Which of the following patients would you recommend for a permanent pacemaker?
Asymptomatic patient with a heart rate of 50 beats per minute.
Third Degree Atrioventricular (AV) block.
First degree Atrioventricular (AV) block.
Atrial Flutter with a controlled ventricular rate.
The Correct Answer is B
Choice A rationale
An asymptomatic bradycardia with a heart rate of 50 beats per minute, which is within the range of 50-60 bpm for normal sinus bradycardia in some individuals, particularly well-conditioned athletes, generally does not require a permanent pacemaker. Pacemaker implantation is typically reserved for symptomatic bradycardia or higher-degree Atrioventricular (AV) blocks.
Choice B rationale
Third-Degree (Complete) Atrioventricular (AV) Block is characterized by a complete failure of electrical conduction between the atria and the ventricles, resulting in independent atrial and ventricular rhythms. The slow, unreliable ventricular escape rhythm often leads to symptoms like syncope, heart failure, or sudden cardiac death, making a permanent pacemaker mandatory.
Choice C rationale
First-degree Atrioventricular (AV) block is a benign condition characterized by a prolonged PR interval (normal range 0.12 - 0.20 seconds) with every impulse conducted. It rarely progresses to higher-degree blocks and is typically asymptomatic, so it does not meet the criteria or indication for permanent pacemaker implantation.
Choice D rationale
Atrial flutter with a controlled ventricular rate means the AV node is effectively regulating the rapid atrial impulses. This rhythm is generally managed with rate-control medications like beta-blockers or calcium channel blockers, and does not warrant a permanent pacemaker, which is primarily for correcting symptomatic bradyarrhythmias. —.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Synchronized cardioversion delivers a low-energy electrical shock timed to the QRS complex to interrupt a rapid, organized rhythm like atrial fibrillation or ventricular tachycardia with a pulse. It is contraindicated in ventricular fibrillation (VF) because VF is a chaotic, unsynchronized rhythm, and mistimed delivery can worsen the rhythm.
Choice B rationale
Ventricular fibrillation (VF) is a lethal cardiac rhythm characterized by chaotic, uncoordinated electrical activity, resulting in no mechanical pump function and immediate cardiac arrest. The definitive and most critical intervention to terminate VF and restore a perfusing rhythm is immediate, high-energy, unsynchronized electrical shock, known as rapid defibrillation.
Choice C rationale
While placing the patient on oxygen (normal range 95-100% saturation) is a general supportive measure in cardiac arrest, it is not the primary intervention for a patient in ventricular fibrillation (VF). The immediate priority is defibrillation to restart the heart, as oxygenation without circulation is ineffective.
Choice D rationale
The Advanced Cardiac Life Support (ACLS) protocol for pulseless cardiac arrest prioritizes high-quality chest compressions and early defibrillation for shockable rhythms like ventricular fibrillation (VF). Rescue breaths are part of the C-A-B sequence (Circulations, Airway, Breathing) but are secondary to defibrillation in VF and should not delay the shock.
Correct Answer is A
Explanation
Choice A rationale
Mechanical heart valve replacement requires lifelong anticoagulation (e.g., Warfarin) to prevent the formation of thrombi on the foreign valve surface, which could lead to a life-threatening embolic stroke or valve obstruction. This teaching is paramount as non-adherence carries a high and immediate risk of catastrophic thromboembolic events.
Choice B rationale
Cardiac rehabilitation is a vital post-operative program focused on physical and lifestyle recovery, but its instruction is secondary to the immediate life-preserving measure of preventing valve-related thrombosis. It addresses long-term functional improvement rather than immediate surgical complication prevention.
Choice C rationale
Instruction on incentive spirometry is essential for preventing atelectasis and pneumonia post-surgery, addressing a common and serious pulmonary complication. However, the risk of a thromboembolic event from a mechanical valve without anticoagulation is a more critical and life-threatening immediate concern.
Choice D rationale
Discussing post-surgery dietary restrictions is important, particularly concerning sodium for fluid management and Vitamin K if on Warfarin, but this is a long-term management component. The most critical immediate preoperative teaching concerns the life-saving necessity of strict, permanent anticoagulation therapy. —.
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