NR 341 Complex Adult Health Exam 2
Questions and answers 2025\2026 update
Pacemakers - ANS>>Permanent and temporary.
stimulate contractions.
Atria = P-wave stimulation (spike right before)
Ventricle = QRS stimulation (spike right before)
Dual Pacemaker - ANS>>Better than single pacemaker b/c CARDIAC OUTPUT IS
INCREASED AND MINICS HEART MUCH CLOSER than a single one.
Will see P-wave and QRS complexes for each paced beat (A-V paced).
Transcutaneous Pacemaker (external) - ANS>>Temporary, noninvasive.
Need to give enough sedation and pain meds.
Attached to D-fib and put in pacer mode to shock heart.
Permanent Pacemaker (internal) - ANS>>Invasive and need informed concent
for Dr.
Need to explain risks and complications.
Clean chest and make sure it's sterile.
,Complications of internal pacemakers - ANS>>Malfunctions, leads can get
displaces, battery can die, pneumothorax, can irritate phrenic
nerve/stimulation (hiccups).
A - paced EKG - ANS>>Pacing stimulus directed to heart and a pacer spike is
seen on EKG strip. Vertical line followed by a P-wave (atrail pacing)
V - paced EKG - ANS>>Pacing stimulus directed to heart and a pacer spike is
seen on EKG strip. Vertical line followed by a QRS complex (ventricular pacing).
Each pacemaker spike needs to be followed by a... - ANS>>complex (p-wave or
QRS)
Failure to Capture - ANS>>Electrical charge to myocardium is insufficient to
produce atrial or ventricular contraction.
What can failure to capture result in? - ANS>>Serious bradycardia or asystole.
What causes failure to capture w/ pacemakers? - ANS>>Pacer lead damage,
battery failure, dislodgement of electrode, electrical charge set too low, fibrosis
od electrode tip.
What to do if see EKG of pacemaker with no complex? - ANS>>Assess first and
, then notify Dr. Means electrical charge is not strong enough to cause
contraction.
Pacemaker Placement - ANS>>PLaced in the OR or Cath Lab.
24 hr stay.
Left arm should not be lifted more than 90 degrees (no greater than shoulder
level).
Pacemaker patient education - ANS>>Monitor incision site, Monitor/check HR
1x/day, always carry pacemaker ID card, NO MRIs (contraindicated bc of
magnet), can't have security wand waved over them (notify security), can't
walk through metal detector.
Notify Dr. if chest pain, palpitations, hiccups, SOB, dizziness.
Cardioversion - ANS>>Indicated for fast rhythms w/ a pulse.
Elective procedure - need to have consent, have crash cart ready, enough
sedation and pain medication (can have skin burns)
Prior to a cardioversion procedure... - ANS>>Echocardiogram needs to be done
to r/o risk of blood clot dislodgement (placed on anticoagulants)
Internal Cardioversion - ANS>>*AICD* - pacemaker w/ ability to shock.
Questions and answers 2025\2026 update
Pacemakers - ANS>>Permanent and temporary.
stimulate contractions.
Atria = P-wave stimulation (spike right before)
Ventricle = QRS stimulation (spike right before)
Dual Pacemaker - ANS>>Better than single pacemaker b/c CARDIAC OUTPUT IS
INCREASED AND MINICS HEART MUCH CLOSER than a single one.
Will see P-wave and QRS complexes for each paced beat (A-V paced).
Transcutaneous Pacemaker (external) - ANS>>Temporary, noninvasive.
Need to give enough sedation and pain meds.
Attached to D-fib and put in pacer mode to shock heart.
Permanent Pacemaker (internal) - ANS>>Invasive and need informed concent
for Dr.
Need to explain risks and complications.
Clean chest and make sure it's sterile.
,Complications of internal pacemakers - ANS>>Malfunctions, leads can get
displaces, battery can die, pneumothorax, can irritate phrenic
nerve/stimulation (hiccups).
A - paced EKG - ANS>>Pacing stimulus directed to heart and a pacer spike is
seen on EKG strip. Vertical line followed by a P-wave (atrail pacing)
V - paced EKG - ANS>>Pacing stimulus directed to heart and a pacer spike is
seen on EKG strip. Vertical line followed by a QRS complex (ventricular pacing).
Each pacemaker spike needs to be followed by a... - ANS>>complex (p-wave or
QRS)
Failure to Capture - ANS>>Electrical charge to myocardium is insufficient to
produce atrial or ventricular contraction.
What can failure to capture result in? - ANS>>Serious bradycardia or asystole.
What causes failure to capture w/ pacemakers? - ANS>>Pacer lead damage,
battery failure, dislodgement of electrode, electrical charge set too low, fibrosis
od electrode tip.
What to do if see EKG of pacemaker with no complex? - ANS>>Assess first and
, then notify Dr. Means electrical charge is not strong enough to cause
contraction.
Pacemaker Placement - ANS>>PLaced in the OR or Cath Lab.
24 hr stay.
Left arm should not be lifted more than 90 degrees (no greater than shoulder
level).
Pacemaker patient education - ANS>>Monitor incision site, Monitor/check HR
1x/day, always carry pacemaker ID card, NO MRIs (contraindicated bc of
magnet), can't have security wand waved over them (notify security), can't
walk through metal detector.
Notify Dr. if chest pain, palpitations, hiccups, SOB, dizziness.
Cardioversion - ANS>>Indicated for fast rhythms w/ a pulse.
Elective procedure - need to have consent, have crash cart ready, enough
sedation and pain medication (can have skin burns)
Prior to a cardioversion procedure... - ANS>>Echocardiogram needs to be done
to r/o risk of blood clot dislodgement (placed on anticoagulants)
Internal Cardioversion - ANS>>*AICD* - pacemaker w/ ability to shock.
