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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 D

Explanation

Wear ﬁtted closed toe shoes daily: It is important for clients with peripheral arterial disease to wear properly ﬁtted closed toe shoes. This helps protect the feet from injury and provides support. Closed toe shoes also help maintain warmth and prevent heat loss, which is especially important for individuals with impaired circulation.

Let's review the other options and explain why they may not be appropriate:

Soak feet in warm water for an hour each day: Soaking the feet in warm water for a prolonged period can actually worsen symptoms in individuals with peripheral arterial disease. It can cause further dilation of blood vessels, leading to increased blood pooling and potential tissue damage. Therefore, soaking the feet for extended periods of time is not recommended.

Set heating pads on a low temperature: Using heating pads, especially at high temperatures, can be harmful to individuals with peripheral arterial disease. It can increase the risk of burns or thermal injury due to reduced sensation in the affected areas. Heating pads should be used with caution and on a low temperature setting, if necessary.

Use callus remover for corns or calluses: Individuals with peripheral arterial disease have reduced blood ﬂow to the lower extremities, which can impair wound healing. It is important to avoid self-treatment of corns or calluses, as it can increase the risk of skin breakdown and infection. Clients should be advised to consult a healthcare professional, such as a podiatrist, for appropriate management of corns and calluses.

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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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 D

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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