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A physical therapist is performing a treadmill exercise stress test using the Bruce protocol.  During stage 3 of the test, the P wave increases in height and the S-T segment begins to become sharply upsloping.  What is the MOST appropriate course of action?

  1. Immediately stop the test and refer patient to a physician.

  2. Immediately lower the stage back to stage 2 and monitor for improved electrocardiographic indicators.

  3. Continue with the test without any modification, monitoring for symptoms of cardiac distress.

  4. Discontinue the test, and monitor the patient’s vital signs for 10 minutes.

The correct answer is: (Please LIKE this post)

  1. The Bruce Protocol for an exercise stress test involves using a 12-lead ECG monitor to evaluate the amount of stress placed on the heart.  You would stop the test if there was S-T elevation or depression, or the signs of a number of other ECG signs (see http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1123032/)  P wave increases and S-T upsloping are normal responses to a stress test.

  2. This is not appropriate for the Bruce Protocol.

  3. This is the correct answer.  Both of these signs are normal responses to the stress test.

  4. If the patient requested to stop, this would be the appropriate action.  Because it is not mentioned in the question, this is NOT the most appropriate course of action.

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