A client on a cardiac unit is experiencing atrial fibrillation with a rapid ventricular response of 140 beats per minute. The client is dizzy, short of breath, and hypotensive. Medications have not been effective at reducing the client's heart rate. Which procedure would the nurse anticipate to be performed for this client?

Defibrillation

Coronary artery stent placement

Echocardiogram

Synchronized cardioversion

Answer and Explanation

The Correct Answer is D

A.   Defibrillation is used to treat life-threatening arrhythmias such as ventricular fibrillation or pulseless ventricular tachycardia, where the heart is in a chaotic rhythm without an effective contraction.

B.   This procedure is performed to relieve significant blockages in coronary arteries that are causing myocardial ischemia or infarction. While coronary artery disease can contribute to cardiac issues, it is not the primary intervention for treating atrial fibrillation with a rapid ventricular response and associated symptoms like dizziness, shortness of breath, and hypotension.
C.   While an echocardiogram may be useful in assessing the overall cardiac function and structure, it is not an immediate intervention for the acute management of atrial fibrillation with a rapid ventricular response and unstable symptoms.
D.   Synchronized cardioversion is a procedure used to convert certain types of rapid arrhythmias, including atrial fibrillation, to a normal sinus rhythm by delivering a synchronized electrical shock to the heart at a specific point in the cardiac cycle.

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Correct Answer is D

Explanation

A. Heparin is an anticoagulant medication used primarily to prevent and treat blood clots. It does not directly affect cardiac output or ejection fraction.
B. Adenosine is used to treat supraventricular tachycardia (SVT) by slowing conduction through the AV node. It does not directly affect cardiac output or ejection fraction in the context of heart failure.
C. Warfarin is an anticoagulant used to prevent blood clots. Similar to heparin, it does not affect cardiac output or ejection fraction.
D. Digoxin is a medication that increases the strength and efficiency of heart contractions (positive inotropic effect) and slows the heart rate (negative chronotropic effect). It is commonly used in heart failure to improve symptoms and increase cardiac output by enhancing the heart's ability to pump blood effectively.

A. "Use this inhaler as the first-line medication to relieve acute symptoms." B. "Inspect your mouth daily for signs of thrush." C. "Check your heart rate before each dose." D. "Skip the morning dose if you do not have any symptoms."

Correct Answer is B

Explanation

A. Fluticasone is a corticosteroid inhaler used for maintenance therapy to reduce inflammation in the airways over time. It is not a rescue medication for acute symptoms. Clients with COPD should use short-acting bronchodilators (such as albuterol) as their first-line treatment for relieving acute symptoms like shortness of breath or wheezing.
B. This statement is correct. Fluticasone is a corticosteroid medication that, when inhaled, can increase the risk of developing oral candidiasis (thrush). Clients should be instructed to rinse their mouth with water and spit after using the inhaler to minimize this risk. Inspecting the mouth daily for signs of white patches, soreness, or difficulty swallowing is important. If thrush develops, clients may need antifungal treatment.
C. This statement is not necessary for fluticasone inhaler use. Fluticasone is not known to significantly affect heart rate. Monitoring heart rate before each dose is more relevant for medications that can cause changes in heart rate, such as bronchodilators (e.g., beta-agonists). However, clients should monitor for symptoms like palpitations or rapid heart rate and report them to their healthcare provider.
D. Fluticasone is a maintenance medication that should be taken regularly as prescribed, regardless of symptoms. Skipping doses can lead to worsening of COPD symptoms and exacerbations. Clients should adhere to the prescribed dosing schedule to achieve optimal control of their condition.

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Naxlex Comprehensive Predictor Exams

The nurse is reviewing the results of the client's echocardiogram and notes that the ejection fraction is 35%. The nurse anticipates that which of the following medications will be ordered to increase the client's cardiac output?

Correct Answer is D

Explanation

A nurse is providing education to a client who has chronic obstructive pulmonary disease and will begin using fluticasone by metered dose inhaler every 12 hours for maintenance. Which of the following instructions should the nurse include?

Correct Answer is B

Explanation

A client in an urgent care clinic is complaining of heart palpitations, fatigue, and shortness of breath. A 12-lead electrocardiogram (ECG) shows no discernable P-waves, and an irregular ventricular rate. The nurse should understand that this finding represents which of the following conditions?

A nurse is providing education to a client who has chronic obstructive pulmonary disease and will begin using fluticasone by metered dose inhaler every 12 hours for maintenance. Which of the following instructions should the nurse include?

A nurse is caring for a client who has myasthenia gravis which has not responded to medication treatments. Which of the following surgeries can treat myasthenia gravis?

A client has been diagnosed with Bell's Palsy. Which statement should the nurse include in the client education?

A client who has been diagnosed with chronic stable angina is placed on multiple medications to manage the condition. The nurse understands that the client is receiving rosuvastatin for which reason?

A nurse is caring for a 24-year-old client who has frequent premature atrial contractions seen on the cardiac monitor. The nurse understands that the client requires additional education when the client selects which of the following items for the breakfast tray?