Question

A nurse is caring for a client following the insertion of a temporary venous pacemaker via the femoral artery that is set as a VVI pacemaker rate of 70/min. Which of the following findings should the nurse report to the provider? (Select all that apply.)

A. Cool and clammy foot with capillary refill of 5 seconds.
B. Observed pacing spike followed by a QRS complex.
C. Persistent hiccups
D. Heart rate 84/min
E. BP 104/62

Answer 1

The nurse should report a cool and clammy foot with delayed capillary refill and persistent hiccups to the provider.

Step-by-step explanation:

The nurse should report the following findings to the provider:

• Cool and clammy foot with capillary refill of 5 seconds: A cool and clammy foot with delayed capillary refill may indicate inadequate blood flow to the extremity, which could be a sign of a vascular complication or thromboembolism.
• Persistent hiccups: Persistent hiccups may indicate irritation or compression of the diaphragm, which could be a potential complication related to the venous pacemaker insertion.