Medical Surgical EKG #2

Question

A client has confirmed second degree type II AV block (Mobitz II) and heart rate of 45 bpm. The nurse expects the following treatment for the condition: Select all that apply.

Answers

  1. Atropine for bradycardia
    • Rationale:

      This answer is correct because if a client has Mobitz type II heart block, both temporary pacing and administration of atropine will increase cardiac output. A permanent pacemaker will most likely follow. Mobitz type II block is considered to be more serious since it has the potential to develop into a 3rd degree (complete heart block). The client may feel dizzy, have palpitations, and feel skipped beats. Mobitz type II block reveals some P waves that are not conducted to the ventricles. If left untreated, electrical impulses may not reach the ventricles to produce a contraction.

  2. Temporary pacemaker
    • Rationale:

      This answer is correct because if a client has Mobitz type II heart block, both temporary pacing and administration of atropine will increase cardiac output. A permanent pacemaker will most likely follow. Mobitz type II block is considered to be more serious since it has the potential to develop into a 3rd degree (complete heart block). The client may feel dizzy, shortness of breath, have palpitations, and feel skipped beats. Mobitz type II block reveals some P waves that are not conducted to the ventricles. If left untreated, electrical impulses may not reach the ventricles to produce a contraction.

  3. Digoxin to improve conduction
    • Rationale:

      This answer is not correct because digoxin improves contractility, not electrical conductivity. If a client has Mobitz type II heart block, both temporary pacing and administration of atropine will increase cardiac output. A permanent pacemaker will most likely follow.

  4. Adenosine 6 mg IV
    • Rationale:

      This answer is not correct because adenosine administration is not an appropriate treatment for Mobitz type II heart block. If a client has Mobitz type II heart block, both temporary pacing and administration of atropine will increase cardiac output. A permanent pacemaker will most likely follow.

  5. Defibrillation immediately at 200 Joules
    • Rationale:

      This answer is not correct because defibrillation of second degree type II AV block (Mobitz II) could be lethal. The only dysrhythmias’ whose treatment is immediate defibrillation is ventricular fibrillation or pulseless ventricular tachycardia.

Overview

Initial treatment of atropine and a temporary pacemaker are the gold standards for bradycardia (45 bpm) experienced with type II AV block (Mobitz II) to help return adequate perfusion to the body.

Explanation

Learning Outcomes

In a second degree Mobitz type II heart block there is equal and similar prolongation of the PR interval (much like first degree AV block), but there is a drop of the QRS complex during this heart block. If a client has Mobitz type II heart block, both temporary pacing and administration of atropine will increase cardiac output. A permanent pacemaker will most likely follow. Mobitz type II block is considered to be more serious since it has the potential to develop into a 3rd degree (complete heart block). The client may feel dizzy, have palpitations, and feel skipped beats. Mobitz type II block reveals some P waves that are not conducted to the ventricles. This type of conduction problem occurs from MI, heart surgery, infections, and at times from hyperkalemia. If left untreated, electrical impulses may not reach the ventricles to produce a contraction.

Test Taking Tip

Atropine and a temporary pacemaker (at least) are gold standards for sustained, symptomatic bradycardia to help return adequate perfusion to the body.

Video Rationale