A client who was discharged from the hospital 2 days ago after having a permanent pacemaker placed presents to the emergency department with sharp chest pain and difficulty breathing. Which assessment findings require the highest priority intervention?

BP 105/70 manually & flat neck veins

Equal breath sounds with a respiratory rate of 28

Distended neck veins & muffled heart sounds

Heart rate 105 & respiratory rate of 28

Answer and Explanation

The Correct Answer is C

A. BP 105/70 manually & flat neck veins: This blood pressure is within a low-normal range, and flat neck veins suggest no evidence of right-sided heart failure or cardiac tamponade. Though the patient needs evaluation, these findings are not emergent.

B. Equal breath sounds with a respiratory rate of 28: A mildly elevated respiratory rate can indicate distress, but equal breath sounds suggest the absence of pneumothorax or hemothorax. While the patient is symptomatic, this finding alone doesn't demand the most urgent intervention.

C. Distended neck veins & muffled heart sounds: These are classic signs of cardiac tamponade, a life-threatening emergency that can occur due to pacemaker lead perforation. This condition results in fluid accumulation in the pericardial sac, impairing cardiac output and requiring immediate intervention such as pericardiocentesis.

D. Heart rate 105 & respiratory rate of 28: These are signs of physiological compensation and indicate stress or early decompensation. However, without signs like neck vein distention or muffled heart sounds, they are less critical than the findings in option C.

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Correct Answer is D

Explanation

A. Presence of fine tremors: Fine tremors are not a typical sign of worsening heart failure. They may be associated with medications (like bronchodilators or lithium), metabolic issues, or neurologic disorders, but not directly with heart failure decompensation.

B. Heart rate 50 per minute: Bradycardia may be notable, especially in the context of beta-blocker therapy, but a heart rate of 50 bpm in a stable patient is not necessarily a sign of worsening heart failure unless accompanied by symptoms like dizziness or hypotension.

C. +1 peripheral edema: Mild peripheral edema is often chronic and common in older adults with heart failure. It does not reliably indicate worsening status unless there is a significant increase in edema or associated weight gain and pulmonary symptoms.

D. Increased confusion: Older adults are more susceptible to changes in cognitive function due to decreased cardiac output in worsening heart failure. New or worsening confusion in older adults is a key sign of decreased cerebral perfusion and may signal worsening heart failure. It can also indicate hypoxia or electrolyte imbalance, making it a critical finding that warrants immediate evaluation.

A. Sinus Bradycardia, with First Degree AV block. Rate 40 B. Second Degree AV block- Mobitz 1, Rate 40 C. Second Degree AV block-Mobitz II, Rate 40 D. Third Degree Heart Block. Rate 40

Correct Answer is A

Explanation

A. Sinus Bradycardia, with First Degree AV block, Rate 40: The rhythm strip shows regular P waves, each followed by a QRS complex, indicating a sinus rhythm. The PR interval is prolonged (greater than 0.20 seconds) but remains consistent across all beats. This confirms a first-degree AV block. The ventricular rate is approximately 40 bpm, consistent with sinus bradycardia.

B. Second Degree AV block – Mobitz I, Rate 40: Mobitz I (Wenckebach) is characterized by a progressively lengthening PR interval followed by a dropped QRS complex. This pattern is not seen here; the PR intervals are consistently prolonged.

C. Second Degree AV block – Mobitz II, Rate 40: Mobitz II involves intermittent dropped QRS complexes without progressive PR prolongation. In the strip, no QRS complexes are missing, ruling out Mobitz II.

D. Third Degree Heart Block, Rate 40: In complete heart block, there is no relationship between P waves and QRS complexes (AV dissociation). Here, the P waves are consistently followed by QRS complexes, indicating intact conduction, even if delayed. This therefore is not a third-degree block.

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A client who was discharged from the hospital 2 days ago after having a permanent pacemaker placed presents to the emergency department with sharp chest pain and difficulty breathing. Which assessment findings require the highest priority intervention?

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Naxlex Comprehensive Predictor Exams

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Explanation

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