A client is admitted with uncontrolled atrial fibrillation with a rate between 120's-130's. IV heparin therapy is prescribed. In addition, the nurse prepares the client for a transesophageal echocardiogram (TEE). What does the nurse understand about this diagnostic study?

The TEE evaluates if emboli are present if cardioversion is required

The study will use electric current to stop the abnormal conduction pathway

A TEE will help restore the client's underlying baseline normal rhythm,

A TEE is required prior to implantable defibrillator placement in clients with atrial fibrillation

Answer and Explanation

The Correct Answer is A

A. The TEE evaluates if emboli are present if cardioversion is required: A transesophageal echocardiogram (TEE) provides detailed imaging of the heart’s chambers, particularly the left atrium and left atrial appendage, where clots often form in atrial fibrillation. It is used to rule out thrombi before cardioversion to reduce the risk of stroke during the procedure.

B. The study will use electric current to stop the abnormal conduction pathway: This describes electrical cardioversion, not TEE. TEE is a diagnostic imaging procedure and does not involve the delivery of electrical currents to modify the heart's rhythm or conduction.

C. A TEE will help restore the client's underlying baseline normal rhythm: TEE does not treat arrhythmias. Its role is diagnostic—to visualize cardiac structures, not to restore normal rhythm. Cardioversion or pharmacologic agents are required to correct atrial fibrillation.

D. A TEE is required prior to implantable defibrillator placement in clients with atrial fibrillation: TEE is not routinely required before implantable cardioverter-defibrillator (ICD) placement. ICD decisions are usually based on ejection fraction, rhythm stability, and risk of sudden cardiac arrest, not the presence or absence of atrial thrombi.

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Correct Answer is A

Explanation

A. Review daily the necessity of the central venous catheter: One of the most effective strategies to reduce the risk of catheter-related bloodstream infections is to remove the central line as soon as it is no longer needed. Daily evaluation of necessity prevents prolonged catheter use, which significantly increases infection risk. Removing the source of potential infection is the ultimate preventative action.

B. Maintain a pressure of 300 mm Hg on the flush bag: While maintaining appropriate flush pressure is important for catheter patency and preventing blood clots, it does not play a direct role in preventing bloodstream infections. This action is more related to ensuring adequate line function rather than infection control.

C. Cleanse the insertion site daily with isopropyl alcohol: Current guidelines recommend using chlorhexidine-based solutions rather than isopropyl alcohol for skin antisepsis due to better antimicrobial efficacy. Daily site care is important, but the choice of antiseptic is critical in reducing infection risk.

D. Change the pressurized tubing system and flush bag daily: Tubing and flush systems should be changed typically every 72–96 hours unless contamination is suspected. Changing them daily is not recommended and does not provide added protection against infection it may even increase risk with unnecessary manipulation.

A. ambulate in the hall 3 times daily without shortness of breath. B. have an increase in systolic blood pressure of 20 mmHg during activity. C. decrease weight from 150 lbs. (68.2 kg.) to 148 lbs. (67.3 kg.) in five days. D. verbalize the signs and symptoms of worsening heart failure by discharge.

Correct Answer is A

Explanation

A. ambulate in the hall 3 times daily without shortness of breath: This directly reflects improved tolerance to activity, the central focus of the nursing diagnosis. Being able to ambulate without dyspnea indicates better cardiac output and ventricular function, marking resolution of the identified problem.

B. have an increase in systolic blood pressure of 20 mmHg during activity: A rise in systolic pressure may occur with exertion, but it does not necessarily indicate improved activity tolerance. In fact, an exaggerated BP response could indicate the heart is working harder than it should to meet the demands, suggesting poor cardiovascular adaptation to exercise.

C. decrease weight from 150 lbs. (68.2 kg.) to 148 lbs. (67.3 kg.) in five days: A slight weight reduction may reflect decreased fluid retention, but this outcome is more relevant to volume status and fluid balance than to resolving activity intolerance specifically.

D. verbalize the signs and symptoms of worsening heart failure by discharge:
While important for client education and self-management, this outcome relates to knowledge rather than physical tolerance to activity. It does not directly measure resolution of activity intolerance.

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A client is admitted with uncontrolled atrial fibrillation with a rate between 120's-130's. IV heparin therapy is prescribed. In addition, the nurse prepares the client for a transesophageal echocardiogram (TEE). What does the nurse understand about this diagnostic study?

Nursing Test Bank

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