Question

A client's cardiac monitor strip shows the following: HR 42/min, rhythm regular, PRI \(0.16\) seconds, QRS \(0.06\) seconds. The client is experiencing dizziness, nausea, and chest pain rated as 3 on a scale of \(1-10\) with 10 being the worst pain. The drug of choice to treat this dysrhythmia is a. Lidocaine (Xylocaine) b. Adenosine (Adenocard) c. Atropine sulfate d. Epinephrine (Adrenalin)

Short answer

c. Atropine sulfate

Step-by-step solution

Identify the dysrhythmia

The client's cardiac monitor shows a heart rate (HR) of 42 beats per minute. This is considered bradycardia since a normal resting heart rate is typically between 60-100 beats per minute.

Assess the symptoms

The client is experiencing dizziness, nausea, and chest pain (rated as 3 on a scale of 1 to 10). These symptoms indicate that the bradycardia is symptomatic and potentially dangerous.

Evaluate the rhythm and intervals

The rhythm is regular, the PR Interval (PRI) is 0.16 seconds, and the QRS complex duration is 0.06 seconds. These values indicate that the rhythm is sinus bradycardia.

Review the treatment options

The drug of choice for symptomatic bradycardia is Atropine sulfate. Atropine works by increasing the heart rate and improving symptoms in bradycardia patients.

Key concepts

Bradycardia

Bradycardia is a condition where the heart rate is slower than normal, usually defined as fewer than 60 beats per minute. In normal adults, the heart rate typically ranges from 60 to 100 beats per minute. Bradycardia can occur naturally in healthy individuals, especially athletes, due to their increased cardiac efficiency. However, it can also be an indicator of potential heart problems or other health issues.
A few common causes of bradycardia include:

• Heart tissue damage from aging or heart disease
• Inflammatory diseases like myocarditis
• Issues within the heart's electrical pathways

Recognizing the symptoms and types of bradycardia is crucial for proper medical intervention.

Symptomatic Bradycardia

When bradycardia is accompanied by symptoms, it is termed symptomatic bradycardia. Symptoms are an indication that the slow heart rate is insufficient for maintaining adequate blood flow and oxygenation to the body's organs. Common symptoms include dizziness, nausea, fatigue, and chest pain. In severe cases, it can lead to more serious complications such as fainting or heart failure.
In the exam scenario, the client displays symptoms like dizziness, nausea, and mild chest pain, indicating that the bradycardia is symptomatic and requires immediate treatment. It's crucial to understand these symptoms for effective clinical decision-making.

Atropine Sulfate

Atropine sulfate is a medication commonly used to treat symptomatic bradycardia. It works by blocking the vagus nerve's action on the heart, thereby increasing the heart rate. This anticholinergic drug is considered the first line of treatment in bradycardia cases where the patient shows symptoms.
Atropine is administered intravenously in a clinical setting for quick action. Healthcare providers must monitor the patient closely for any side effects or response to the drug. Knowing when and how to use atropine sulfate can be life-saving.

Cardiac Rhythms

Understanding cardiac rhythms is crucial for managing conditions like bradycardia. The heart's electrical activity, viewed through an ECG, can show various rhythms such as normal sinus rhythm, tachycardia, and bradycardia. Each has distinct characteristics:

• Sinus Rhythm: Regular heart rate (60-100 bpm), normal P wave, PR interval 0.12-0.20 seconds
• Bradycardia: Slow heart rate (<60 bpm), can be regular or irregular
• Tachycardia: Fast heart rate (>100 bpm), can indicate infection, anxiety, or other conditions

Proper interpretation of these rhythms helps in diagnosing and managing heart conditions effectively.

NCLEX-RN Examination

The NCLEX-RN Examination is a critical step for nursing graduates to obtain licensure as a Registered Nurse. It tests the knowledge, skills, and abilities essential for safe and effective practice at the entry-level. Questions on the exam can cover a wide range of topics, including the management of cardiac emergencies like bradycardia.
It's important for candidates to understand key treatment protocols, such as the use of atropine sulfate in symptomatic bradycardia. Reviewing cardiac rhythms and their management ensures readiness for the exam and future clinical practice. Consistent study and practice with these concepts will significantly improve success in the NCLEX-RN examination.