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colleen colleen
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11 years ago
Which is the priority nursing intervention for a patient with a junctional escape rhythm?
1. Assess the patient for symptoms associated with this rhythm.
2. Contact the physician immediately for emergency orders.
3. Eliminate caffeine from the diet.
4. Prepare for a pacemaker insertion.
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KassieKassie
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11 years ago Edited: 11 years ago, Kassie
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11 years ago
1 -- Junctional escape rhythms may be monitored if the patient is not symptomatic. It is most important to assess the patient to see how they are affected by the rhythm. Then, calling the physician to report the rhythm may be appropriate. Eliminating caffeine or preparing for a pacemaker insertion is not an appropriate action for this patient with a junctional escape rhythm. No indication of symptoms relating to the rhythm was given.
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