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A patient is undergoing preoperative teaching before his cardiac surgery and the nurse is aware that a temporary pacemaker will be placed later that day. What is the nurses responsibility in the care of the patients pacemaker?
- A. Monitoring for pacemaker malfunction or battery failure
- B. Determining when it is appropriate to remove the pacemaker
- C. Making necessary changes to the pacemaker settings
- D. Selecting alternatives to future pacemaker use
Correct Answer: A
Rationale: Monitoring for pacemaker malfunctioning and battery failure is a nursing responsibility. The other listed actions are physician responsibilities.
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The nurse is providing care to a patient who has just undergone an electrophysiologic (EP) study. The patient states that she is nervous about things going wrong during the procedure. What is the nurses best response?
- A. This is basically a risk-free procedure.
- B. Thousands of patients undergo EP every year.
- C. Remember that this is a step that will bring you closer to enjoying good health.
- D. The whole team will be monitoring you very closely for the entire procedure.
Correct Answer: D
Rationale: Patients who are to undergo an EP study may be anxious about the procedure and its outcome. A detailed discussion involving the patient, the family, and the electrophysiologist usually occurs to ensure that the patient can give informed consent and to reduce the patients anxiety about the procedure. It is inaccurate to state that EP is risk-free and stating that it is common does not necessarily relieve the patients anxiety. Characterizing EP as a step toward good health does not directly address the patients anxiety.
During a patients care conference, the team is discussing whether the patient is a candidate for cardiac conduction surgery. What would be the most important criterion for a patient to have this surgery?
- A. Angina pectoris not responsive to other treatments
- B. Decreased activity tolerance related to decreased cardiac output
- C. Atrial and ventricular tachycardias not responsive to other treatments
- D. Ventricular fibrillation not responsive to other treatments
Correct Answer: C
Rationale: Cardiac conduction surgery is considered in patients who do not respond to medications and antitachycardia pacing. Angina, reduced activity tolerance, and ventricular fibrillation are not criteria.
A patient has undergone diagnostic testing and received a diagnosis of sinus bradycardia attributable to sinus node dysfunction. When planning this patients care, what nursing diagnosis is most appropriate?
- A. Acute pain
- B. Risk for unilateral neglect
- C. Risk for activity intolerance
- D. Risk for fluid volume excess
Correct Answer: C
Rationale: Sinus bradycardia causes decreased cardiac output that is likely to cause activity intolerance. It does not typically cause pain, fluid imbalances, or neglect of a unilateral nature.
An ECG has been ordered for a newly admitted patient. What should the nurse do prior to electrode placement?
- A. Clean the skin with providone-iodine solution.
- B. Ensure that the area for electrode placement is dry.
- C. Apply tincture of benzoin to the electrode sites and wait for it to become tacky.
- D. Gently abrade the skin by rubbing the electrode sites with dry gauze or cloth.
Correct Answer: D
Rationale: An ECG is obtained by slightly abrading the skin with a clean dry gauze pad and placing electrodes on the body at specific areas. The abrading of skin will enhance signal transmission. Disinfecting the skin is unnecessary and conduction gel is used.
The nurse is planning discharge teaching for a patient with a newly inserted permanent pacemaker. What is the priority teaching point for this patient?
- A. Start lifting the arm above the shoulder right away to prevent chest wall adhesion.
- B. Avoid cooking with a microwave oven.
- C. Avoid exposure to high-voltage electrical generators.
- D. Avoid walking through store and library antitheft devices.
Correct Answer: C
Rationale: High-output electrical generators can reprogram pacemakers and should be avoided. Recent pacemaker technology allows patients to safely use most household electronic appliances and devices (e.g., microwave ovens). The affected arm should not be raised above the shoulder for 1 week following placement of the pacemaker. Antitheft alarms may be triggered so patients should be taught to walk through them quickly and avoid standing in or near these devices. These alarms generally do not interfere with pacemaker function.