A nurse is educating a Type 1 diabetic client with new-onset atrial fibrillation about the risks associated with the condition.
Which complications should the nurse emphasize?
Increased risk of hyperglycemia.
Greater risk of diabetic retinopathy.
Risk of thromboembolic events such as stroke.
Higher likelihood of diabetic ketoacidosis.
The Correct Answer is C
Educating a patient with atrial fibrillation requires applying knowledge of cardiac hemodynamics and the coagulation cascade. The nurse must focus on how ineffective atrial contractions lead to blood stasis, increasing the probability of clot formation and subsequent systemic embolization.
Choice A rationale
Atrial fibrillation does not directly cause hyperglycemia. While the stress of an acute arrhythmia might slightly elevate blood glucose due to cortisol release, it is not a primary complication or a major risk specifically linked to this rhythm.
Choice B rationale
Diabetic retinopathy is a microvascular complication resulting from chronic poor glucose control over many years. It is not exacerbated or caused by the onset of atrial fibrillation, which is a macrovascular and electrical conduction issue of the heart.
Choice C rationale
In atrial fibrillation, the atria quiver instead of contracting effectively, allowing blood to pool in the left atrial appendage. This stasis leads to thrombus formation; if a clot dislodges, it can travel to the brain.
Choice D rationale
Diabetic ketoacidosis is typically triggered by infection, insulin omission, or extreme physiological stress in Type 1 diabetics. While an arrhythmia is a stressor, the most specific and dangerous direct risk of atrial fibrillation remains systemic thromboembolism
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Managing acute decompensated heart failure requires understanding perfusion pressure and cardiovascular hemodynamics. Knowledge of mean arterial pressure and vasopressor pharmacology is necessary. The priority is maintaining vital organ perfusion when the MAP falls below critical thresholds required for cellular oxygenation.
Choice A rationale
Fluid boluses can exacerbate pulmonary edema in acute decompensated heart failure. While MAP is low, adding volume increases preload, which a failing left ventricle cannot pump, leading to further respiratory distress and worsening of the cardiac crisis.
Choice B rationale
Intubation addresses respiratory failure and oxygenation but does not directly correct the primary hemodynamic issue of low perfusion pressure. While it may become necessary, the immediate priority is restoring MAP to ensure coronary and renal perfusion.
Choice C rationale
High Fowler's position assists with oxygenation by reducing venous return and decreasing pulmonary congestion. However, in the presence of a dangerously low MAP of 55 mm Hg, this position may further decrease cerebral and systemic perfusion.
Choice D rationale
A MAP below 60 to 65 mm Hg indicates inadequate organ perfusion. Norepinephrine provides potent vasoconstriction and minimal inotropy, raising systemic vascular resistance to increase the MAP quickly, thereby protecting the brain, heart, and kidneys from ischemia..
Correct Answer is C
Explanation
Post-procedure assessment for esophageal varices requires prioritizing the system most likely to experience re-bleeding. Knowledge of portal hypertension and gastrointestinal assessment is necessary to monitor for therapeutic success or acute recurrence of life-threatening hemorrhage after treatment.
Choice A rationale
While neurological status is important to assess for hepatic encephalopathy in liver patients, it is not the primary system for a focused assessment immediately following a successful intervention for an active gastrointestinal bleed unless symptoms arise.
Choice B rationale
Integumentary assessment might show jaundice or bruising in liver disease, but it does not provide critical information regarding the immediate stability of the esophageal varices or the potential for a sudden recurrence of internal bleeding.
Choice C rationale
The gastrointestinal system is the priority because the client is at high risk for re-bleeding. Monitoring for hematemesis, melena, and abdominal girth helps detect early signs of failure in the variceal ligation or sclerotherapy treatment provided.
Choice D rationale
Renal function is monitored in liver failure due to the risk of hepatorenal syndrome, but it remains secondary to the gastrointestinal system during the immediate twenty-four-hour post-procedure window focused on stabilizing the variceal hemorrhage.
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