PN Adult Medical Surgical Practice Exam

What specific finding should be reported for a client with a newly-inserted permanent pacemaker?

1. The client experiences hiccups when sitting.

2. The client's pulse rate is 5/min faster than the preset pacemaker rate.

3. There is a pacing spike before the P-wave on the ECG rhythm strip.

4. The dressing over the insertion site is dry and intact.

The correct answer is: The client experiences hiccups when sitting.

The most appropriate finding to report for a client with a newly-inserted permanent pacemaker is the experience of hiccups when sitting. Hiccups can be a sign of diaphragmatic irritation, which may occur due to lead placement or movement of the diaphragm from pacing. It's important to assess any unusual symptoms that the patient reports, as they could indicate a potential issue with the pacemaker function, lead placement, or irritation of surrounding structures. The slight increase in pulse rate, while it may be notable, is not typically alarm-worthy unless it significantly exceeds the preset pacemaker rate, as pacemakers often allow for slight fluctuations in heart rate. The presence of a pacing spike before the P-wave is an expected finding in a properly functioning pacemaker and indicates that the pacemaker is delivering electrical impulses as designed. Lastly, the condition of the dressing, being dry and intact, suggests that there are no immediate issues at the insertion site, which typically would not require reporting.