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The nurse is caring for a client with a pacemaker/ICD on a continuous cardiac monitor. Which trace should require immediate follow up by the nurse? Select all that apply

Pacer spikes are adequate in number.

Pacer spikes occur directly before the P waves.

Pacer spikes occur directly before the QRS waves.

Pacer spikes occur on the T waves.

The heart rate is within programmed parameters.

Answer and Explanation

Correct Answer : D,E

The traces that should require immediate follow-up by the nurse are:

● Pacer spikes occur directly before the T waves.

Pacer spikes occurring on the T waves indicate an issue with the pacemaker's timing or sensing. This could lead to inappropriate pacing or pacing during the refractory period, which can be detrimental to the client's heart function.

● The heart rate is outside of programmed parameters.

If the heart rate is outside of the programmed parameters set for the client's pacemaker, it may indicate a malfunction or failure of the device or a change in the client's cardiac status. It is important for the nurse to assess the client's condition and notify the healthcare provider for further evaluation and intervention.

Let's review the other options and explain why they do not require immediate follow-up:

Pacer spikes are adequate in number: This indicates that the pacemaker is delivering the appropriate number of electrical impulses as programmed. As long as the other parameters are normal, this finding does not require immediate follow-up.

Pacer spikes occur directly before the P waves: This is the desired and expected pattern for a pacemaker in normal sinus rhythm. It indicates proper timing and coordination between the pacemaker and the client's intrinsic electrical activity.

Pacer spikes occur directly before the QRS waves: This is also the desired and expected pattern for a pacemaker in clients with ventricular pacing. It indicates proper timing and coordination between the pacemaker and the client's intrinsic electrical activity.

The heart rate is within programmed parameters: If the heart rate falls within the programmed parameters set for the client's pacemaker, it indicates that the device is functioning appropriately in maintaining the desired heart rate.

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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. "I will avoid long periods of sitting down with my legs crossed over." B. "I will walk to the point of pain, rest, and walk again for at least 30 minutes." C. "I will use a heating pad on my feet at night to increase the circulation." D. "I will buy some loose clothes that do not bind across my legs or waist."

Correct Answer is C

Explanation

"I will use a heating pad on my feet at night to increase the circulation.": Using a heating pad on the feet at night is not recommended for clients with peripheral artery disease. The application of heat, such as from a heating pad, can dilate blood vessels and potentially worsen the symptoms of peripheral artery disease. This can lead to reduced blood flow to the affected limbs and increase the risk of complications.

The other client statements demonstrate an understanding of peripheral artery disease management:

"I will avoid long periods of sitting down with my legs crossed over." This statement shows awareness of the importance of maintaining good blood flow and avoiding positions that can restrict circulation.

"I will walk to the point of pain, rest, and walk again for at least 30 minutes." This statement indicates an understanding of the concept of intermittent claudication, a common symptom of peripheral artery disease. Walking until pain occurs, resting, and then resuming walking helps improve circulation and increases walking distance over time.

"I will buy some loose clothes that do not bind across my legs or waist." This statement reflects an awareness of the need to wear loose-fitting clothes that do not constrict blood flow to the legs or waist area.

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The nurse is caring for a client with a pacemaker/ICD on a continuous cardiac monitor. Which trace should require immediate follow up by the nurse? Select all that apply

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is A

Explanation

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Correct Answer is C

Explanation

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