A client converts from normal sinus rhythm at 80 bpm to atrial fibrillation with a ventricular response at 165 bpm.
Blood pressure is 162/74 mm Hg. Respiratory rate is 20 breaths per minute with normal chest expansion and clear lungs bilaterally.
IV heparin and Diltiazem are given.
What is the main goal of treatment?
Maintain anticoagulation
Improve oxygenation
Control ventricular heart rate
Decrease SA node conduction
The Correct Answer is C
Choice A rationale:
While maintaining anticoagulation is important in atrial fibrillation to prevent blood clots, it is not the main goal of treatment in this specific scenario.
The client's blood pressure is elevated, suggesting that the rapid heart rate is the more immediate concern.
Additionally, the prompt indicates that heparin has already been administered, addressing the anticoagulation need.
Choice B rationale:
The client's respiratory rate and lung sounds are normal, indicating that oxygenation is not a primary concern at this time.
The fast heart rate is the more pressing issue, as it can lead to decreased cardiac output and potential complications.
Choice C rationale:
Controlling the ventricular heart rate is the main goal of treatment in this case.
Atrial fibrillation with a rapid ventricular response can lead to several detrimental consequences, including:
Decreased cardiac output due to shortened ventricular filling time
Increased myocardial oxygen demand, potentially causing angina or heart failure
Increased risk of stroke or other thromboembolic events
Diltiazem, a calcium channel blocker, is a medication commonly used to slow the heart rate in atrial fibrillation.
By slowing the conduction of electrical impulses through the atrioventricular (AV) node, it effectively reduces the number of impulses that reach the ventricles, thereby controlling the ventricular response.
Choice D rationale:
Decreasing SA node conduction is not a primary goal in this situation.
The SA node is responsible for initiating the normal electrical impulses that trigger heart contractions.
In atrial fibrillation, the electrical activity is chaotic and originates from multiple foci within the atria, rather than the SA node.
Therefore, targeting the SA node would not effectively address the underlying rhythm disturbance.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale:
Gently abrading the skin with dry gauze or cloth is not recommended prior to ECG electrode placement.
Research has shown that this practice can actually increase skin impedance and lead to poor signal quality.
It can also cause discomfort and skin irritation, particularly in patients with sensitive skin.
In some cases, it may even damage the skin, leading to infection.
Therefore, it is best to avoid abrading the skin before ECG electrode placement.
Choice B rationale:
Ensuring that the skin is dry is essential for optimal ECG signal quality.
Moisture on the skin can interfere with the electrical connection between the electrodes and the skin, leading to artifacts in the ECG tracing.
These artifacts can make it difficult to interpret the ECG and may even lead to misdiagnosis.
Therefore, it is important to dry the skin thoroughly before applying the electrodes. This can be done using a soft towel or cloth.
Choice C rationale:
Tincture of benzoin is a sticky substance that is sometimes used to improve the adhesion of electrodes to the skin.
However, it is not necessary for ECG electrode placement and can actually irritate the skin.
It is also important to note that tincture of benzoin is flammable and should not be used near open flames or electrical equipment.
Therefore, it is generally not recommended for use with ECG electrode placement.
Choice D rationale:
Povidone-iodine solution is an antiseptic that is used to cleanse the skin and reduce the risk of infection.
However, it is not necessary for ECG electrode placement and can actually interfere with the electrical connection between the electrodes and the skin.
Therefore, it is generally not recommended for use with ECG electrode placement.
Correct Answer is D
Explanation
Choice A Rationale:
Atrial Flutter is a rapid, regular atrial rhythm characterized by a "sawtooth" pattern on the ECG. It is caused by a reentrant circuit in the atria, usually involving the cavo-tricuspid isthmus. The atrial rate in atrial flutter is typically between 250 and 350 beats per minute. However, the ventricular rate is often slower due to varying degrees of AV block.
Key differentiating features: Atrial flutter has a regular, sawtooth pattern on ECG, while ventricular fibrillation is irregular and chaotic. Atrial flutter usually has a slower ventricular rate than ventricular fibrillation.
Choice B Rationale:
Ventricular Tachycardia (VT) is a rapid heart rhythm that originates in the ventricles. It is defined as three or more consecutive ventricular beats at a rate greater than 100 beats per minute. VT can be either non-sustained (lasting less than 30 seconds) or sustained (lasting more than 30 seconds).
Key differentiating features: VT has a regular or slightly irregular rhythm with wide QRS complexes, while ventricular fibrillation is irregular and chaotic with no discernible QRS complexes. VT may have a pulse, while ventricular fibrillation is pulseless.
Choice C Rationale:
Atrial Fibrillation (AF) is a common heart rhythm disorder characterized by rapid, irregular atrial electrical activity. This results in an irregular and often rapid heart rate. AF can be caused by a variety of factors, including high blood pressure, heart valve disease, coronary artery disease, and hyperthyroidism.
Key differentiating features: AF has an irregular, disorganized rhythm with no discernible P waves, while ventricular fibrillation is irregular and chaotic with no discernible QRS complexes. AF may have a pulse, while ventricular fibrillation is pulseless.
Choice D Rationale:
Ventricular Fibrillation (VF) is a life-threatening heart rhythm that is characterized by rapid, disorganized electrical activity in the ventricles. This results in the heart muscle quivering instead of pumping blood effectively. VF is a medical emergency that requires immediate treatment with cardiopulmonary resuscitation (CPR) and defibrillation.
Key features: VF is characterized by an irregular, chaotic rhythm with no discernible QRS complexes on the ECG. It is also pulseless, meaning that there is no palpable pulse.
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