Final answer:
The first step is to double-check the monitoring equipment to ensure it's functioning correctly. Following that, Jack's blood pressure should be taken for further clinical assessment. Suggesting new medication or assuming there's no issue is not advisable without a thorough assessment.
Step-by-step explanation:
Jack Johnson, a 58-year-old with an internal, fixed-rate pacemaker, has no spikes on the cardiac monitor. The absence of pacing spikes can indicate a pacemaker malfunction or an issue with the monitoring equipment. First, it is essential to double-check the monitoring equipment (option b) to ensure it's functioning correctly. If the equipment is working properly and no spikes are visible, the next step would be to further assess the patient clinically. You should also consider taking Jack's blood pressure (option d) to get more information about his current hemodynamic status, as well as check his pulse and overall condition. If you find that Jack is symptomatic or if his vital signs are unstable, this could be an urgent situation requiring immediate medical intervention. It's important not to assume that the lack of spikes is typical; thus, doing nothing (option c) is not advisable. Suggesting the need for a new beta-blocker (option a) without further assessment would be premature and might not address the potential pacemaker issue.