dys·rhyth·mi·a

Which part of the electrocardiogram (ECG) represents depolarization of the ventricles? P wave T wave PR interval QRS interval

QRS interval

When caring for a patient with mitral valve stenosis, it is most important that the nurse assess for a. diastolic murmur. b. peripheral edema. c. shortness of breath on exertion. d. right upper quadrant tenderness.

ANS: C The pressure gradient changes in mitral stenosis lead to fluid backup into the lungs, resulting in hypoxemia and dyspnea. The other findings also may be associated with mitral valve disease but are not indicators of possible hypoxemia.

When a client's cardiac monitor shows a PQRST wave for each beat, with a regular rhythm and a rate of 120 beats per minute, how will the nurse document the rhythm? a. Atrial fibrillation b Sinus tachycardia c Ventricular fibrillation d First-degree atrioventricular block

b

The cardiac monitor shows sudden bursts of a regular heart rhythm with a rate of 220 beats/minute, normal QRS duration, and P waves that are difficult to see. Which rhythm is the client experiencing? a. Sinus tachycardia b. Atrial fibrillation c. Ventricular tachycardia (VT) d. Paroxysmal supraventricular tachycardia (PSVT)

d

A patients cardiac monitor shows a pattern of undulations of varying contours and amplitude with no measurable ECG pattern. The patient is unconscious and pulseless. Which action should the nurse take first? a. Perform immediate defibrillation. b. Give epinephrine (Adrenalin) IV. c. Prepare for endotracheal intubation. d. Give ventilations with a bag-valve-mask device.

ANS: A The patients rhythm and assessment indicate ventricular fibrillation and cardiac arrest; the initial action should be to defibrillate. If a defibrillator is not immediately available or is unsuccessful in converting the patient to a better rhythm, the other actions may be appropriate.

The nurse has received the laboratory results for a patient who developed chest pain 4 hours ago and may be having a myocardial infarction. The most important laboratory result to review will be a. myoglobin b. low density lipoprotein cholesterol c. troponin T and I d. creatine kinase MB (CK-MB)

ANS: C Cardiac troponins start to elevate 4 to 6 hours after myocardial injury and are highly specific to myocardium. They are the preferred diagnostic marker for myocardial infarction. Myoglobin rises in response to myocardial injury within 30 to 60 minutes. It is rapidly cleared from the body, thus limiting its use in the diagnosis of myocardial infarction. LDL cholesterol is useful in assessing cardiovascular risk but is not helpful in determining whether a patient is having an acute myocardial infarction. Creatine kinase (CK-MB) is specific to myocardial injury and infarction and increases 4 to 6 hours after the infarction occurs. It is often trended with troponin levels.

A patient recovering from heart surgery develops pericarditis and complains of level 6 (0 to 10 scale) chest pain with deep breathing. Which ordered PRN medication will be the most appropriate for the nurse to give? a. Fentanyl 1 mg IV b. IV morphine sulfate 4 mg c. Oral ibuprofen (Motrin) 600 mg d. Oral acetaminophen (Tylenol) 650 mg

ANS: C The pain associated with pericarditis is caused by inflammation, so nonsteroidal antiinflammatory drugs (NSAIDs) (e.g., ibuprofen) are most effective. Opioid analgesics are usually not used for the pain associated with pericarditis.

Two days after an acute myocardial infarction (MI), a patient complains of stabbing chest pain that increases with a deep breath. Which action will the nurse take first? a. Auscultate the heart sounds. b. Check the patients temperature. c. Notify the patients health care provider. d. Give the PRN acetaminophen (Tylenol).

NS: A The patients clinical manifestations and history are consistent with pericarditis, and the first action by the nurse should be to listen for a pericardial friction rub. Checking the temperature and notifying the health care provider are also appropriate actions but would not be done before listening for a rub. It is not stated for what symptom (e.g., headache) or finding (e.g., increased temperature) the PRN acetaminophen (Tylenol) is ordered.

To determine whether there is a delay in impulse conduction through the atria, the nurse will measure the duration of the patients a. P wave. b. Q wave. c. P-R interval. d. QRS complex.

ANS: A The P wave represents the depolarization of the atria. The P-R interval represents depolarization of the atria, atrioventricular (AV) node, bundle of His, bundle branches, and the Purkinje fibers. The QRS represents ventricular depolarization. The Q wave is the first negative deflection following the P wave and should be narrow and short.

A patient has ST segment changes that support an acute inferior wall myocardial infarction. Which lead would be best for monitoring the patient? a. I b. II c. V2 d. V6

ANS: B Leads II, III, and AVF reflect the inferior area of the heart and the ST segment changes. Lead II will best capture any electrocardiographic (ECG) changes that indicate further damage to the myocardium. The other leads do not reflect the inferior part of the myocardial wall and will not provide data about further ischemic changes in that area.

A client with supraventricular tachycardia (SVT) has a heart rate of 170 beats/minute. After treatment with diltiazem, which assessment indicates to the nurse that the diltiazem is effective? a. Increased urine output b Blood pressure of 90/60 mm Hg c Heart rate of 98 beats/minute d No longer complaining of heart palpations

c Diltiazem hydrochloride's purpose is to slow down the heart rate. SVT has a heart rate of 150 to 250 beats/minute. A heart rate of 110 beats/minute indicates that the diltiazem hydrochloride is having the desired effect. Hypotension is a side effect of diltiazem hydrochloride, not a desired effect. Heart palpations are experienced by some with various dysrhythmias. A decreased sensation of heart palpations is a positive finding but is not present in all clients. Increased urine output may occur over a period of time because of the increased ventricular filling time but would not occur until after the heart rate had stabilized.

When a client's cardiac rhythm strips shows more P waves than QRS complexes and there is no relationship between the atria and the ventricles, how would the nurse document the rhythm? First degree atrioventricular (AV) block Second degree AV block Mobitz I (Wenckebach) Second degree AV block Mobitz II Third degree AV block (complete heart block)

Third-degree block often is called 'complete heart block' because no atrial impulses are conducted through the AV node to the ventricles. In complete heart block, the atria and ventricles beat independently of each other because the AV node is completely blocked to the sinus impulse and is not conducted to the ventricles. One hallmark of third- degree heart block is that the P waves have no association with the QRS complexes and appear throughout the QRS waveform. In first-degree AV block, a P wave precedes every QRS complex, and every P wave is followed by a QRS, but the PR interval is prolonged beyond 0.2 seconds. Second-degree AV block type I, also called Mobitz I or Wenckebach heart block, is represented on the electrocardiogram (ECG) as a progressive lengthening of the PR interval until there is a P wave without a QRS complex. Second-degree AV block type II (Mobitz II) is a more critical type of heart block that requires early recognition and intervention. There is no progressive lengthening of the PR interval, which remains the same throughout with the exception. However, some P waves are not followed by a QRS.

Which action would the nurse anticipate taking when a client develops third degree atrioventricular block with a heart rate of 30 beats/minute? a Assist with rapid defibrillation. b Prepare for synchronized cardioversion. c Obtain the transcutaneous pacemaker. d Initiate cardiopulmonary resuscitation.

Transcutaneous pacing is used for emergency treatment of bradycardia, because it is noninvasive and can be rapidly initiated. Defibrillation would be used for ventricular fibrillation. Synchronized cardioversion would be used as the treatment for rapid atrial or ventricular rhythms such as atrial fibrillation, atrial flutter, and ventricular tachycardia. Cardiopulmonary resuscitation is used when the client has cardiac or respiratory arrest.

Which finding will the nurse expect when analyzing the cardiac rhythm for a client with first degree atrioventricular (AV) block? a Every P wave is conducted to the ventricles. b Some P waves are conducted to the ventricles. c There are no P waves visible on the rhythm strip. d None of the P waves are conducted to the ventricles.

a In first degree AV block, a P wave precedes every QRS complex, but the PR interval is prolonged. Second degree heart block refers to AV conduction that is intermittently blocked. Some P waves are conducted and some are not. When no P waves are visible, rhythms such as junctional dysrhythmias or atrial fibrillation are suspected. Third degree block is often called complete heart block because no atrial impulses are conducted through the AV node to the ventricles.

Which client in the emergency department would the nurse assess first? a Client with chest pressure and ST segment elevation on the electrocardiogram b Client who reports a sharp chest pain with deep inspiration for the past week c Client who has history of heart failure with ascites and bilateral 4+ ankle swelling d Client with palpitations and paroxysmal atrial fibrillation at a rate of 136 beats/minute

a The client with chest pressure and ST segment elevation on the electrocardiogram will need emergency treatment for ST segment elevation myocardial infarction (STEMI), including transport to the cardiac catheterization laboratory for percutaneous coronary intervention within 90 minutes, and should be seen first. The client with sharp pain with deep inspiration has symptoms consistent with pericarditis or pleural effusion and does need rapid assessment and treatment, but is not at risk for life-threatening complications. The client with heart failure and ascites and ankle swelling has symptoms of right ventricular failure that are not life-threatening. The client with palpitations and rapid atrial fibrillation will need assessment and evaluation, but the client experiencing myocardial infarction has a more life-threatening diagnosis.

After noting that a client in the clinic has an irregularly irregular pulse rhythm at a rate of 88 beats/ minute, the nurse will anticipate further testing for which possible dysrhythmia? a Atrial fibrillation b Ventricular tachycardia c Complete heart block d Supraventricular tachycardia

a An irregularly irregular rhythm is a classic sign of atrial fibrillation, a very common dysrhythmia seen in clinical practice. The irregularity occurs because impulses from multiple atrial sites depolarize the atria in a disorganized fashion. Ventricular tachycardia is a regular rhythm, with a rate usually 140 to 180 beats per minute or more. In complete heart block, the atrial impulses are unable to conduct to the ventricles and the ventricular rate is 20 to 60 beats per minute. Supraventricular tachycardias are characterized by regular rhythms and rates of 150 beats per minute or more.

Which client response must the nurse monitor to determine the effectiveness of amiodarone? a Absence of ischemic chest pain b Decrease in cardiac dysrhythmias c Improvement in fasting lipid profile d Maintenance of blood pressure control

b Amiodarone is a class III antidysrhythmic used for treating ventricular and supraventricular tachycardia and for conversion of atrial fibrillation. Results of fasting lipid profile are expected with antilipidemics. A degree of blood pressure control is expected with antihypertensives. Incidence of ischemic chest pain is expected with antianginal agents, such as nitrates.

When caring for a client with acute coronary syndrome who has frequent premature ventricular complexes (PVCs), the nurse will be most concerned about PVCs occurring in which phase of the cardiac cycle? a P wave b T wave c P-R interval d QRS complex

b The T wave is the period of repolarization of the ventricles; stimulation of the ventricles during this vulnerable period often causes ventricular fibrillation. If a premature ventricular contraction strikes on the P wave, it will not cause ventricular fibrillation; the P wave represents atrial contraction. The P-R interval represents the time it takes the impulse to travel from the sinoatrial (SA) node to the ventricular musculature, and a PVC during the PR interval will not cause ventricular fibrillation. QRS complex is the term used to represent the entire phase of ventricular contraction.

Which assessment finding by the nurse caring for a client with new-onset atrial fibrillation would be most important to communicate to the health care provider? a Irregular apical pulse b Sudden vision change c Exertional dyspnea d Lower extremity edema

b Atrial fibrillation causes pooling of blood in the atria, leading to atrial clots and risk for stroke if clots are ejected from the left ventricle into the systemic circulation. A sudden onset change in vision may indicate stroke and would be immediately communicated to the health care provider so that actions such as rapid administration of thrombolytic medications can be considered. An irregular apical pulse is characteristic of atrial fibrillation and would not be immediately reported to the health care provider. Although exertional dyspnea would be reported to the health care provider, it is common with atrial fibrillation and does not require any immediate change in treatment. Edema may occur with atrial fibrillation because of decreased cardiac output, but it does not require an immediate change in treatment.

When a client has supraventricular tachycardia that has persisted despite treatment with vagal maneuvers and medications, which collaborative intervention will the nurse anticipate to treat the dysrhythmia? a Defibrillation b Pacemaker placement c Synchronized cardioversion d Cardiac resynchronization therapy

c Synchronized cardioversion is application of a shock that is timed to land on the R wave to depolarize the myocardium and allow the normal cardiac pacemaker in the sinoatrial node to take over normal cardiac stimulation. Defibrillation is not synchronized and might cause fatal dysrhythmias such as ventricular fibrillation if used on a client with supraventricular tachycardia. A pacemaker would be used for slow heart rates such as might occur with atrioventricular blocks. Cardiac resynchronization therapy is used for clients with severe left ventricular failure to synchronize the contraction of the right and left ventricles and improve cardiac output.

Which action by a new registered nurse (RN) who is orienting to the progressive care unit indicates a good understanding of the treatment of cardiac dysrhythmias? a. Injects IV adenosine (Adenocard) over 2 seconds to a patient with supraventricular tachycardia b. Obtains the defibrillator and quickly brings it to the bedside of a patient whose monitor shows asystole c. Turns the synchronizer switch to the on position before defibrillating a patient with ventricular fibrillation d. Gives the prescribed dose of diltiazem (Cardizem) to a patient with new-onset type II second degree AV block

ANS: A Adenosine must be given over 1 to 2 seconds to be effective. The other actions indicate a need for more education about treatment of cardiac dysrhythmias. The RN should hold the diltiazem until talking to the health care provider. The treatment for asystole is immediate CPR. The synchronizer switch should be off when defibrillating.

After the nurse gives IV atropine to a patient with symptomatic type 1, second-degree atrioventricular (AV) block, which finding indicates that the medication has been effective? a. Increase in the patients heart rate b. Increase in strength of peripheral pulses c. Decrease in premature atrial contractions d. Decrease in premature ventricular contractions

ANS: A Atropine will increase the heart rate and conduction through the AV node. Because the medication increases electrical conduction, not cardiac contractility, the quality of the peripheral pulses is not used to evaluate the drug effectiveness. The patient does not have premature atrial or ventricular contractions.

The nurse is caring for a 64-year-old patient admitted with mitral valve regurgitation. Which information obtained by the nurse when assessing the patient should be communicated to the health care provider immediately? a. The patient has bilateral crackles. b. The patient has bilateral, 4+ peripheral edema. c. The patient has a loud systolic murmur across the precordium. d. The patient has a palpable thrill felt over the left anterior chest.

ANS: A Crackles that are audible throughout the lungs indicate that the patient is experiencing severe left ventricular failure with pulmonary congestion and needs immediate interventions such as diuretics. A systolic murmur and palpable thrill would be expected in a patient with mitral regurgitation. Although 4+ peripheral edema indicates a need for a change in therapy, it does not need to be addressed urgently.

While caring for a patient with aortic stenosis, the nurse identifies a nursing diagnosis of acute pain related to decreased coronary blood flow. A priority nursing intervention for this patient would be to a. promote rest to decrease myocardial oxygen demand. b. teach the patient about the need for anticoagulant therapy. c. teach the patient to use sublingual nitroglycerin for chest pain. d. raise the head of the bed 60 degrees to decrease venous return

ANS: A Rest is recommended to balance myocardial oxygen supply and demand and to decrease chest pain. The patient with aortic stenosis requires higher preload to maintain cardiac output, so nitroglycerin and measures to decrease venous return are contraindicated. Anticoagulation is not recommended unless the patient has atrial fibrillation.

The nurse notes that a patients cardiac monitor shows that every other beat is earlier than expected, has no visible P wave, and has a QRS complex that is wide and bizarre in shape. How will the nurse document the rhythm? a. Ventricular couplets b. Ventricular bigeminy. c. Ventricular R-on-T phenomenond. d. Multifocal premature ventricular contractions

ANS: B Ventricular bigeminy describes a rhythm in which every other QRS complex is wide and bizarre looking. Pairs of wide QRS complexes are described as ventricular couplets. There is no indication that the premature ventricular contractions (PVCs) are multifocal or that the R-on-T phenomenon is occurring.

A patient reports dizziness and shortness of breath for several days. During cardiac monitoring in the emergency department (ED), the nurse obtains the following electrocardiographic (ECG) tracing. The nurse interprets this heart rhythm as a. junctional escape rhythm. b. accelerated idioventricular rhythm. c. third-degree atrioventricular (AV) block. d. sinus rhythm with premature atrial contractions (PACs).

ANS: C The inconsistency between the atrial and ventricular rates and the variable P-R interval indicate that the rhythm is third-degree AV block. Sinus rhythm with PACs will have a normal rate and consistent P-R intervals with occasional PACs. An accelerated idioventricular rhythm will not have visible P waves.

A patient who is complaining of a racing heart and feeling anxious comes to the emergency department. The nurse places the patient on a heart monitor and obtains the following electrocardiographic (ECG) tracing. Which action should the nurse take next? a. Prepare to perform electrical cardioversion. b. Have the patient perform the Valsalva maneuver. c. Obtain the patients vital signs including oxygen saturation. d. Prepare to give a b-blocker medication to slow the heart rate.

ANS: C The patient has sinus tachycardia, which may have multiple etiologies such as pain, dehydration, anxiety, and myocardial ischemia. Further assessment is needed before determining the treatment. Vagal stimulation or b- blockade may be used after further assessment of the patient. Electrical cardioversion is used for some tachydysrhythmias, but would not be used for sinus tachycardia.

When reviewing the 12-lead electrocardiograph (ECG) for a healthy 79-year-old patient who is having an annual physical examination, what will be of most concern to the nurse? a. The PR interval is 0.21 seconds. b. The QRS duration is 0.13 seconds. c. There is a right bundle-branch block. d. The heart rate (HR) is 42 beats/minute.

ANS: D The resting HR does not change with aging, so the decrease in HR requires further investigation. Bundle- branch block and slight increases in PR interval or QRS duration are common in older individuals because of increases in conduction time through the AV node, bundle of His, and bundle branches.

When analyzing the rhythm of a patients electrocardiogram (ECG), the nurse will need to investigate further upon finding a(n) a. isoelectric ST segment. b. P-R interval of 0.18 second. c. Q-T interval of 0.38 second. d. QRS interval of 0.14 second.

ANS: D Because the normal QRS interval is 0.04 to 0.10 seconds, the patients QRS interval of 0.14 seconds indicates that the conduction through the ventricular conduction system is prolonged. The P-R interval and Q-T interval are within normal range, and ST segment should be isoelectric (flat).

A patient has a normal cardiac rhythm and a heart rate of 72 beats/minute. The nurse determines that the P-R interval is 0.24 seconds. The most appropriate intervention by the nurse would be to a notify the health care provider immediately. b give atropine per agency dysrhythmia protocol. c prepare the patient for temporary pacemaker insertion. d document the finding and continue to monitor the patient

ANS: D First-degree atrioventricular (AV) block is asymptomatic and requires ongoing monitoring because it may progress to more serious forms of heart block. The rate is normal, so there is no indication that atropine is needed. Immediate notification of the health care provider about an asymptomatic rhythm is not necessary.

Which laboratory result for a patient with multifocal premature ventricular contractions (PVCs) is most important for the nurse to communicate to the health care provider? a. Blood glucose 243 mg/dL b. Serum chloride 92 mEq/L c. Serum sodium 134 mEq/L d. Serum potassium 2.9 mEq/L

ANS: D Hypokalemia increases the risk for ventricular dysrhythmias such as PVCs, ventricular tachycardia, and ventricular fibrillation. The health care provider will need to prescribe a potassium infusion to correct this abnormality. Although the other laboratory values also are abnormal, they are not likely to be the etiology of the patients PVCs and do not require immediate correction.

The nurse obtains a rhythm strip on a patient who has had a myocardial infarction and makes the following analysis: no visible P waves, P-R interval not measurable, ventricular rate 162, R-R interval regular, and QRS complex wide and distorted, QRS duration 0.18 second. The nurse interprets the patients cardiac rhythm as a atrial flutter. b sinus tachycardia. c ventricular fibrillation. d ventricular tachycardia.

ANS: D The absence of P waves, wide QRS, rate >150 beats/minute, and the regularity of the rhythm indicate ventricular tachycardia. Atrial flutter is usually regular, has a narrow QRS configuration, and has flutter waves present representing atrial activity. Sinus tachycardia has P waves. Ventricular fibrillation is irregular and does not have a consistent QRS duration.

The nurse has received change-of-shift report about the following patients on the progressive care unit. Which patient should the nurse see first? a. A patient who is in a sinus rhythm, rate 98, after having electrical cardioversion 2 hours ago b. A patient with new onset atrial fibrillation, rate 88, who has a first dose of warfarin (Coumadin) due c. A patient with second-degree atrioventricular (AV) block, type 1, rate 60, who is dizzy when ambulating d. A patient whose implantable cardioverter-defibrillator (ICD) fired two times today who has a dose of amiodarone (Cordarone) due

ANS: D The frequent firing of the ICD indicates that the patients ventricles are very irritable, and the priority is to assess the patient and administer the amiodarone. The other patients may be seen after the amiodarone is administered.

When caring for a client who presents to the emergency department with an ST-segment-elevation myocardial infarction (STEMI), which laboratory result will the nurse expect? Decreased white blood cell count Elevated serum troponins I and T Decreased creatine kinase-MB (CK-MB) Decreased B-type natriuretic peptide (BNP)

Elevated serum troponins I and T Elevations of troponin I and T levels are indicative and specific for cardiac muscle damage as would occur with STEMI. White blood cell count would increase in the first days after myocardial infarction because of the inflammatory response associated with myocardial cell death. CK-MB is found in cardiac muscle and levels increase with myocardial cell death. BNP levels are not directly reflective of myocardial infarction, but might increase if the client develops heart failure as a complication of myocardial infarction.

Which finding for a client who has a diagnosis of paroxysmal atrial fibrillation is most important to report quickly to the health care provider? Irregular heartbeat Right arm weakness Client report of palpitations Client report of lightheadedness

Right arm weakness Because stagnation of blood in the atria with atrial fibrillation may lead to atrial clot formation and then embolization and stroke, the nurse would immediately notify the health care provider about any stroke symptoms so that thrombolytic medications could be administered as quickly as possible. An irregular heartbeat is expected with atrial fibrillation, which is characterized by an irregularly irregular rhythm. Palpitations can occur with sudden onset of rapid atrial fibrillation and would be expected in a client with this diagnosis. Lightheadedness may occur with rapid atrial rates, but would not require treatment as rapidly as stroke.

A patient has a junctional escape rhythm on the monitor. The nurse will expect the patient to have a heart rate of _____ beats/minute. a 15to20 b 20to40 c 40to60 d 60 to 100

ANS: C If the sinoatrial (SA) node fails to discharge, the atrioventricular (AV) node will automatically discharge at the normal rate of 40 to 60 beats/minute. The slower rates are typical of the bundle of His and the Purkinje system and may be seen with failure of both the SA and AV node to discharge. The normal SA node rate is 60 to 100 beats/minute.

A patient whose heart monitor shows sinus tachycardia, rate 132, is apneic and has no palpable pulses. What is the first action that the nurse should take? a. Perform synchronized cardioversion. b. Start cardiopulmonary resuscitation (CPR). c. Administer atropine per agency dysrhythmia protocol. d. Provide supplemental oxygen via non-rebreather mask.

ANS: B The patients clinical manifestations indicate pulseless electrical activity and the nurse should immediately start CPR. The other actions would not be of benefit to this patient.

Which action should the nurse perform when preparing a patient with supraventricular tachycardia for cardioversion who is alert and has a blood pressure of 110/66 mm Hg? a. Turn the synchronizer switch to the off position. b. Give a sedative before cardioversion is implemented. c. Set the defibrillator/cardioverter energy to 360 joules. d. Provide assisted ventilations with a bag-valve-mask device.a

ANS: B When a patient has a nonemergency cardioversion, sedation is used just before the procedure. The synchronizer switch is turned on for cardioversion. The initial level of joules for cardioversion is low (e.g., 50). Assisted ventilations are not indicated for this patient.

A patient who is on the progressive care unit develops atrial flutter, rate 150, with associated dyspnea and chest pain. Which action that is included in the hospital dysrhythmia protocol should the nurse do first? a. Obtain a 12-lead electrocardiogram (ECG). b. Notify the health care provider of the change in rhythm. c. Give supplemental O2 at 2 to 3 L/min via nasal cannula. d. Assess the patients vital signs including oxygen saturation.

ANS: C Because this patient has dyspnea and chest pain in association with the new rhythm, the nurses initial actions should be to address the patients airway, breathing, and circulation (ABC) by starting with oxygen administration. The other actions also are important and should be implemented rapidly.

A 19-year-old student comes to the student health center at the end of the semester complaining that, My heart is skipping beats. An electrocardiogram (ECG) shows occasional premature ventricular contractions (PVCs). What action should the nurse take next? a. Start supplemental O2 at 2 to 3 L/min via nasal cannula. b. Ask the patient about current stress level and caffeine use. c. Ask the patient about any history of coronary artery disease. d. Have the patient taken to the hospital emergency department (ED).

ANS: B In a patient with a normal heart, occasional PVCs are a benign finding. The timing of the PVCs suggests stress or caffeine as possible etiologic factors. It is unlikely that the patient has coronary artery disease, and this should not be the first question the nurse asks. The patient is hemodynamically stable, so there is no indication that the patient needs to be seen in the ED or that oxygen needs to be administered.