How should the nurse identify the rhythm shown in the diagram?
ventricular tachycardia
asystole
normal sinus rhythm
ventricular fibrillation
The Correct Answer is A
A. Ventricular tachycardia: Ventricular tachycardia (VT) is identified by a regular, fast rhythm with wide QRS complexes, typically without visible P waves. This rhythm often appears as consecutive, large, uniform waves, which is consistent with what is seen in the diagram.
B. Asystole: Asystole is characterized by a flat line, indicating no electrical activity, which is not present in this strip.
C. Normal sinus rhythm: Normal sinus rhythm would show identifiable P waves, a normal QRS complex, and a regular rate, which are not observed here.
D. Ventricular fibrillation: Ventricular fibrillation appears as chaotic, irregular waveforms with no clear QRS complexes or organization, which does not match the rhythm shown.
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Correct Answer is D
Explanation
A. Generalized joint discomfort is not commonly associated with contact dermatitis; this condition typically affects the skin locally rather than causing systemic joint symptoms.
B. Systemic symptoms such as elevated temperature are generally not expected with contact dermatitis, as it is usually a localized skin reaction.
C. Pruritus (itching) is a common symptom of contact dermatitis, so denial of pruritus would not be expected.
D. Contact dermatitis often occurs due to exposure to a skin irritant, making a report of such exposure a typical finding in the assessment.
Correct Answer is D
Explanation
A. In the anterior chest assessment, auscultation usually follows inspection and is typically done before percussion.
B. In the neck assessment, the nurse may inspect and then auscultate (e.g., carotid arteries) before palpation.
C. In the heart assessment, auscultation follows inspection but may not involve percussion.
D. In the abdomen, the correct order is to inspect, auscultate, and then percuss to assess bowel sounds effectively before creating additional disturbances with percussion.