A client on a cardiac unit is experiencing atrial fibrillation with a rapid ventricular response of 140 beats per minute. The client is dizzy, short of breath, and hypotensive. Medications have not been effective at reducing the client's heart rate. Which procedure would the nurse anticipate to be performed for this client?

Defibrillation

Coronary artery stent placement

Echocardiogram

Synchronized cardioversion

Answer and Explanation

The Correct Answer is D

A.   Defibrillation is used to treat life-threatening arrhythmias such as ventricular fibrillation or pulseless ventricular tachycardia, where the heart is in a chaotic rhythm without an effective contraction.

B.   This procedure is performed to relieve significant blockages in coronary arteries that are causing myocardial ischemia or infarction. While coronary artery disease can contribute to cardiac issues, it is not the primary intervention for treating atrial fibrillation with a rapid ventricular response and associated symptoms like dizziness, shortness of breath, and hypotension.
C.   While an echocardiogram may be useful in assessing the overall cardiac function and structure, it is not an immediate intervention for the acute management of atrial fibrillation with a rapid ventricular response and unstable symptoms.
D.   Synchronized cardioversion is a procedure used to convert certain types of rapid arrhythmias, including atrial fibrillation, to a normal sinus rhythm by delivering a synchronized electrical shock to the heart at a specific point in the cardiac cycle.

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Correct Answer is C

Explanation

A. Involves the use of physical force that may result in bodily injury, pain, or impairment. This option does not fit the scenario described because it does not involve direct physical harm.
B. Involves behaviors such as intimidation, threats, humiliation, and isolation that cause mental or emotional distress. While similar to neglect in some aspects, neglect specifically refers to the failure to provide essential care rather than actively causing psychological harm.
C. Neglect refers to the failure of a caregiver or responsible person to provide the necessary care, assistance, or supervision that is essential to maintain the health and well-being of an elderly person.
D. Involves unauthorized or improper use of an elderly person's financial resources. This option does not apply to the scenario described as it involves financial exploitation rather than the physical or emotional neglect of the resident.

A. A client with myasthenia gravis who has bilateral ptosis and a positive edrophonium (Tensilon) test. B. A client with Bell's palsy who has an order for prednisone and acyclovir. C. A client with Parkinson's disease who has hypokinetic dysarthria and a lack of facial expressions. D. A client with multiple sclerosis who has bladder flaccidity and is retaining urine.

Correct Answer is A

Explanation

A. A client with myasthenia gravis who has bilateral ptosis and a positive edrophonium test is likely experiencing a myasthenic crisis, which is a life-threatening condition that requires immediate attention. This client would be the priority because they may require rapid intervention to maintain airway and breathing.
B. Bell's palsy is characterized by sudden onset of facial paralysis due to inflammation of the facial nerve. While Bell's palsy can be distressing for the client, it does not typically require urgent intervention unless there are complications such as corneal abrasion due to inability to close the eye.
C. Parkinson's disease is a chronic neurodegenerative disorder characterized by motor symptoms such as tremors, rigidity, bradykinesia (slowness of movement), and postural instability. While this client requires ongoing assessment and care, the symptoms described do not typically indicate an acute or urgent need for intervention.
D. A client with multiple sclerosis who has bladder flaccidity and is retaining urine needs assessment and intervention to prevent complications such as urinary tract infections or renal damage. However, this is not as immediately life-threatening as a myasthenic crisis.

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