Which assessment data would require immediate intervention by the nurse for the client who is six (6) hours post-operative abdominal aortic aneurysm repair?

Absent bilateral pedal pulses.

Complaints of pain at the site of the incision.

Distended, tender abdomen.

An elevated temperature of 100 F

Answer and Explanation

The Correct Answer is A

Absent bilateral pedal pulses indicate a potential vascular complication, such as impaired circulation or blood flow to the lower extremities. It may suggest compromised perfusion and could be a sign of arterial occlusion or thrombosis, which requires immediate intervention. The nurse should notify the healthcare provider promptly to assess the client's condition and initiate appropriate interventions to restore circulation to the lower extremities.

While complaints of pain at the site of the incision are significant, post-operative pain is expected after abdominal surgery. The nurse should assess the pain and provide appropriate pain management interventions, but it may not require immediate intervention unless the pain is severe or accompanied by other concerning symptoms.

A distended, tender abdomen could indicate various post-operative complications, such as bowel obstruction or peritonitis. Although it should be evaluated and reported to the healthcare provider, it may not require immediate intervention unless the client's condition deteriorates or other signs of a surgical emergency are present.

An elevated temperature of 100°F (37.8°C) alone, without other signs of infection or systemic complications, may not necessarily require immediate intervention. It could be a normal response to surgery or a mild post-operative infection. The nurse should monitor the client's temperature and assess for other signs of infection, and if necessary, report it to the healthcare provider for further evaluation.

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Correct Answer is A

Explanation

ST-segment elevation during exercise stress testing is a concerning ﬁnding that may indicate reduced blood ﬂow to the heart muscle. It can be a sign of myocardial ischemia or coronary artery disease. Cardiac catheterization is a diagnostic procedure that allows direct visualization of the coronary arteries and helps identify any blockages or narrowing that may be causing the ST-segment elevation.

Here's an explanation of why the other options are not the most appropriate procedures:

Transesophageal echocardiogram: Transesophageal echocardiogram (TEE) is a diagnostic test that involves inserting a probe into the esophagus to obtain detailed images of the heart. It is not typically used to evaluate ST-segment elevation, which primarily indicates coronary artery issues rather than structural abnormalities.

Telemetry monitoring: Telemetry monitoring involves continuous monitoring of a patient's heart rhythm and can be used for various cardiac conditions. While telemetry monitoring may be necessary for ongoing cardiac assessment, it is not a speciﬁc procedure to address the ST-segment elevation found during the exercise stress test.

Pharmacologic stress test: A pharmacologic stress test is an alternative to an exercise stress test for patients who cannot exercise. It involves administering medications that stimulate the heart to mimic the effects of exercise. While a pharmacologic stress testcan also reveal ST-segment changes, the presence of ST-segment elevation usually requires further evaluation with a more invasive procedure like cardiac catheterization.

A. The procedure stimulates the growth of new pathways between the atria B. The procedure uses cold therapy to stop the formation of the ﬂutter waves C. The procedure prevents or minimizes the patient's risk for sudden cardiac death D. The procedure uses electrical energy to destroy areas of the conduction system

Correct Answer is D

Explanation

The procedure uses electrical energy to destroy areas of the conduction system: Catheter ablation is a minimally invasive procedure performed to treat abnormal heart rhythms, such as atrial ﬂutter. During the procedure, a catheter is inserted into the heartand used to deliver electrical energy to speciﬁc areas of the heart tissue. This energy is used to destroy or ablate the abnormal conduction pathways that are causing the atrial ﬂutter.

Let's go through the other options and explain why they are not accurate:

The procedure stimulates the growth of new pathways between the atria: Catheter ablation does not stimulate the growth of new pathways. Instead, it aims to eliminate or modify existing abnormal pathways in the heart to restore normal electrical conduction.

The procedure uses cold therapy to stop the formation of the ﬂutter waves: Catheter ablation does not use cold therapy. It primarily utilizes radiofrequency energy or other sources of heat to ablate the targeted areas of the heart tissue.

The procedure prevents or minimizes the patient's risk for sudden cardiac death: While catheter ablation can be an effective treatment for certain arrhythmias, including atrial ﬂutter, it is not primarily performed to prevent or minimize the risk of sudden cardiac death. Its main purpose is to restore normal heart rhythm and alleviate symptoms associated with the arrhythmia.

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Which assessment data would require immediate intervention by the nurse for the client who is six (6) hours post-operative abdominal aortic aneurysm repair?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse accompanies a client to an exercise stress test. The client can achieve the target heart rate, but the electrocardiogram indicates ST-segment elevation. Which procedure will the nurse prepare the patient for?

Correct Answer is A

Explanation

The nurse is teaching a client with atrial ﬂutter who is scheduled for a catheter ablation? What should the nurse include in the teaching plan?

Correct Answer is D

Explanation

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