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 B

Explanation

A. Furosemide is a loop diuretic used to treat fluid overload by increasing urine output. In an Addisonian crisis, the primary issue is the severe lack of adrenal hormones rather than fluid overload. Administering furosemide is not indicated in this situation, as it does not address the underlying cause of the crisis or correct electrolyte imbalances that are common in Addisonian crisis.
B. This is a common intravenous fluid choice for managing Addisonian crisis. The 0.9% sodium chloride (normal saline) helps to restore blood volume and correct electrolyte imbalances, while the 5% dextrose provides glucose to support energy needs. This combination helps to address hypovolemia (low blood volume) and prevent hypoglycemia (low blood sugar), both of which can occur in an adrenal crisis.

C. Ketoconazole is an antifungal medication that can be used to treat Cushing’s syndrome, not Addisonian crisis. Insulin is used to manage blood glucose levels and would not be the primary treatment for Addisonian crisis. This option does not directly address the adrenal insufficiency or the immediate needs of an Addisonian crisis.
D. Addisonian crisis often presents with hyponatremia (low sodium) and hyperkalemia (high potassium) due to inadequate aldosterone production. Administering potassium chloride could exacerbate hyperkalemia, which is a concern in Addisonian crisis. Therefore, potassium chloride infusion is not appropriate and could worsen the electrolyte imbalance.

A. tertiary prevention B. primary prevention C. secondary prevention D. treatment for hepatitis B

Correct Answer is B

Explanation

A. Tertiary prevention focuses on managing the consequences of an existing disease or condition. The hepatitis B vaccination prevents the disease from occurring in the first place.
B. Primary prevention aims to prevent the occurrence of a disease or condition. The hepatitis B vaccination is a classic example of primary prevention, as it protects individuals from contracting the virus.
C. Secondary prevention involves early detection and treatment of a disease or condition. The hepatitis B vaccination is not intended for the early detection or treatment of an existing infection.
D. The hepatitis B vaccination is not a treatment for hepatitis B. It is a preventative measure to protect individuals from contracting the virus.

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Naxlex Comprehensive Predictor Exams

A nurse is admitting a client who is experiencing an Addisonian crisis. Which of the following should the nurse anticipate an order for?

Correct Answer is B

Explanation

A nursing student preparing for his first clinical rotation must receive a hepatitis B vaccination series prior to attending clinicals. The nursing student understands that this is

Correct Answer is B

Explanation

A nurse is preparing to administer heparin 2,000 units by IV bolus. Available is heparin injection 5,000 units/mL. How many mL should the nurse administer? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)

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