A client in sinus bradycardia, with a heart rate of 45 beats per minute and blood pressure of 82/60 mm Hg, reports dizziness. Which intervention should the nurse anticipate will be prescribed?

Administer digoxin

Continue to monitor the client.

Defibrillate the client.

Prepare for transcutaneous pacing

Answer and Explanation

The Correct Answer is D

A.   Digoxin is a medication used primarily to treat heart failure and certain types of arrhythmias, such as atrial fibrillation. It works by increasing the force of heart contractions and slowing the heart rate. However, digoxin is not typically used to treat bradycardia and may actually exacerbate the condition by further slowing the heart rate.
B.   While monitoring is an essential part of patient care, it is not sufficient alone in this situation. The client’s heart rate is very low (45 beats per minute) and their blood pressure is low (82/60 mm Hg), which suggests they are symptomatic and potentially unstable.
C.   Defibrillation is used to treat life-threatening arrhythmias such as ventricular fibrillation or pulseless ventricular tachycardia. It is not used for sinus bradycardia, which is a slow heart rate rather than a rapid, disorganized rhythm requiring electrical shock.

D.   Transcutaneous pacing involves applying external pacing pads to the skin to stimulate the heart and increase the heart rate. This is a suitable intervention for symptomatic bradycardia, especially when accompanied by low blood pressure and dizziness.

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Correct Answer is C

Explanation

A. While a recent upper respiratory infection might be relevant to overall health and could potentially influence cardiac symptoms, it is not as directly pertinent to the management of hypertrophic cardiomyopathy. HCM is primarily a genetic condition affecting the heart muscle, and a recent infection does not significantly impact the primary concerns related to HCM.
B. A family history of coronary artery disease (CAD) can be relevant, but it is less directly related to hypertrophic cardiomyopathy than other factors. CAD involves the narrowing or blockage of coronary arteries and can lead to other cardiac issues, but HCM is more specifically associated with genetic factors and structural heart abnormalities rather than CAD.
C. This information is very important for planning care for the patient with hypertrophic cardiomyopathy. A family history of sudden cardiac death, particularly at a young age, raises significant concerns about the genetic nature of the condition and the potential for similar outcomes.
D. Cocaine use can have serious cardiovascular effects and might contribute to other heart issues, but its relevance in the context of hypertrophic cardiomyopathy is less direct. While substance abuse is a concern, it is not as critical in understanding or managing the risk associated with HCM compared to a family history of sudden cardiac arrest.

A. Avoid direct blows to the chest. B. Start lifting the arm above the shoulder right away to prevent a "frozen shoulder". C. Avoid cooking with microwave ovens. D. Use mild analgesics to control the chest spasms caused by the pacing current.

Correct Answer is A

Explanation

A. The pacemaker and its leads are implanted in the chest area, and direct blows or trauma to this area can potentially dislodge the leads or damage the pacemaker. Patients should be advised to avoid activities that could result in trauma to the chest to protect the pacemaker and ensure its proper function.
B. Patients are generally advised to avoid lifting the arm on the side of the pacemaker above shoulder level for a period (usually about 4-6 weeks) to prevent complications and ensure proper healing. Early lifting of the arm might dislodge the pacemaker leads or cause other issues. Exercises and range-of- motion activities are typically started under guidance once the initial healing period is over.

C. Modern pacemakers are designed to be shielded against common household electrical appliances, including microwave ovens. Patients with pacemakers do not need to avoid using microwave ovens, as there is no significant risk of interference from these devices.
D. Mild analgesics might be used for discomfort or pain in some cases, but the notion that chest spasms are caused by the pacing current is generally incorrect. Pacemakers are designed to be non-intrusive and should not cause spasm-like sensations if functioning correctly.

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A client in sinus bradycardia, with a heart rate of 45 beats per minute and blood pressure of 82/60 mm Hg, reports dizziness. Which intervention should the nurse anticipate will be prescribed?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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