NEXT GENERATION NCLEX GUIDEBOOK 2023 2024 Next Generation NCLEX Questions Dysrhythmia and Pacemaker Chapter 35 Scenario A 38 year old female is admitted to the emergency department after feeling palpitations and almost fainting She states that this started a few hours ago and got progressively worse as she tried to get ready for work The ECG reveals nonconducted P waves without progressive PR intervals On conducted beats the PR interval is constant with a ratio of 3 1 three P waves to one conducted QRS interval The ventricular rate ranges from 50 to 60 The PR interval is slightly prolonged the QRS complex is greater than 0 12 seconds Blood pressure is 108 54 mm hg temperature 97 8 F 36 6 C respirations 18 breaths minute Currently she is not feeling faint but reports feeling occasional palpitations She reports that she has felt extremely tired for the past few days The patient states that she has a family history of heart disease and that her mother had a heart attack at age 35 She denies having any chest pain or tightness The patient states that she has smoked 1 pack of cigarettes a day for years but stopped smoking a month ago Her skin is warm and dry and capillary refill is brisk 1 NGN Item Type Highlighting Enhanced Hot Spot Highlight or place a check mark next to the assessment findings that require follow up by the Choose the most likely options for the information missing from the statement below by selecting from the list of options provided The nurse recognizes that based on the assessment data and patient s history the patient is currently at risk for complications including Hypotension and nurse 2 NGN Item Type Cloze Options Heart failure Complete heart block Tachycardia Myocardial ischemia Decreased cardiac output First degree heart block Hypotension Infection ARC L Nowicki Sp 22 This study source was downloaded by 100000831448967 from CourseHero com on 07 22 2023 03 37 44 GMT 05 00 https www coursehero com file 144909771 Next Generation NCLEX Questions studentdocx NEXT GENERATION NCLEX GUIDEBOOK 2023 2024 Scenario Four hours after her arrival to the emergency department the patient remains in second degree type II heart block and her vital signs are stable She is transferred to a telemetry unit to prepare for insertion of a permanent pacemaker later in the day When she gets out of bed to use the restroom she felt faint and had to sit on the floor The nurse finds her sitting on the floor beside the commode the patient is awake but somewhat confused The patient is assisted back to bed The nurse notes that the ECG monitor shows that the patient s heart rate is at 40 beats minute and she is now in third degree heart block The Rapid Response team is called and preparations are made for the immediate application of a transcutaneous pacemaker TCP 1 Angina 3 NGN Item Type Extended Multiple Response Based on the patient s current treatment plan the patient s priority needs will be to prevent which of the following Select all that apply X 2 Injury from falling due to syncope 3 Hypertension X 4 Hypotension 5 Pacemaker failure to pace X 6 Infection of the incision site 7 Pneumothorax 8 Dislodged pacing electrodes 4 NGN Item Type Extended Drag and Drop Use an X or drag and drop to indicate which actions listed in the left column would be included in the plan of care for this patient Relevant Nursing Actions X wrong X X Nursing Actions Prepare to administer atropine Prepare to administer epinephrine Reassure the patient that the TCP is temporary Place both TCP pads on the chest over the heart Provide analgesia as needed after the TCP is placed Monitor vital signs and ECG X X Scenario That afternoon the patient is sent to the operating room and receives a dual chamber rate responsive pacemaker implanted via the left upper chest The rate is set at 70 beats minute Postoperatively she is sent back to the telemetry unit Vital signs Blood pressure 122 84 mm Hg pulse 70 beats minute respirations 18 breaths minute and temperature 98 4 F 36 9 C The ECG shows paced rhythm rate 70 beats minute The incision is covered with a light dressing The patient comments that she feels better with less fatigue That evening after dinner the nurse reviews education about pacemakers with the patient and her spouse 5 NGN Item Type Matrix ARC L Nowicki Sp 22 This study source was downloaded by 100000831448967 from CourseHero com on 07 22 2023 03 37 44 GMT 05 00 https www coursehero com file 144909771 Next Generation NCLEX Questions studentdocx NEXT GENERATION NCLEX GUIDEBOOK 2023 2024 Indicated Contraindicated Nonessential X Use an X for nursing actions listed below that are Indicated necessary Contraindicated could be harmful or Nonessential not necessary Only one selection can be made for each nursing action Nursing Action Encourage the patient to exercise the operative side after the pacemaker is inserted Check the patient s ECG every 4 hours X wrong mi Min once an hour Instruct the patient to keep follow up appointments for pacemaker checks Wash the incision site with soap and water twice a day Teach the patient to avoid the use of microwave ovens Instruct the patient to check her pulse and notify the HCP if the heart rate drops below 70 beats minute Teach the patient to report any redness drainage or swelling of the incision site X NCLEX says this X X X X x 6 NGN Item Type Extended Multiple Response The nurse evaluates the effectiveness of actions Which of the following findings indicate effectiveness Select all that apply X 1 Blood pressure 122 84 X 2 ECG shows paced rhythm rate 70 beats min failure to capture X an MRI test 3 Patient states she will limit use of her left arm and shoulder 4 The incision dressing has serosanguinous drainage visible 5 The patient states she will change the pacemaker battery every 6 months 6 The ECG shows occasional pacer spikes that are not followed by a QRS complex 7 The patient states that she will remind HCPs about her pacemaker before undergoing ARC L Nowicki Sp 22 This study source was downloaded by 100000831448967 from CourseHero com on 07 22 2023 03 37 44 GMT 05 00 https www coursehero com file 144909771 Next Generation NCLEX Questions studentdocx