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. Amiodarone: Amiodarone is a Class III antiarrhythmic that primarily works by blocking potassium channels, thereby prolonging repolarization and the action potential duration. It is used to manage various atrial and ventricular arrhythmias, including atrial fibrillation and ventricular tachycardia.

B. Digoxin: Digoxin is a cardiac glycoside that increases myocardial contractility and slows conduction through the AV node. It does not affect potassium channels directly but rather works by inhibiting the sodium-potassium ATPase pump.

C. Verapamil: Verapamil is a calcium channel blocker (Class IV antiarrhythmic) that slows conduction through the AV node and is used to treat supraventricular tachyarrhythmias and hypertension. It has no significant effect on potassium channels.

D. Carvedilol: Carvedilol is a non-selective beta-blocker with some alpha-blocking effects. It reduces heart rate and blood pressure but does not block potassium channels or have antiarrhythmic properties in that classification.

A. Radiofrequency ablation B. Administration of amiodarone C. insertion of a pacemaker D. Administration of adenosine

Correct Answer is C

Explanation

A. Radiofrequency ablation: This is used to treat tachyarrhythmias such as atrial fibrillation, atrial flutter, or supraventricular tachycardia (SVT). The ECG shown does not demonstrate any tachycardic rhythm rather, it shows a bradyarrhythmia with dropped QRS complexes, which suggests a conduction block, not a reentrant circuit.

B. Administration of amiodarone: Amiodarone is primarily used for ventricular arrhythmias or atrial fibrillation. It is not effective in treating bradyarrhythmias or heart blocks such as those seen in this rhythm strip.

C. Insertion of a pacemaker: The rhythm strip shows intermittent dropped QRS complexes with consistent P waves—this is indicative of second-degree AV block, Mobitz II. This type of conduction block can progress to complete heart block and is often treated with the insertion of a permanent pacemaker to maintain cardiac output.

D. Administration of adenosine: Adenosine is used to terminate SVT by temporarily blocking AV node conduction. It is contraindicated in heart blocks, especially Mobitz II or third-degree AV block, because it can worsen the block and cause asystole.

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Potassium 2.8 mEq/L
Sodium 133 mEq/L
Chloride 90 mEq/L
Glucose 200 mg/dl
Magnesium 2.5 mg/dL
Calcium 8.0 mg/dL

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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