A nurse assesses the following electrocardiography (ECG) strip from a client’s telemetry monitor. What does the nurse chart as the client’s approximate ventricular heart rate?

The ventricular rate on a cardiac monitor is determined by calculating the frequency of the QRS complexes over a specific period. In clinical practice, the six-second method is the most versatile technique for estimating heart rates, especially when the rhythm is irregularly irregular, as it involves counting the total number of R-waves within a marked 6-second interval and multiplying by 10. A. A heart rate of 50 to 60 beats/min would be classified as sinus bradycardia. On a standard ECG strip, this would be represented by 5 or 6 QRS complexes within a 6-second window. The provided strip contains 9 QRS complexes, clearly indicating that the rate is significantly higher than this bradycardic range. B. A rate of 70 to 80 beats/min is a normal resting heart rate for an adult but does not match the data on this specific telemetry strip. Based on the 6-second method, 9 complexes multiplied by 10 equals 90, meaning the rate exceeds the 80 beats per minute threshold found in this choice. C. A rate of 60 to 70 beats/min is also within the normal sinus rhythm range. However, calculating the rate using the large block method (300 divided by the number of large boxes between R-waves) or the 6-second method confirms that the ventricular response is more rapid than 70 beats per minute. D. By counting the R-waves in the provided strip, there are 9 QRS complexes. Utilizing the 6-second rule (9 complexes × 10), the approximate heart rate is 90 beats/min. This falls within the 80 to 90 range, accurately reflecting the moderate ventricular response seen in this irregularly irregular atrial fibrillation rhythm.