During removal of a fetal impaction, which of the following would occur because of vagal stimulation?

Appeared in: RAK Nursing Officer - 2019

Explanation

The question asks for the effect of vagal stimulation during the removal of a fecal impaction.
Manipulation of the rectum is a known trigger for stimulating the vagus nerve (Cranial Nerve X).
The vagus nerve is the primary nerve of the parasympathetic nervous system, which slows down body functions.
When stimulated, the vagus nerve releases acetylcholine at the heart's sinoatrial (SA) node, which decreases the heart rate.
A decreased heart rate is known as bradycardia.
This physiological reaction is often referred to as a vasovagal response.

Option B: Atelectasis is the collapse of a lung or part of a lung. It is a respiratory condition and is not caused by vagal stimulation from a rectal procedure.
Option C: Tachycardia is a heart rate that is too fast. Vagal (parasympathetic) stimulation slows the heart rate, while sympathetic stimulation (the 'fight or flight' response) increases it.
Option D: Cardiac tamponade is a mechanical compression of the heart caused by fluid accumulation in the pericardial sac. It is not a nerve-mediated reflex.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Physiological response to vagal stimulation as background academic context rather than a clinical decision trigger.
Nurses must be vigilant in monitoring for a vagal response during procedures like digital disimpaction, enema administration, or even suctioning.
A key patient safety measure is to obtain baseline vitals before the procedure and stop immediately if the patient shows signs of bradycardia, dizziness, or pallor.
This knowledge is crucial for preventing complications like syncope (fainting) and potential injury from falls.

How to Approach the Question

First, identify the key terms in the question: 'removal of a fetal impaction' and 'vagal stimulation'.
Recognize that removing an impaction is a form of rectal manipulation.
Recall the function of the vagus nerve. It is the main nerve of the parasympathetic ('rest and digest') nervous system.
Connect the parasympathetic system to its effect on the heart. Its primary role is to slow the heart rate.
Scan the options for the term that means 'slow heart rate'. Bradycardia is the correct medical term.
Eliminate the other options by defining them: Atelectasis (lung collapse), Tachycardia (fast heart rate, the opposite effect), and Cardiac Tamponade (fluid around the heart).

Concept Tested & Keywords

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E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 767-769

E6 Physiology Ganong 27e Vol 2 Part 1 p. 138-140

E6 Pharmacology Katzung 16e p. 177-179

Practise the full RAK Nursing Officer - 2019

Attempt every question from this paper in a timed mock, then review the full solution for each one.