Symptomatic Bradycardia
A nurse is caring for a 60-year-old male client in the medical-surgical unit who was recently admitted with symptomatic bradycardia and has undergone permanent pacemaker insertion.
Complete the following sentence by using the list of options.
The nurse is caring for the client immediately following the insertion of the permanent pacemaker. The nurse should monitor the client for
The Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"A"}
The nurse is caring for the client immediately following the insertion of the permanent pacemaker. The nurse should monitor the client for hematoma at the insertion site and pacemaker failure to capture.
Rationale for correct answers:
Hematoma at the insertion site is a common complication following pacemaker placement due to vascular injury during lead insertion or anticoagulation therapy. It may present as swelling, bruising, or firmness near the generator pocket and can lead to discomfort or device displacement if not addressed promptly.
Pacemaker failure to capture occurs when the pacemaker delivers an electrical impulse but fails to stimulate myocardial contraction. It can result in persistent bradycardia or asystole. Monitoring for pacing spikes on telemetry without corresponding QRS complexes is critical. This is particularly important given the client's low apical pulse of 42/min, which suggests potential malfunction despite recent device placement.
Rationale for incorrect answers:
Increased respiratory rate is already documented in the client’s baseline assessment. While notable, it is not a pacemaker-specific complication and may reflect pre-existing symptoms rather than an acute issue needing focused post-pacemaker monitoring.
Elevated potassium levels (normal: 3.5–5.0 mEq/L) are borderline in this client (5.1 mEq/L), but mild elevation is not an immediate concern in the context of pacemaker insertion unless rapidly rising, which isn’t evident.
Decreased oxygen saturation (normal: >94%) is currently 94% and improving. This level does not require urgent intervention unless it continues to decline or respiratory distress worsens.
Peripheral edema is not present and usually develops gradually. It is more indicative of chronic heart failure rather than an acute post-pacemaker concern.
Elevated temperature (normal: 36.5–37.5°C) is not present; the client's temperature is normal. Fever would suggest infection, which is unlikely this soon after insertion.
Decreased blood pressure (normal: >90/60 mm Hg) is not present. BP is stable at 104/68 mm Hg, not warranting concern for hypotension.
Take-home points:
- Monitor for hematoma and lead displacement as common immediate complications of pacemaker insertion.
- Pacemaker malfunction may present as bradycardia with absent capture on ECG despite pacing spikes.
- Differentiate symptoms of pacemaker issues from preexisting cardiac conditions like sick sinus syndrome or AV block.
- Evaluate post-procedure symptoms in the context of baseline vital signs and device-specific risks.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
Adding more water to the suction control chamber is only indicated if the water level is below the prescribed mark, which would reduce the amount of negative pressure being applied. However, the absence of bubbling suggests a problem with the suction itself or a leak, not merely low water.
Choice B rationale
Milking the chest tube to dislodge clots is an intervention that is generally discouraged due to the potential for causing tissue damage and increasing intrathoracic pressure. Current evidence-based practice guidelines do not support routine milking of chest tubes.
Choice C rationale
Continuing to monitor the client is incorrect because the absence of bubbling in the suction control chamber indicates that the suction is not active or effective, which can compromise lung re-expansion and fluid drainage. This is not an expected finding when suction is applied.
Choice D rationale
Verifying that the suction regulator is on and checking the tubing for leaks are crucial initial steps. The absence of bubbling indicates a loss of suction, which could be due to the regulator being off, a disconnected tube, or a leak in the system, preventing proper negative pressure application.
Correct Answer is C
Explanation
Choice A rationale
Discomfort at the puncture site is a common and expected finding following a thoracentesis due to the needle insertion through the intercostal muscles and parietal pleura. Sensory nerve endings in these tissues are stimulated, causing localized pain. This typically resolves with mild analgesia and does not indicate a significant complication such as pneumothorax or hemorrhage.
Choice B rationale
Serosanguineous drainage from the puncture site, while requiring monitoring, is often a normal finding in small amounts after a thoracentesis. It represents a mixture of serous fluid and blood, indicating minor capillary oozing from the needle tract. Excessive or persistent bleeding would be concerning for hemorrhage, but minimal serosanguineous discharge is not immediately indicative of a major complication.
Choice C rationale
An increased heart rate, or tachycardia, after a thoracentesis can signify significant complications like hypovolemia due to hemorrhage or tension pneumothorax. A tension pneumothorax shifts mediastinal structures, impairing venous return and leading to compensatory tachycardia. Hypovolemia from internal bleeding also triggers a sympathetic response, increasing heart rate to maintain cardiac output.
Choice D rationale
A decreased temperature, or hypothermia, is not typically a direct or immediate complication of a thoracentesis. While systemic reactions can occur in rare instances, a sudden drop in temperature is not a characteristic sign of the most common acute post-procedure complications such as pneumothorax, hemorrhage, or infection, which usually manifest with fever or normal temperature.
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