper socks for the client. Slipper socks can provide warmth without applying direct heat, which is safer for clients with impaired circulation.
B. Increase the client's oral fluid intake. Increasing fluids does not directly address cold feet and may be contraindicated depending on the client’s condition.
C. Rub the client's feet briskly for several minutes. Rubbing can damage skin and tissue in clients with poor circulation and should be avoided.
D. Place a moist heating pad under the client's feet. Heating pads can cause burns and further impair circulation in clients with vascular issues.
Correct Answer is A
Explanation
A. The ST segment is above the isoelectric line. An elevated ST segment is a hallmark sign of acute myocardial infarction (MI), indicating myocardial injury.
B. The QRS intervals are 0.08 second. A QRS interval of 0.08 seconds is within the normal range and does not indicate myocardial infarction.
C. The QT interval is equal to the R to R interval. QT interval measurements are not diagnostic for acute MI.
D. The PR intervals are 0.15 second. A PR interval of 0.15 seconds is within the normal range and is not indicative of acute MI.