A patient with a permanent pacemaker is experiencing syncope.
Which of the following should the nurse assess first?
Battery life of the pacemaker.
Signs of infection at the insertion site.
Recent changes in diet.
Patient's medication history.
The Correct Answer is A
Choice A rationale
Syncope, or transient loss of consciousness, in a patient with a pacemaker is often a sign of inadequate cardiac output, potentially due to a sudden drop in heart rate. This can happen if the pacemaker is malfunctioning or if the battery voltage has dropped below a critical level, indicating a need for urgent assessment and possible device replacement.
Choice B rationale
While infection is a risk and can cause systemic symptoms like fever and malaise, it is less likely to be the immediate and primary cause of acute syncope. Syncope suggests a hemodynamic issue, making direct assessment of the device's function and battery life a more critical initial step compared to checking for localized infection signs.
Choice C rationale
Recent dietary changes are generally not a direct, immediate cause of acute syncope unless they lead to severe electrolyte imbalances or hypoglycemia. Although nutrition is important for overall health, a pacemaker patient's acute syncope requires an initial focus on cardiac function and device performance over lifestyle changes.
Choice D rationale
A patient's medication history can certainly contribute to syncope (e.g., hypotension from antihypertensives). However, in a patient with a pacemaker, the most likely cause of an acute syncopal episode is device malfunction or battery depletion, making the assessment of the pacemaker's electrical integrity the highest priority. —. ##.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
In junctional dysrhythmias, the atrioventricular (AV) node assumes pacemaker activity when the sinoatrial node fails or impulses are blocked. The intrinsic firing rate of the AV junction is 40–60 beats/min. This rhythm ensures continued cardiac output despite primary pacemaker dysfunction. The impulse may travel retrograde to depolarize the atria and antegrade to the ventricles, resulting in inverted or absent P waves with normal QRS morphology on electrocardiography.
Choice B rationale
The AV node does not act as a defibrillator. Defibrillation delivers external electrical energy to depolarize all myocardial cells simultaneously, terminating lethal ventricular dysrhythmias. The AV node conducts physiologic impulses and cannot discharge electrical energy externally. Its function is impulse relay and backup pacemaking, not synchronized high-voltage energy delivery typical of defibrillation equipment used for cardiac arrest management.
Choice C rationale
The AV node does not replace parasympathetic nervous system function. Parasympathetic stimulation via the vagus nerve reduces heart rate by decreasing SA and AV nodal automaticity. The AV node’s role in junctional rhythms arises from intrinsic automaticity, not autonomic modulation. Although parasympathetic tone can influence AV conduction velocity, the node itself cannot substitute for neural parasympathetic activity controlling systemic heart rate and vascular tone balance.
Choice D rationale
The AV node does not assume sympathetic nervous system function. Sympathetic activation increases heart rate and conduction velocity via β1-adrenergic receptor stimulation. Junctional rhythms result from intrinsic pacemaker shift, not sympathetic compensation. Although sympathetic stimulation may accelerate junctional rate, it does not make the AV node a sympathetic structure. The node’s role is electrical impulse initiation and conduction rather than systemic neurohormonal regulation.
Correct Answer is ["A","B","D"]
Explanation
Choice A rationale:
Survivors of sudden cardiac death due to ventricular fibrillation or pulseless ventricular tachycardia are prime candidates for ICDs. These devices detect and terminate life-threatening arrhythmias via defibrillation or antitachycardia pacing. ICDs reduce mortality by preventing recurrence of fatal arrhythmias. Guidelines recommend ICDs for secondary prevention in patients with structurally abnormal hearts and documented ventricular arrhythmias.
Choice B rationale
Spontaneous sustained ventricular tachycardia, especially if symptomatic or hemodynamically unstable, warrants ICD placement. Sustained VT is defined as lasting more than 30 seconds or requiring intervention. ICDs monitor rhythm and deliver therapy when VT is detected, preventing progression to ventricular fibrillation. This is a Class I indication for ICDs in patients with structural heart disease.
Choice C rationale
Unstable angina is caused by transient myocardial ischemia due to plaque rupture or vasospasm. It is managed with anti-ischemic therapy and revascularization. ICDs are not indicated unless the patient develops sustained ventricular arrhythmias or survives cardiac arrest. ICDs do not treat ischemia directly and are not used for primary prevention in unstable angina.
Choice D rationale
Heart failure patients with reduced ejection fraction (≤35%) and NYHA class II–III symptoms despite optimal medical therapy are candidates for ICDs for primary prevention. These patients are at increased risk for sudden cardiac death due to ventricular arrhythmias. ICDs improve survival by terminating malignant rhythms. This is supported by trials like MADIT-II and SCD-HeFT.
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