A nurse is caring for a client in the emergency department (ED). Afib
Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, two actions the nurse should take to address that condition, and two parameters the nurse should monitor to assess the client's progress.
The Correct Answer is []
- Atrial fibrillation is characterized by an irregular, often rapid heart rate that can lead to poor blood flow. The client's symptoms of a "fluttering" and "racing" heartbeat, dizziness, and shortness of breath, along with the irregular cardiac rhythm and unclear P waves, are indicative of atrial fibrillation.
- Obtaining a 12 lead ECG is essential to confirm the diagnosis and assess the extent of the arrhythmia.
- Administering an anticoagulant is crucial to prevent thromboembolic events, such as stroke, which are common complications of atrial fibrillation.
- Monitoring for manifestations of stroke is important because atrial fibrillation increases the risk of stroke.
- PT/INR should be monitored to ensure the effectiveness and safety of anticoagulant therapy.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. After a cardiac catheterization, the client is typically required to lie flat for several hours to prevent complications such as bleeding or hematoma formation at the catheter insertion site, especially if the femoral artery was used. This helps ensure the clotting process is not disturbed and reduces the risk of complications.
B. Elevating the head of the bed to 45° is not recommended immediately after a cardiac catheterization, as it could increase pressure at the insertion site, leading to complications. The client should remain flat to avoid stress on the site.
C. Keeping the client NPO (nothing by mouth) for 4 hours is unnecessary unless the client is scheduled for another procedure or if there are concerns about nausea or vomiting. The priority after cardiac catheterization is monitoring the insertion site and ensuring the client remains flat.
D. Keeping the affected leg slightly flexed is not appropriate. The leg should remain straight and immobile to avoid dislodging any clot or causing bleeding at the insertion site.
Correct Answer is C
Explanation
A. Dyspnea (difficulty breathing) may occur as the cancer progresses and affects the airway, but it is not typically the earliest manifestation of laryngeal cancer.
B. Weight loss can be a late manifestation of cancer, often associated with systemic effects, but it is not the first sign of laryngeal cancer.
C. Hoarseness is the earliest and most common symptom of laryngeal cancer. It occurs because the tumor affects the vocal cords, causing changes in the voice. This symptom often appears early in the disease process, especially in individuals with a history of smoking.
D. Dysphagia (difficulty swallowing) can occur as the tumor progresses and obstructs the throat, but it is usually a later symptom and not the first sign of laryngeal cancer.
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