An older client is transferred to a telemetry unit after placement of a pacemaker. What action should the RN take first?

An older client is transferred to a telemetry unit after placement of a pacemaker. What action should the RN take first?

• A. Establish telemetry monitoring
• B. Administer prescribed antiarrhythmic medication
• C. Schedule a chest X-ray
• D. Obtain discharge instructions

Answer: (A)

The immediate priority is establishing continuous telemetry monitoring. After pacemaker placement, the first concern is watching the heart’s rhythm and the device’s function in real time. Telemetry lets you detect any immediate problems—such as arrhythmias, inappropriate pacing, or signs that the leads aren’t functioning properly—so you can respond quickly and adjust settings or call for help as needed. While other steps are important, they don’t take precedence over real-time monitoring. A chest X‑ray is useful to verify lead position and rule out pneumothorax, but it’s typically done after ensuring the patient’s rhythm is being continuously observed and stable. Administering antiarrhythmic medication depends on the specific rhythm and would not be started just because a pacemaker was placed. Discharge instructions come later, once the patient is stable and ready for transition.

The immediate priority is establishing continuous telemetry monitoring. After pacemaker placement, the first concern is watching the heart’s rhythm and the device’s function in real time. Telemetry lets you detect any immediate problems—such as arrhythmias, inappropriate pacing, or signs that the leads aren’t functioning properly—so you can respond quickly and adjust settings or call for help as needed.

While other steps are important, they don’t take precedence over real-time monitoring. A chest X‑ray is useful to verify lead position and rule out pneumothorax, but it’s typically done after ensuring the patient’s rhythm is being continuously observed and stable. Administering antiarrhythmic medication depends on the specific rhythm and would not be started just because a pacemaker was placed. Discharge instructions come later, once the patient is stable and ready for transition.