The nurse is caring for a patient with refractory atrial fibrillation who underwent the maze procedure several months ago.
The nurse reviews the result of the patient’s most recent cardiac imaging, which notes the presence of scarring on the atria.
Recognize that the procedure was unsuccessful.
Prepare the patient for pacemaker implantation.
Consult with the care team in preparation for repeating the maze procedure.
Recognize this as a therapeutic goal of the procedure.
The Correct Answer is C
Choice A rationale:
Incorrect. Scarring on the atria is not an indication of procedure failure in the context of the maze procedure. In fact, it's a desired outcome.
Pacemaker implantation: Not routinely indicated after the maze procedure, even if scarring is present. Pacemakers are primarily used to treat bradyarrhythmias (slow heart rhythms), not atrial fibrillation.
Choice B rationale:
Incorrect. Repeating the maze procedure is generally not considered unless there's clear evidence of recurrent atrial fibrillation despite initial scarring. Scarring formation takes time, and premature repeat procedures are often not necessary.
Consulting the care team: While collaboration is essential, consultation specifically for repeating the procedure based solely on scarring would be premature.
Choice C rationale:
Correct. The maze procedure intentionally creates scar tissue within the atria to block abnormal electrical signals that cause atrial fibrillation. Scarring disrupts the pathways that allow these signals to circulate and trigger fibrillation. Therefore, the presence of scarring is a positive finding that suggests the procedure has achieved its intended effect.
Choice D rationale:
Incorrect. Further diagnostic testing is not routinely indicated solely based on the presence of scarring after the maze procedure. Additional testing might be considered if the patient experiences recurrent atrial fibrillation or other concerning symptoms, but scarring itself does not necessitate immediate further investigation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Cardiac tamponade is a life-threatening condition that occurs when fluid accumulates in the pericardial sac, the thin, doublelayered membrane that surrounds the heart. This fluid buildup compresses the heart, preventing it from filling properly and pumping blood effectively.
The classic triad of symptoms of cardiac tamponade is muffled heart sounds, jugular vein distention (JVD), and hypotension.
Muffled heart sounds occur because the fluid in the pericardial sac dampens the sound of the heart's valves closing. JVD occurs because the fluid in the pericardial sac compresses the superior vena cava, which is a large vein that carries blood from the upper body back to the heart. Hypotension occurs because the compressed heart is unable to pump blood effectively.
Other signs and symptoms of cardiac tamponade may include:
Tachycardia (rapid heart rate)
Dyspnea (shortness of breath)
Chest pain
Pulsus paradoxus (a drop in blood pressure during inspiration)
Anxiety or restlessness
Altered mental status
Cardiac tamponade is a medical emergency that requires immediate treatment. The goal of treatment is to relieve the pressure on the heart by removing the fluid from the pericardial sac. This is typically done through a procedure called pericardiocentesis, which involves inserting a needle into the pericardial sac and draining the fluid.
Choice B rationale:
Artery dissection is a condition that occurs when the inner layer of an artery tears, allowing blood to flow between the layers of the artery wall. This can lead to a number of complications, including aneurysm formation, rupture, and ischemia (lack of blood flow) to the organs and tissues supplied by the affected artery.
The signs and symptoms of artery dissection vary depending on the location of the dissection. Common symptoms include sudden, severe pain; weakness or numbness; and a difference in blood pressure between the arms or legs.
Artery dissection is a serious condition that requires prompt medical attention. Treatment options may include medication, surgery, or a combination of both.
Choice C rationale:
It is not normal to have muffled heart sounds, JVD, and hypotension following stent placement. These are signs of a serious complication, such as cardiac tamponade or artery dissection.
Choice D rationale:
Myocardial infarction (MI), also known as a heart attack, occurs when blood flow to a portion of the heart is blocked, causing damage to the heart muscle. The classic symptom of an MI is chest pain, but other symptoms may include shortness of breath, nausea, vomiting, sweating, and lightheadedness.
The signs and symptoms of cardiac tamponade and MI can overlap, but there are some key differences. For example, chest pain is more common in MI, while JVD is more common in cardiac tamponade.
Correct Answer is B
Explanation
Choice A rationale:
Normal sinus rhythm (NSR) is the typical heart rhythm in healthy individuals. It's characterized by the following features on an ECG:
Heart rate: 60-100 beats per minute
Regular rhythm
P waves present, upright, and uniform in appearance
PR interval: 0.12-0.20 seconds
QRS complex: narrow (less than 0.12 seconds)
The rhythm in question does not meet the criteria for NSR because the heart rate exceeds 100 beats per minute.
Choice B rationale:
Sinus tachycardia is a rhythm that originates in the sinus node (the heart's natural pacemaker) but has a faster rate than normal. Its ECG features include:
Heart rate: greater than 100 beats per minute (typically 100-150)
Regular rhythm
P waves present, upright, and uniform in appearance
PR interval: 0.12-0.20 seconds
QRS complex: narrow (less than 0.12 seconds)
The rhythm in question aligns with the characteristics of sinus tachycardia, making it the most likely correct answer.
Choice C rationale:
Sinus bradycardia is a rhythm that also originates in the sinus node but has a slower rate than normal. Its ECG features include:
Heart rate: less than 60 beats per minute
Regular rhythm
P waves present, upright, and uniform in appearance
PR interval: 0.12-0.20 seconds
QRS complex: narrow (less than 0.12 seconds)
The rhythm in question does not meet the criteria for sinus bradycardia due to its heart rate being above 60 beats per minute.
Choice D rationale:
Atrial fibrillation (AFib) is a common arrhythmia characterized by rapid, irregular, and disorganized electrical activity in the atria. Its ECG features include: Irregular rhythm
Absence of distinct P waves (replaced by fibrillatory waves)
QRS complexes typically narrow (unless there's concomitant bundle branch block)
The rhythm in question does not exhibit the characteristic features of AFib, notably the irregular rhythm and absence of P waves.
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