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. D.

Rationale: A. The strip displays a Sinus Rhythm with Premature Ventricular Contractions (PVCs). This rhythm is identifiable by the wide, distorted QRS complexes that appear earlier than expected in the underlying regular rhythm. These ectopic beats are not preceded by a pacemaker spike, indicating they are spontaneous rather than device-initiated. B. The strip illustrates Ventricular Tachycardia, which is a life-threatening rhythm. It is characterized by a very rapid rate and wide, "sawtooth" shaped QRS complexes. This rhythm lacks P waves and pacemaker spikes, representing a dangerous state where the heart's lower chambers beat too quickly to pump blood effectively. C. The strip depicts Atrial Fibrillation with a controlled ventricular response. This rhythm is recognized by its irregularly irregular R-R intervals and the absence of distinct, organized P waves before the QRS complexes. There are no vertical pacemaker spikes present to suggest the heart is being electrically stimulated by a device. D. The strip is the correct choice because it shows a Ventricular Paced Rhythm. This rhythm features a sharp, narrow vertical deflection or spike immediately preceding each QRS complex. The QRS complex itself is wide and abnormally shaped because the electrical impulse originates from the pacemaker lead in the ventricle.