CMT Pacemaker Monitoring and Function 3

Question 1

A patient with a biventricular pacemaker (cardiac resynchronization therapy, CRT) has two ventricular leads. What is the PRIMARY purpose of CRT?

Accepted Answer

To resynchronize left and right ventricular contraction in heart failure patients

Answer

To increase heart rate in patients with bradycardia

Answer

To replace the function of the SA node in sick sinus syndrome

Answer

To provide backup pacing during complete heart block

Question 2

An ICD (Implantable Cardioverter Defibrillator) differs from a standard pacemaker in that it can:

Accepted Answer

Deliver high-energy shocks to terminate life-threatening arrhythmias

Answer

Pace at faster rates than a standard pacemaker

Answer

Sense only atrial rhythms

Answer

Be programmed remotely without a programmer device

Question 3

When monitoring a patient with a pacemaker, what should a cardiac monitor technician do if the paced QRS morphology suddenly changes from the patient's established baseline?

Accepted Answer

Notify the nurse or physician immediately as this may indicate lead displacement or malfunction

Answer

Assume the pacemaker reprogrammed itself automatically

Answer

Ignore it as normal variation in pacemaker output

Answer

Increase the monitor sensitivity to better capture the spike

Question 4

Which of the following rhythms would be MOST concerning in a patient who is 100% pacemaker-dependent?

Accepted Answer

Pacemaker spikes without capture (failure to capture)

Answer

Occasional PACs

Answer

Mild rate variation around programmed rate

Answer

Narrow paced QRS complexes

Question 5

What is the significance of a 'pacemaker spike' artifact on an ECG?

Accepted Answer

It represents the electrical pulse delivered by the pacemaker generator

Answer

It represents the T wave of the paced beat

Answer

It indicates the pacemaker battery is depleted

Answer

It represents the patient's intrinsic P wave

Question 6

A patient's pacemaker is programmed in VOO mode. What does this mean for monitoring purposes?

Accepted Answer

The pacemaker fires at a fixed rate regardless of the patient's intrinsic rhythm, with no sensing

Answer

The pacemaker paces only on demand when the rate drops below the lower rate limit

Answer

The pacemaker paces the atrium and ventricle alternately

Answer

The pacemaker will inhibit if any intrinsic beat is detected

Question 7

During telemetry monitoring, you notice a patient's pacemaker is firing at a rate of 65 bpm, but native QRS complexes appear at 72 bpm. The pacemaker spikes appear to compete with the patient's own beats without consistent capture. What is the MOST likely explanation?

Accepted Answer

The pacemaker is undersensing the patient's intrinsic rhythm

Answer

The pacemaker upper rate limit has been reached

Answer

The patient's heart rate has exceeded the programmed lower rate limit normally

Answer

The pacemaker is in a rate-responsive mode