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. Parkinson's disease is not generally considered to be caused by an autoimmune reaction or a recent infection. Autoimmune reactions leading to neurodegeneration are more commonly associated with other conditions such as multiple sclerosis, not Parkinson's disease.
B. The exact cause of Parkinson's disease is indeed unknown, but research suggests that it results from a combination of genetic predispositions and environmental factors. Genetic mutations may contribute to the development of Parkinson's disease in some individuals, while environmental factors such as exposure to certain toxins or other external influences might also play a role. The interplay between these factors is still being studied.
C. There is no evidence to support the idea that Parkinson's disease is caused by the reactivation of a virus affecting cranial nerve VII (the facial nerve). Parkinson's disease involves the degeneration of dopamine-producing neurons in the brain, not specifically related to viral reactivation or isolated to cranial nerve VII.
D. Demyelination of nerves is characteristic of multiple sclerosis, not Parkinson's disease. In Parkinson's disease, the primary issue is the loss of dopamine-producing neurons in the substantia nigra of the brain, not demyelination. This option describes a different pathological process unrelated to Parkinson's disease.

A. Instruct the client on pursed-lip breathing B. Place the client in Trendelenburg position C. Apply a high-frequency chest wall oscillation vest D. Determine the client's FEV1/FVC ratio

Correct Answer is A

Explanation

A. Pursed-lip breathing is an effective technique for managing COPD symptoms, particularly tachypnea and dyspnea. It helps to keep the airways open by creating back pressure that prevents the collapse of bronchioles and reduces air-trapping. This technique improves ventilation and helps with the expiration of trapped air, making it a valuable intervention for COPD patients.
B. The Trendelenburg position involves lying flat on the back with the legs elevated higher than the head. This position is not suitable for managing COPD symptoms and can actually worsen breathing difficulties by increasing abdominal pressure on the diaphragm.
C. High-frequency chest wall oscillation (HFCWO) vests are used to help with airway clearance in conditions like cystic fibrosis or chronic bronchitis by loosening mucus. While beneficial for mucus management, they do not specifically address bronchiolar collapse or air-trapping associated with COPD.
D. Measuring the FEV1/FVC ratio is a diagnostic tool used to assess the severity of airflow obstruction in COPD. While this information is important for diagnosis and treatment planning, it is not an immediate intervention to manage symptoms such as tachypnea and dyspnea.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client who has a new diagnosis of Parkinson's Disease asks the nurse "Why did I develop this disease? What caused it?" Which response should the nurse provide?

Correct Answer is B

Explanation

A client with chronic obstructive pulmonary disease (COPD) is experiencing tachypnea and dyspnea. The nurse should plan to implement which of the following interventions to reduce bronchiolar collapse and air-trapping?

Correct Answer is A

Explanation

Which medication is commonly used in the treatment of multiple sclerosis?

A client is scheduled for an adrenocorticotropic hormone (ACTH) stimulation test to help diagnose suspected Addison's disease. What should the nurse include when teaching the client about this test?

A nurse is providing discharge education to a client who has undergone extracapsular cataract extraction surgery. What should the nurse include in the discharge teaching? (Select all that apply.)

A nurse is caring for a client who has a diagnosis of myasthenia gravis. When creating the nutritional plan of care for the client, which of the following foods would be appropriate to include?

The nurse is providing care for a geriatric patient with loss of hearing acuity over the past several years. Which statement by the nurse is most accurate?

A client who is receiving chemotherapy for breast cancer is experiencing myelosuppression as a side effect of the treatment. Which of the following is a manifestation directly related to myelosuppression?

A miotic medication has been prescribed for a client with acute angle-closure glaucoma. The client asks the nurse about the purpose of the medication. Which response should the nurse provide to the client?

A client with age-related macular degeneration (AMD) is undergoing photodynamic therapy with the medication Verteporfin. What should the nurse include in the discharge teaching for this client?