The nurse is caring for a patient with refractory atrial fibrillation who underwent the maze procedure several months ago.
The nurse reviews the result of the patient’s most recent cardiac imaging, which notes the presence of scarring on the atria.
Recognize that the procedure was unsuccessful.
Prepare the patient for pacemaker implantation.
Consult with the care team in preparation for repeating the maze procedure.
Recognize this as a therapeutic goal of the procedure.
The Correct Answer is C
Choice A rationale:
Incorrect. Scarring on the atria is not an indication of procedure failure in the context of the maze procedure. In fact, it's a desired outcome.
Pacemaker implantation: Not routinely indicated after the maze procedure, even if scarring is present. Pacemakers are primarily used to treat bradyarrhythmias (slow heart rhythms), not atrial fibrillation.
Choice B rationale:
Incorrect. Repeating the maze procedure is generally not considered unless there's clear evidence of recurrent atrial fibrillation despite initial scarring. Scarring formation takes time, and premature repeat procedures are often not necessary.
Consulting the care team: While collaboration is essential, consultation specifically for repeating the procedure based solely on scarring would be premature.
Choice C rationale:
Correct. The maze procedure intentionally creates scar tissue within the atria to block abnormal electrical signals that cause atrial fibrillation. Scarring disrupts the pathways that allow these signals to circulate and trigger fibrillation. Therefore, the presence of scarring is a positive finding that suggests the procedure has achieved its intended effect.
Choice D rationale:
Incorrect. Further diagnostic testing is not routinely indicated solely based on the presence of scarring after the maze procedure. Additional testing might be considered if the patient experiences recurrent atrial fibrillation or other concerning symptoms, but scarring itself does not necessitate immediate further investigation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale:
Incorrect. PVCs are not caused by a malfunctioning SA node. The SA node is responsible for initiating the normal heartbeat, while PVCs originate from the ventricles. The underlying cause of PVCs can vary, but it's not directly related to SA node dysfunction. Choice C rationale:
Incorrect. Ventricular tachycardia (VT) is a rapid heart rhythm originating from the ventricles, typically defined as three or more consecutive PVCs. Two PVCs in a row are usually classified as a couplet, not VT.
Choice D rationale:
Incorrect. While PVCs are often harmless, they can sometimes be associated with underlying heart disease or lead to complications, especially if they are frequent or occur in specific patterns. Therefore, careful assessment and potential treatment are necessary.
Choice B rationale:
Correct. Treatment for PVCs is generally only recommended if the patient experiences concerning symptoms or if the PVCs are associated with a risk of developing more serious arrhythmias. Additionally, the QRS complex on the EKG/ECG should be evaluated. A narrow QRS complex during PVCs typically suggests a less concerning origin within the ventricles, while a wide QRS complex may indicate a higher risk of complications.
Correct Answer is D
Explanation
Choice A rationale:
Digoxin is a medication that slows the heart rate. It would be contraindicated in this patient because they are already bradycardic.
Administering digoxin could further slow the heart rate and worsen the patient's symptoms.
Additionally, digoxin can have a negative inotropic effect, which could further compromise the patient's hemodynamic status. Choice B rationale:
While it is important to continue to monitor the patient, this is not an intervention that will address the patient's bradycardia and hypotension.
The patient is already symptomatic, and their heart rate and blood pressure are likely to continue to decline without intervention. Choice C rationale:
Defibrillation is used to treat life-threatening arrhythmias such as ventricular fibrillation and pulseless ventricular tachycardia.
It is not indicated for sinus bradycardia.
Choice D rationale:
Transcutaneous pacing is a non-invasive method of pacing the heart.
It can be used to temporarily increase the heart rate in patients with symptomatic bradycardia.
This is the most appropriate intervention for this patient because it will address the underlying problem of bradycardia and improve the patient's hemodynamic status.
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