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 A

Explanation

A. Elevated serum cholesterol is a common finding in hypothyroidism. The thyroid hormones play a role in regulating lipid metabolism, so low levels of thyroid hormones can lead to increased cholesterol levels. This is a typical finding in Hashimoto's disease, as it often results in hypothyroidism.
B. In Hashimoto's disease, which leads to hypothyroidism, TSH levels are usually elevated rather than low. TSH is produced by the pituitary gland and stimulates the thyroid gland to produce thyroid hormones (T3 and T4). When the thyroid gland is underactive and not producing enough hormones, the pituitary gland compensates by increasing TSH production. Therefore, a low TSH level would not be expected in Hashimoto's disease.
C. Free T4 (thyroxine) is typically low in hypothyroidism. Hashimoto's disease causes an underactive thyroid gland, which leads to decreased production of thyroid hormones, including free T4. Elevated free T4 would not be consistent with the diagnosis of Hashimoto's disease.
D. Elevated ACTH is more relevant to conditions involving the adrenal glands, such as Addison's disease or Cushing's syndrome. It is not a typical finding in Hashimoto's disease. Hashimoto's primarily affects thyroid function and does not directly impact ACTH levels.

A. Bleeding of the gums after oral care. B. Hemoglobin of 14 g/dL. C. Tachycardia and shortness of breath. D. Petechiae on the oral mucosa.

Correct Answer is C

Explanation

A. Gum bleeding can be a sign of thrombocytopenia (low platelet count) and is concerning because it indicates a potential for bleeding complications. However, while it's significant, it might not be the most urgent symptom in the context of HIT compared to symptoms indicating acute thrombosis.

B. A hemoglobin level of 14 g/dL is generally within the normal range for most adults. In the context of HIT, this level does not indicate any immediate abnormality or severe issue related to anemia or bleeding, making it less concerning compared to other symptoms that might indicate acute complications.
C. Tachycardia (increased heart rate) and shortness of breath are concerning symptoms in the context of HIT. These symptoms can be indicative of a thrombotic event such as a pulmonary embolism (PE) or deep vein thrombosis (DVT), which are serious complications of HIT. The presence of these symptoms requires urgent evaluation as they suggest possible life-threatening complications.
D. Petechiae are small, pinpoint red or purple spots that appear due to bleeding under the skin, often associated with low platelet counts. While petechiae are a concerning sign and indicate bleeding issues, the presence of tachycardia and shortness of breath generally represents a more immediate threat to the patient's life due to potential thromboembolic events.

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Naxlex Comprehensive Predictor Exams

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?

Correct Answer is A

Explanation

A nurse is caring for a client who has been diagnosed with heparin-induced thrombocytopenia (HIT). Which of the following clinical manifestations should the nurse recognize as the most concerning for a client with this condition?

Correct Answer is C

Explanation

A nurse is caring for a client who has a diagnosis of myasthenia gravis. When creating the nutritional plan of care for the client, which of the following foods would be appropriate to include?

The nurse is collecting a stool specimen from a client. What stool characteristic indicates to the nurse that the client may have an upper gastrointestinal (GI) bleed?

A nurse is caring for a 43-year-old female client who reports abdominal pain. Exhibits For each potential provider's order, click to specify if the potential order is anticipated or contraindicated for this client.

A client with chronic obstructive pulmonary disease (COPD) is experiencing tachypnea and dyspnea. The nurse should plan to implement which of the following interventions to reduce bronchiolar collapse and air-trapping?

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 client is in the oliguric phase of acute kidney injury (AKI) which was caused by massive tissue trauma. The nurse notes peaked T-waves and a widened QRS complex on the cardiac monitor. What is the first action the nurse should take?

Which of the following clients is at risk for sensorineural hearing loss?