A nurse is monitoring a client's heart rhythm following insertion of a permanent pacemaker. Which of the following images should the nurse expect? A. B. C.

A. Pacemaker rhythm: Characterized by pacing spikes (stimulus artifacts) on the ECG. Spikes appear just before the P wave (atrial pacing), before the QRS complex (ventricular pacing), or before both (dual-chamber pacing). It indicates the pacemaker is firing appropriately and capturing. B. Ventricular pentageminy: A ventricular ectopy pattern where one premature ventricular contraction (PVC) occurs after every five normal sinus beats. The key ECG characteristics include regular sinus rhythm for the underlying beats and one PVC after every five normal QRS complexes (pattern repeats). The PVC features include wide, tall, bizarre-looking QRS, no preceding P wave, and T-wave opposite in direction to the QRS. C. Atrial fibrillation: This rhythm is "irregularly irregular." There are no discernible P waves; instead, there is a wavy or fibrillatory baseline between the narrow QRS complexes. It is not an expected rhythm immediately following pacemaker insertion unless the client has a separate underlying dysrhythmia.