Progressive Care Nursing Certification (PCCN) Practice Exam

What is the initial nursing intervention for a patient who develops second-degree heart block after a heart transplant?

1. Administer 0.5 mg IV atropine

2. Call for an emergency consult

3. Prepare for immediate defibrillation

4. Apply a topical anesthetic

The correct answer is: Administer 0.5 mg IV atropine

Administering 0.5 mg IV atropine is the initial nursing intervention for a patient who develops second-degree heart block after a heart transplant because atropine is an anticholinergic medication that increases heart rate by blocking vagal effects on the heart. In the context of second-degree heart block, the main priority is to address potential bradycardic episodes and improve cardiac output. After a heart transplant, patients are particularly vulnerable to various arrhythmias due to denervation of the heart, which can alter the normal autonomic control. The use of atropine can be effective in transient situations where the heart rate is insufficient for the patient’s needs, alleviating symptoms such as dizziness or hypotension that may occur due to bradycardia associated with the heart block. Calling for an emergency consult or preparing for immediate defibrillation would be more appropriate for a patient who presents with complete heart block or severe bradycardia leading to hemodynamic instability. These interventions indicate a more critical situation that requires immediate medical intervention beyond initial nursing management. Applying a topical anesthetic is unrelated to the cardiac condition and is not a relevant intervention for heart block, which pertains specifically to the heart's conduction system.