Question

Patient with mitral valve stenosis and coronary artery disease (CAD) is in the telemetry unit with pneumonia. The nurse assesses a 6-second rhythm strip and determines that the ventricular rhythm is highly irregular at 88, with no discernible P waves. What does the nurse determine this rhythm to be?

A) Atrial flutter
B) Ventricular flutter
C) Sinus tachycardia
D) Nonparoxysmal junctional tachycardia

Answer 1

The telemetry strip showing an irregular ventricular rhythm of 88 bpm without P waves is consistent with atrial fibrillation. This is identified by aberrant electrical patterns before the QRS complex and irregular spacing of QRS complexes.

Step-by-step explanation:

The patient described has a highly irregular ventricular rhythm at 88 beats per minute with no discernible P waves. Given this information, the most likely diagnosis for the rhythm on the telemetry monitor would be atrial fibrillation (b) according to Figure 19.25b, where the electrical pattern is abnormal before the QRS complex, and the frequency of QRS complexes is irregular.

Atrial flutter typically presents with a saw-tooth pattern of atrial activity known as flutter waves, not complete absence of discernible P waves. Ventricular flutter and ventricular tachycardia often show broad and abnormal QRS complexes. Sinus tachycardia maintains regularity and P waves, although at a faster rate. Nonparoxysmal junctional tachycardia is typically regular. Atrial fibrillation fits the presentation of an irregular rhythm and absence of visible P waves.