Question

A patient admitted with acute coronary syndrome (ACS) has continuous ECG monitoring. An examination of the rhythm strip reveals the following characteristics: atrial rate of 74 beats/minute and regular; ventricular rate of 62 beats/minute and irregular; P wave with a normal shape; PR interval that lengthens progressively until a P wave is not conducted; and QRS complex with a normal shape. Your priority nursing intervention involves

A. performing synchronized cardioversion.
B. administering 1 mg of epinephrine by IVP.
C. observing for symptoms of hypotension or angina.
D. preparing the patient for a transcutaneous pacemaker.

Answer 1

The priority nursing intervention for a patient with signs of Mobitz Type I AV block is to observe for symptoms of hypotension or angina, as immediate intervention is typically not required unless the patient is symptomatic.

Step-by-step explanation:

The patient described is showing signs of Mobitz Type I second-degree atrioventricular (AV) block, also known as Wenckebach phenomenon. This is evident by the atrial rate being regular while the ventricular rate is irregular, with a progressively lengthening PR interval until a P wave is not conducted. Here, the key intervention is to observe for symptoms of hypotension or angina, as these may indicate that the heart's pumping efficacy is compromised. In many cases, patients with this type of AV block may not require immediate intervention unless they are symptomatic. Other interventions like synchronized cardioversion, epinephrine administration, or preparing for a transcutaneous pacemaker might be necessary only if the patient becomes hemodynamically unstable or exhibits severe symptoms.