The occupational health nurse is evaluating a patient who is 3 weeks post pacemaker insertion. Which nursing intervention is MOST appropriate at this time?

Assessing the incision for any redness, swelling, or discharge

Applying wet-to-dry dressings every 4 hours to the insertion site

Reinforcing the pressure dressing as needed

Encouraging range-of-motion exercises of the involved arm

Answer and Explanation

The Correct Answer is A

A. Assessing the incision for any redness, swelling, or discharge: At 3 weeks post pacemaker insertion, the wound should be well into the healing process. Monitoring for signs of infection—such as redness, swelling, or discharge—remains a top priority to identify delayed wound complications like infection or erosion.

B. Applying wet-to-dry dressings every 4 hours to the insertion site: Wet-to-dry dressings are used for debridement of open wounds with significant drainage and necrotic tissue, not for healing surgical incisions. By 3 weeks post-procedure, the site should be dry and closed; such dressing changes would be inappropriate and potentially increase risk of infection.

C. Reinforcing the pressure dressing as needed: Pressure dressings are typically used in the immediate post-operative period to control bleeding and are not maintained weeks after insertion. Reinforcing one at this stage would suggest poor wound healing or inappropriate post-op management.

D. Encouraging range-of-motion exercises of the involved arm: While regaining full range of motion is important after pacemaker insertion, it's usually initiated gradually. Gentle arm movement may be resumed after a few weeks but early aggressive range-of-motion exercises are discouraged immediately post-insertion to prevent lead dislodgement. At the 3-week mark, movement should be cautious and per the provider’s specific clearance.

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Correct Answer is A

Explanation

A. Atrial fibrillation: Atrial fibrillation is characterized by an irregularly irregular rhythm, absence of identifiable P waves, and an unmeasurable PR interval. The ventricular rate can vary (in this case, 92/min), and QRS duration is usually normal. These findings match the classic ECG criteria for atrial fibrillation.

B. Sinus bradycardia: Sinus bradycardia features a regular rhythm, visible P waves before each QRS, and a rate below 60 bpm. The client's rate is 92 and the rhythm is irregular, ruling out this option.

C. Supraventricular tachycardia: SVT typically presents with a regular, rapid rhythm, often over 150 bpm, and P waves may be hidden in the preceding T wave. The client’s rate is 92 with an irregular rhythm, which does not fit SVT.

D. First-degree heart block: First-degree AV block is defined by a prolonged PR interval (>0.20 seconds) with otherwise normal sinus rhythm. In this case, the PR interval is unmeasurable and the rhythm is irregular, making this diagnosis unlikely.

A. "The diaphragmatic nerve overdrives the rapid rhythm." B. "Vagal stimulation decreases peripheral vascular resistance." C. "The vagus nerve increases the heart rate, overdriving the rhythm." D. "The vagus nerve slows the heart rate"

Correct Answer is D

Explanation

A. "The diaphragmatic nerve overdrives the rapid rhythm:" The phrenic (diaphragmatic) nerve controls the diaphragm for breathing and plays no role in cardiac rhythm regulation. It is unrelated to the autonomic control of heart rate or supraventricular tachycardia (SVT) management.

B. "Vagal stimulation decreases peripheral vascular resistance:" Vagal stimulation primarily affects the heart by decreasing the rate and conduction through the AV node. Its effect on vascular resistance is minimal, making this explanation inaccurate in the context of SVT treatment.

C. "The vagus nerve increases the heart rate, overdriving the rhythm:" The vagus nerve has a parasympathetic effect, slowing down the heart rate, not increasing it. Overdrive pacing is a different concept and not related to vagal maneuvers like carotid massage.

D. "The vagus nerve slows the heart rate": The carotid sinuses in the neck contain baroreceptors that are sensitive to pressure. Massaging these sinuses stimulates the vagus nerve to release acetylcholine, which in turn slows conduction through the AV node and may terminate episodes of SVT. This response demonstrates an accurate understanding of the purpose of the procedure.

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The occupational health nurse is evaluating a patient who is 3 weeks post pacemaker insertion. Which nursing intervention is MOST appropriate at this time?

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Naxlex Comprehensive Predictor Exams

Correct Answer is A

Explanation

A client with paroxysmal supraventricular tachycardia asks the nurse why the health care provider (HCP) is going to perform carotid sinus massage. The nurse educates the client about the treatment. Which statement by the client indicates that the teaching has been effective?

Correct Answer is D

Explanation

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