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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.
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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.
A patient calls his cardiologists office and talks to the nurse. He is concerned because he feels he is being defibrillated too often. The nurse tells the patient to come to the office to be evaluated because the nurse knows that the most frequent complication of ICD therapy is what?
- A. Infection
- B. Failure to capture
- C. Premature battery depletion
- D. Oversensing of dysrhythmias
Correct Answer: D
Rationale: Inappropriate delivery of ICD therapy, usually due to oversensing of atrial and sinus tachycardias with a rapid ventricular rate response, is the most frequent complication of ICD. Infections, failure to capture, and premature battery failure are less common.
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.
A nurse is providing health education to a patient scheduled for cryoablation therapy. The nurse should describe what aspect of this treatment?
- A. Peeling away the area of endocardium responsible for the dysrhythmia
- B. Using electrical shocks directly to the endocardium to eliminate the source of dysrhythmia
- C. Using high-frequency sound waves to eliminate the source of dysrhythmia
- D. Using a cooled probe to eliminate the source of dysrhythmia
Correct Answer: D
Rationale: Cryoablation therapy involves using a cooled probe to create a small scar on the endocardium to eliminate the source of the dysrhythmias. Endocardium resection involves peeling away a specified area of the endocardium. Electrical ablation involves using shocks to eliminate the area causing the dysrhythmias. Radio frequency ablation uses high-frequency sound waves to destroy the area causing the dysrhythmias.
A patient the nurse is caring for has a permanent pacemaker implanted with the identification code beginning with VVI. What does this indicate?
- A. Ventricular paced, ventricular sensed, inhibited
- B. Variable paced, ventricular sensed, inhibited
- C. Ventricular sensed, ventricular situated, implanted
- D. Variable sensed, variable paced, inhibited
Correct Answer: A
Rationale: The identification of VVI indicates ventricular paced, ventricular sensed, inhibited.