The nurse is caring for a client who had a permanent pacemaker inserted because of a complete heart block. The nurse determines that which of the following client outcomes indicates a successful procedure?

Correct Answer: D

Rationale: The correct answer is D because a successful permanent pacemaker insertion for complete heart block should result in the client's ECG monitor showing paced beats at the appropriate rate. In complete heart block, the electrical signals from the atria do not reach the ventricles, leading to a slow heart rate. The pacemaker is designed to stimulate the ventricles to contract at a set rate, ensuring an adequate heart rate. Choices A, B, and C do not specifically address the key outcome of a successful permanent pacemaker insertion, which is to establish an appropriate heart rate through pacing. Therefore, they are incorrect.

Correct Answer: D

Rationale: The correct answer is D: Unstable angina. This type of angina is characterized by chest pain that is increasing in intensity and duration, indicating a higher risk of a heart attack. Unstable angina is considered a medical emergency requiring immediate attention. A: Stable angina refers to chest pain that occurs with exertion and resolves with rest. B: Variant angina, also known as Prinzmetal's angina, is caused by coronary artery spasm and often occurs at rest. C: Predictable angina refers to chest pain that occurs predictably with certain activities or triggers and is relieved with rest or medication. In summary, D is the correct answer because the patient's symptoms of increasing chest pain intensity and duration suggest unstable angina, which requires urgent medical intervention.

Correct Answer: A

Rationale: The correct answer is A: P wave. The P wave represents atrial depolarization in an ECG waveform, typically lasting around 0.06 to 0.1 seconds. A nurse measuring this waveform within this time range indicates the measurement aligns with the characteristics of a P wave. The PRI (choice B) represents the time from the beginning of the P wave to the beginning of the QRS complex, usually around 0.12 to 0.2 seconds. The QRS complex (choice C) represents ventricular depolarization, typically lasting around 0.06 to 0.1 seconds. The QT interval (choice D) represents the time from the start of the Q wave to the end of the T wave, which varies but is generally around 0.36 to 0.44 seconds. Therefore, choices B, C, and D are incorrect as they do not match the description provided in the question.

Correct Answer: D

Rationale: The correct answer is D: Reducing afterload. ACE inhibitors reduce afterload by inhibiting the conversion of angiotensin I to angiotensin II, leading to vasodilation and decreased peripheral resistance. This results in reduced workload on the heart, improved cardiac output, and overall improvement in heart failure symptoms. Option A is incorrect as ACE inhibitors do not increase preload. Option B is incorrect as ACE inhibitors cause vasodilation, not vasoconstriction. Option C is incorrect as ACE inhibitors actually reduce afterload, rather than increasing it.

Correct Answer: C

Rationale: Rationale: 1. Dobutamine is a beta-1 adrenergic agonist, leading to increased heart rate (tachycardia). 2. Bradycardia and heart failure are not common adverse effects of dobutamine. 3. Respiratory distress is not a typical adverse effect of dobutamine. 4. Therefore, choice C (Tachycardia) is the correct answer as it aligns with dobutamine's pharmacological effects.