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.

Answer and Explanation

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.

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Correct Answer is D

Explanation

Choice A rationale:

Bleeding is a concern due to the recent surgery and heparin therapy, which can increase bleeding risk. However, wound dehiscence (wound separation) is less likely in a percutaneous insertion compared to open surgery.

Percutaneous insertion involves a smaller incision and less tissue disruption, reducing the chances of wound dehiscence.

While monitoring for bleeding is crucial, wound dehiscence may not be the most immediate concern in this specific scenario.

Choice B rationale:

Wound dehiscence and evisceration (protrusion of internal organs) are serious complications, but they are less likely to occur with percutaneous insertion compared to open surgery.

The smaller incision and minimal tissue disruption in percutaneous insertion lower the risk of these complications.

While vigilance for wound complications is essential, the priority in this case lies with bleeding and infection.

Choice C rationale:

Thrombosis (blood clot formation) is a potential complication of IVC filter placement, but it's not typically associated with the surgical site itself.

Infection is a concern for any surgical procedure, but it's not the most immediate risk in this scenario given the emphasis on bleeding and the patient's recent heparin therapy.

Choice D rationale:

Bleeding:

Heparin therapy, a blood thinner, increases the risk of bleeding.

The surgical site is a potential area for bleeding, as it involves disruption of blood vessels.

Meticulous monitoring for bleeding is essential to ensure prompt intervention if it occurs.

Infection:

Any surgical procedure carries a risk of infection.

The surgical site is a potential entry point for bacteria.

Close observation for signs of infection, such as redness, swelling, warmth, or drainage, is crucial for early detection and treatment.

A. Men present with atypical symptoms such as nausea and indigestion B. The most common symptom of CAD is chest pain C. The most common cause of CAD is atherosclerosis D. Elevated LDL is a risk factor for developing CAD

Correct Answer is A

Explanation

Choice A rationale:

It is inaccurate to state that men exclusively present with atypical symptoms of CAD. While men are more likely than women to experience atypical symptoms, this does not mean that they never experience chest pain or other typical symptoms.

Chest pain remains the most common symptom of CAD in both men and women. However, it's important to recognize that both genders can experience a range of symptoms, including atypical ones.

Attributing atypical symptoms solely to men can lead to misdiagnosis or delayed diagnosis of CAD in women. This is because women are more likely to present with atypical symptoms, and healthcare professionals may not recognize these symptoms as indicative of CAD.

It's crucial to consider a broad spectrum of symptoms when evaluating patients for potential CAD, regardless of gender.

Choice B rationale:

Chest pain is indeed the most common symptom of CAD. It typically manifests as a feeling of pressure, squeezing, or tightness in the chest, often radiating to the left arm, jaw, neck, or back.

Chest pain usually occurs during exertion or emotional stress and is relieved by rest or nitroglycerin.

Choice C rationale:

Atherosclerosis is the most common underlying cause of CAD. It's a condition characterized by the buildup of plaque within the arteries, leading to narrowing and hardening of the vessels.

This plaque buildup can restrict blood flow to the heart muscle, resulting in ischemia (lack of oxygen) and the symptoms of CAD.

Choice D rationale:

Elevated LDL cholesterol is a significant risk factor for developing CAD. LDL cholesterol is often referred to as "bad" cholesterol because it can contribute to plaque buildup in the arteries.

Managing LDL cholesterol levels through lifestyle modifications and medications, if necessary, is crucial for reducing the risk of CAD.

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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.

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Naxlex Comprehensive Predictor Exams

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Correct Answer is D

Explanation

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Correct Answer is A

Explanation

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Please identify the following rhythm:

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.