A client in an urgent care clinic is reports having heart palpitations, and occasional shortness of breath. A 12-lead electrocardiogram (ECG) shows regular P- waves in a sawtooth formation at a rate of 260 beats per minute, and a regular ventricular rate of 82 beats per minute. The nurse should understand that this ECG finding represents which of the following conditions?

Atrial fibrillation

Atrial flutter

Unstable angina

Premature atrial contractions

Answer and Explanation

The Correct Answer is B

A.   Atrial fibrillation is characterized by irregularly irregular rhythms with no distinct P-waves. Instead, it has a chaotic baseline with fibrillatory waves. The ventricular response can be irregular and variable. The description provided (regular P-waves in a sawtooth formation) does not match the typical appearance of atrial fibrillation, which lacks regular P-waves and has an irregular rhythm.
B.   Atrial flutter is characterized by regular, sawtooth-shaped P-waves known as "F-waves" or "flutter waves." The classic pattern is referred to as "F-waves" with a "sawtooth" appearance, often seen in the inferior leads (II, III, aVF). The atrial rate is typically between 240 to 340 beats per minute, which fits the rate of 260 beats per minute in the description. The ventricular rate can be regular or irregular, depending on the degree of AV node conduction. A

C.   Unstable angina is a clinical diagnosis of chest pain due to myocardial ischemia. It is not associated with specific ECG findings related to the P-wave morphology or rate. The ECG findings described do not correspond to unstable angina, which would typically present with ST-segment changes or other signs of myocardial ischemia rather than a specific P-wave pattern.
D.   Premature atrial contractions (PACs) are early beats originating from the atria that interrupt the normal rhythm. They usually present as a single early beat with a different morphology of the P-wave compared to the sinus P-waves, but do not result in a regular sawtooth pattern or a sustained rhythm at high rates like the one described.

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Correct Answer is C

Explanation

A. Prednisone is a corticosteroid used to reduce inflammation and suppress the immune system. While effective for reducing inflammation and pain, corticosteroids are generally not the first-line treatment for osteoarthritis. They are more commonly used for inflammatory arthritis conditions like rheumatoid arthritis.
B. Etanercept is a biologic agent used to treat autoimmune conditions like rheumatoid arthritis and psoriatic arthritis by targeting tumor necrosis factor-alpha (TNF-alpha) to reduce inflammation. It is not indicated for osteoarthritis, which is a non-inflammatory degenerative joint disease rather than an autoimmune inflammatory disease.
C. Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that is commonly used to manage pain and inflammation associated with osteoarthritis. NSAIDs like ibuprofen are often the first-line treatment for osteoarthritis because they help reduce pain and inflammation, improve function, and enhance the quality of life for patients. Ibuprofen is a suitable and preferred option for managing symptoms of osteoarthritis.
D. Hydroxychloroquine is an antimalarial drug that is also used to treat autoimmune diseases such as rheumatoid arthritis and lupus. It works by modulating the immune system and reducing inflammation. However, it is not typically used for osteoarthritis, which is not an autoimmune condition.

A. Low adrenocorticotropic hormone (ACTH) and low cortisol B. Elevated adrenocorticotropic hormone (ACTH) and elevated cortisol C. Low adrenocorticotropic hormone (ACTH) and elevated cortisol D. Elevated adrenocorticotropic hormone (ACTH) and low cortisol

Correct Answer is C

Explanation

A. This would indicate adrenal insufficiency, not Cushing syndrome.
B. Elevated adrenocorticotropic hormone (ACTH) and elevated cortisol would indicate Cushing syndrome caused by pituitary adenoma, not adrenal gland hyperplasia.
C. Low adrenocorticotropic hormone (ACTH) and elevated cortisol is consistent with Cushing syndrome caused by adrenal gland hyperplasia. In this condition, the adrenal glands produce excess cortisol independently of ACTH stimulation.
D. Elevated adrenocorticotropic hormone (ACTH) and low cortisol would indicate adrenal insufficiency, not Cushing syndrome.

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Naxlex Comprehensive Predictor Exams

A nurse is assessing a client who has osteoarthritis of the right hand. Which of the following would be the preferred treatment for this client?

Correct Answer is C

Explanation

A nurse is caring for a client who has a diagnosis of Cushing syndrome. After performing magnetic resonance imaging (MRI), the underlying cause of the condition is found to be hyperplasia of the adrenal glands. Which of the following lab results would the nurse anticipate with this condition?

Correct Answer is C

Explanation

A nurse is reviewing the laboratory results of a client who has a new diagnosis of Hashimoto's disease. Which of the following lab results would the nurse expect to find?

The nurse is assisting while a neurologist administers an edrophonium (Tensilon) test to a client with facial weakness and ptosis. If the test is positive for myasthenia gravis, which outcome would the nurse observe?

A client who received a kidney transplant 3 months ago is in the nephrologists office for a follow up appointment. Which finding would indicate that the client is experiencing a complication which is common after a kidney transplant?

A nurse is discussing the importance of following a low-sodium diet with a client who has heart failure. Which of the following food items would be appropriate for this patient to choose?

The patient is admitted with upper GI bleeding following an episode of forceful vomiting due to excessive alcohol intake. The nurse suspects a Mallory-Weiss tear. Which of the following is true of a Mallory-Weiss tear?

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A client experiencing exophthalmos is seen in a primary care provider's clinic. The nurse understands that the most likely endocrine disorder which would cause this symptom is which of the following?