NORCET-7 Mains-2024
Medical & Surgical Nursing
Medium
In a patient who is on cardiac monitor showing QRS complex more than 0.12 seconds. The possible cause is?
Appeared in: NORCET-7 Mains-2024
Explanation
- The QRS complex represents ventricular depolarization, and its normal duration is less than 0.12 seconds.
- A QRS duration of 0.12 seconds or more signifies a significant delay in ventricular depolarization.
- A Bundle Branch Block (BBB) is a conduction delay in one of the ventricles, forcing the electrical signal to travel through a slower pathway (myocardium instead of the Purkinje system).
- This slow, inefficient conduction is the direct cause of the QRS complex widening on the ECG.
Why Other Options Were Wrong
- Option A: This is not a standard medical term. If it is interpreted as Premature Atrial Contractions (PACs), the impulse originates above the ventricles (supraventricular) and follows the normal conduction pathway, resulting in a narrow QRS complex.
- Option C: Atrial flutter is a supraventricular tachycardia. The impulses originate in the atria and travel down the normal, fast conduction pathway to the ventricles. This results in a narrow QRS complex.
- Option D: Atrial fibrillation is a supraventricular rhythm. The impulses originate chaotically in the atria but travel through the normal AV node and bundle branches. This results in a narrow QRS complex. A wide QRS in atrial fibrillation indicates a co-existing bundle branch block.
Related Visual
Clinical Relevance
- Nursing practice connection: Use the key finding related to ECG Interpretation: QRS Complex Duration to guide bedside assessment, documentation, and the next nursing action.
- Nurses monitoring cardiac rhythms must be able to identify a wide QRS complex, as it can signify a new or worsening conduction system disease.
- A new-onset bundle branch block can be a sign of an acute myocardial infarction (MI), especially in a patient with chest pain. This requires prompt assessment and immediate notification of the healthcare provider.
- Recognizing the difference between supraventricular rhythms (usually narrow QRS) and ventricular rhythms or conduction blocks (wide QRS) is critical for determining the stability of the patient and the appropriate treatment.
How to Approach the Question
- First, identify the key clinical data provided in the question stem: 'QRS complex more than 0.12 seconds'.
- Recall the normal value for the QRS duration, which is 0.06 to 0.10 seconds (or <0.12s).
- Understand the pathophysiology: a QRS duration greater than 0.12 seconds indicates a delay in the electrical conduction through the ventricles.
- Analyze the options. Atrial fibrillation and atrial flutter are supraventricular rhythms, meaning they originate above the ventricles and should have a narrow QRS if conduction is normal.
- Conclude that a bundle branch block is a primary ventricular conduction delay that directly causes the QRS complex to widen.
- Therefore, 'Bundle branch block' is the most direct and certain cause among the choices.
Concept Tested & Keywords
- Concept Tested: ECG Interpretation: QRS Complex Duration
- Stem keywords: cardiac monitor, QRS complex, more than 0.12 seconds
- Lead-in keywords: possible cause
- Negative lead-in flag: false
Question ID
Qee6pJbJ2oKJTA_s6oajQU
Reference Book
E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) p. 7321-7323
E6 Medicine Harrison 22e Part 1 p. 1912-1914
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