What testing is done prior to a Transcatheter Aortic Valve Replacement (TAVR) to help plan out the procedure?
Chest X-ray.
Blood work.
Pulmonary function tests.
Coronary CT angiogram.
The Correct Answer is D
Choice A rationale
A chest X-ray is a standard pre-operative screen to assess lung fields, heart size, and position. While it provides useful anatomical context, it lacks the detailed 3D visualization necessary to precisely measure the aortic annulus, calculate valve size, and plan the complex delivery route for the transcatheter procedure.
Choice B rationale
Blood work provides information on organ function, coagulation status, and electrolyte balance. While essential for patient safety and risk assessment, it provides no structural or anatomical information required to physically plan the precise pathway for the catheter and the sizing of the prosthetic valve.
Choice C rationale
Pulmonary function tests assess respiratory capacity. They are important for risk stratification, especially for patients with significant lung disease, but they do not provide the detailed vascular and anatomical measurements of the aorta, femoral arteries, or the aortic annulus needed for TAVR procedural planning.
Choice D rationale
A Coronary CT angiogram (CTA) is the critical planning tool. It uses contrast to create a detailed 3D reconstruction of the aorta, the aortic annulus (to precisely size the valve), the access vessels (e.g., femoral arteries), and their calcification, ensuring the safest and most effective catheter route and valve size. —.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
ST-segment elevation on an ECG indicates acute myocardial injury, often progressing to an ST-elevation myocardial infarction (STEMI). Leads II, III, and aVF view the inferior wall of the left ventricle, which is typically supplied by the Right Coronary Artery (RCA). This finding localizes the area of infarction to the heart's inferior surface.
Choice B rationale
Prinzmetal's (variant) Angina is a type of chest pain caused by coronary artery spasm, leading to transient myocardial ischemia. While it can cause temporary ST-segment elevation during an episode, these changes resolve quickly once the spasm ceases, unlike the persistent elevation seen in a full-blown acute STEMI.
Choice C rationale
Myocardial ischemia (inadequate blood flow) is usually characterized by ST-segment depression or T-wave inversion. ST-segment elevation specifically indicates myocardial injury (a more severe, evolving stage) or infarction, meaning the patient is past the stage of "ischemia only.”.
Choice D rationale
A permanent pacemaker is used to treat symptomatic bradyarrhythmias or certain heart blocks, not acute STEMI. ST-segment elevation in the inferior leads is a sign of an acute coronary syndrome requiring urgent treatment like percutaneous coronary intervention (PCI) or fibrinolytic therapy, not pacing.
Correct Answer is B
Explanation
Choice A rationale
Dyspnea (shortness of breath) is a common symptom of heart failure or pulmonary congestion, which can be related to poor cardiac function, but it is not a direct, specific sign of diaphragmatic pacing. This symptom is generally too non-specific to pinpoint lead misplacement to the diaphragm.
Choice B rationale
The diaphragm is innervated by the phrenic nerve, which passes close to the heart. When a pacemaker lead is positioned incorrectly and stimulates the phrenic nerve, it causes rhythmic, involuntary contractions of the diaphragm, which clinically manifest as persistent hiccups. This is a classic and specific sign of lead migration or perforation causing extracardiac stimulation.
Choice C rationale
Coughing up blood (hemoptysis) suggests damage to the pulmonary or tracheobronchial system, which is a serious but rare complication, and not the primary clinical manifestation associated with stimulation of the diaphragm or the phrenic nerve by an incorrectly positioned pacemaker lead.
Choice D rationale
Chest pain can occur after a pacemaker insertion due to irritation of the surrounding tissues or a complication like pneumothorax, but it is a general symptom. It is not a direct consequence of phrenic nerve stimulation and diaphragmatic contraction, which specifically causes hiccups.
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