When a fast rhythm needs treating
Before you read
Test yourself first: 3 questions
Question 1 of 3
The nurse observes three or more consecutive PVCs at a rate of 160 with wide QRS complexes and no visible P waves. Which rhythm is most likely?
Answer: B. Ventricular tachycardia is defined as three or more consecutive ventricular beats (wide QRS, no P waves) at a rapid rate, commonly 100-250. Supraventricular tachycardia produces a narrow QRS, atrial flutter has sawtooth waves, and sinus tachycardia has normal P waves and narrow QRS complexes.
Question 2 of 3
A client's rhythm strip shows occasional wide, bizarre QRS complexes that occur earlier than expected and are not preceded by a P wave. How does the nurse document these complexes?
Answer: B. Premature ventricular contractions (PVCs) are early, wide, bizarre QRS complexes that originate in the ventricles and are not preceded by a P wave; they are usually followed by a compensatory pause. Premature atrial contractions have an abnormal P wave with a narrow QRS, and the other options do not match this description.
Question 3 of 3
A client recovering from a myocardial infarction frequently develops premature ventricular contractions. Which finding associated with the PVCs would most concern the nurse and require prompt provider notification?
Answer: B. Isolated occasional PVCs are common, but PVCs become dangerous when they are frequent (more than 6 per minute), occur in runs or pairs, are multifocal, or fall on the T wave (R-on-T phenomenon), because these patterns can deteriorate into ventricular tachycardia or fibrillation. A single PVC once an hour, a normal potassium, and relief of chest pain are reassuring rather than concerning.
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References
Clinical references for this topic
