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The nurse is assessing a patient who had a pacemaker implanted 4 weeks ago. During the patients most recent follow-up appointment, the nurse identifies data that suggest the patient may be socially isolated and depressed. What nursing diagnosis is suggested by these data?
- A. Decisional conflict related to pacemaker implantation
- B. Deficient knowledge related to pacemaker implantation
- C. Spiritual distress related to pacemaker implantation
- D. Ineffective coping related to pacemaker implantation
Correct Answer: D
Rationale: Depression and isolation may be symptoms of ineffective coping with the implantation. These psychosocial symptoms are not necessarily indicative of issues related to knowledge or decisions. Further data would be needed to determine a spiritual component to the patients challenges.
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A patient has returned to the cardiac care unit after having a permanent pacemaker implantation. For which potential complication should the nurse most closely assess this patient?
- A. Chest pain
- B. Bleeding at the implantation site
- C. Malignant hyperthermia
- D. Bradycardia
Correct Answer: B
Rationale: Bleeding, hematomas, local infections, perforation of the myocardium, and tachycardia are complications of pacemaker implantations. The nurse should monitor for chest pain and bradycardia, but bleeding is a more common immediate complication. Malignant hyperthermia is unlikely because it is a response to anesthesia administration.
The nurse caring for a patient whose sudden onset of sinus bradycardia is not responding adequately to atropine. What might be the treatment of choice for this patient?
- A. Implanted pacemaker
- B. Trancutaneous pacemaker
- C. ICD
- D. Asynchronous defibrillator
Correct Answer: B
Rationale: If a patient suddenly develops a bradycardia, is symptomatic but has a pulse, and is unresponsive to atropine, emergency pacing may be started with transcutaneous pacing, which most defibrillators are now equipped to perform. An implanted pacemaker is not a time-appropriate option. An asynchronous defibrillator or ICD would not provide relief.
An adult patient with third-degree AV block is admitted to the cardiac care unit and placed on continuous cardiac monitoring. What rhythm characteristic will the ECG most likely show?
- A. PP interval and RR interval are irregular.
- B. PP interval is equal to RR interval.
- C. Fewer QRS complexes than P waves
- D. PR interval is constant.
Correct Answer: C
Rationale: In third-degree AV block, no atrial impulse is conducted through the AV node into the ventricles. As a result, there are impulses stimulating the atria and impulses stimulating the ventricles. Therefore, there are more P waves than QRS complexes due to the difference in the natural pacemaker (nodes) rates of the heart. The other listed ECG changes are not consistent with this diagnosis.
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.
A patient is scheduled for catheter ablation therapy. When describing this procedure to the patients family, the nurse should address what aspect of the treatment?
- A. Resetting of the hearts contractility
- B. Destruction of specific cardiac cells
- C. Correction of structural cardiac abnormalities
- D. Clearance of partially occluded coronary arteries
Correct Answer: B
Rationale: Catheter ablation destroys specific cells that are the cause or central conduction route of a tachydysrhythmia. It does not reset the hearts contractility and it does not address structural or vascular abnormalities.