The nurse is doing discharge teaching with a client who has coronary artery disease.

The client asks why he has to take an aspirin every day if he doesn’t have any pain.

What would be the nurse’s best response?

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.

Choice A rationale:

Digoxin is a medication that slows the heart rate. It would be contraindicated in this patient because they are already bradycardic.

Administering digoxin could further slow the heart rate and worsen the patient's symptoms.

Additionally, digoxin can have a negative inotropic effect, which could further compromise the patient's hemodynamic status. Choice B rationale:

While it is important to continue to monitor the patient, this is not an intervention that will address the patient's bradycardia and hypotension.

The patient is already symptomatic, and their heart rate and blood pressure are likely to continue to decline without intervention. Choice C rationale:

Defibrillation is used to treat life-threatening arrhythmias such as ventricular fibrillation and pulseless ventricular tachycardia.

It is not indicated for sinus bradycardia.

Choice D rationale:

Transcutaneous pacing is a non-invasive method of pacing the heart.

It can be used to temporarily increase the heart rate in patients with symptomatic bradycardia.

This is the most appropriate intervention for this patient because it will address the underlying problem of bradycardia and improve the patient's hemodynamic status.