You are assisting a RN with discharging a patient who had a permanent pacemaker placed two days ago for sustained bradycardia. You are reinforcing the discharge teaching, what statement by the client indicates a need for further teaching?
"I can go back to the gym and do light weight baring exercise and yoga."
"I will report any new dizziness or lightheadedness to my health care provider."
"I will take my pulse every day and left my health care provider if my heart rate is less than 60 beats per minute."
"I will avoid raising my arm over my head until cleared by my health care provider."
The Correct Answer is A
A. "I can go back to the gym and do light weight baring exercise and yoga.": Patients must avoid vigorous upper body activity and lifting heavy weights for several weeks to prevent lead dislodgement. Yoga often involves stretching the arms above the shoulder, which can pull on the newly implanted pacemaker leads. This statement reflects a misunderstanding of the immediate postoperative activity restrictions required for device stability.
B. "I will report any new dizziness or lightheadedness to my health care provider.": These symptoms may indicate pacemaker malfunction, such as failure to pace or loss of capture. Dizziness suggests that the heart rate is not being maintained at a level sufficient for adequate cerebral perfusion. Reporting these signs is a critical component of post-implantation safety and monitoring.
C. "I will take my pulse every day and left my health care provider if my heart rate is less than 60 beats per minute.": Monitoring the daily pulse ensures the pacemaker is maintaining the programmed minimum heart rate. A rate lower than the set threshold indicates a potential battery or electrode problem that requires urgent evaluation. This demonstrates the patient's understanding of how to monitor their own cardiac stability.
D. "I will avoid raising my arm over my head until cleared by my health care provider.": Restricting the range of motion on the affected side prevents the accidental pulling or displacement of the cardiac leads before they have scarred into place. This is a standard instruction during the first few weeks following a permanent pacemaker procedure. It is essential for ensuring long-term device functionality and successful healing.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Call the cardiologist: Contacting the specialist is necessary for definitive management but is not the most immediate nursing action. Delays in providing basic physiological support while waiting for a physician's response can lead to further myocardial damage. Initial stabilization must occur before coordinating the next level of specialized care.
B. Administer oxygen: Myocardial infarction involves a critical mismatch between oxygen supply and demand in the cardiac tissue. Providing supplemental oxygen increases the concentration of oxygen in the blood to help salvage ischemic myocardium and relieve dyspnea. This is a primary intervention to reduce the severity of the infarct and stabilize the patient.
C. Obtain vital signs: While baseline data is important for monitoring, the patient's immediate report of shortness of breath indicates an acute respiratory and circulatory crisis. Taking blood pressure and temperature does not actively treat the underlying hypoxia or chest pain. Interventions to improve oxygenation should take precedence over data collection during active ischemia.
D. Place the client in a supine position: Lying flat increases venous return and the workload of the heart, which can worsen both chest pain and shortness of breath. Patients in respiratory distress should be placed in a high-Fowler's position to maximize lung expansion and decrease cardiac strain. A supine position is physiologically detrimental during an acute coronary event.
Correct Answer is D
Explanation
A. Discourage walking in order to limit pain: Physical inactivity promotes further vascular stasis and muscle atrophy in the lower extremities. While claudication causes discomfort, complete avoidance of movement prevents the development of collateral circulation. Reduced mobility exacerbates the underlying pathology of arterial insufficiency and impairs long-term functional outcomes.
B. Encourage extended periods of sitting or standing: Prolonged static positioning increases hydrostatic pressure and can worsen peripheral tissue perfusion. Dependency or stasis does not facilitate the arterial inflow required to oxygenate ischemic tissues. Frequent position changes are necessary to prevent localized pressure and maintain adequate circulatory flow.
C. Elevate his legs and arms above his heart when resting: This position hinders gravity-assisted arterial flow to the distal extremities, worsening ischemia. Unlike venous insufficiency, arterial disease requires the limbs to be maintained in a neutral or slightly dependent position. Elevation significantly reduces the perfusion pressure needed to reach peripheral tissues.
D. Encourage the client to engage in moderate amount of exercise: Structured walking programs stimulate the formation of collateral vessels to bypass occluded arteries. Physical activity improves oxygen extraction by the muscles and increases the pain-free walking distance. This intervention remains a cornerstone of conservative management for improving peripheral arterial circulation.
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