A nurse is assessing clients on a medical-surgical unit. Which client would the nurse identify as being at greatest risk for atrial fibrillation?

An 80-year-old with chronic obstructive pulmonary disease.

A 78-year-old who had a carotid endarterectomy.

A 45-year-old who takes an aspirin daily.

A 50-year-old who is post coronary artery bypass graft surgery.

Answer and Explanation

The Correct Answer is A

A. Atrial fibrillation (AF) is more common in older adults, particularly those with underlying conditions like chronic obstructive pulmonary disease (COPD). COPD can lead to structural changes in the heart, increasing the risk of AF. The elderly are particularly vulnerable due to age-related heart changes and comorbidities such as lung disease.

B. While carotid endarterectomy is a surgical procedure that can be related to stroke prevention, it is not directly associated with a higher risk of AF compared to COPD.

C. Aspirin is used for its antiplatelet effects, not directly related to the risk of AF.

D. Post coronary artery bypass graft (CABG) surgery increases the risk for arrhythmias, but it is less directly linked to AF than conditions like COPD in an older adult.

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Correct Answer is A

Explanation

A. A client with low blood pressure (98/58 mm Hg) who requires a beta blocker should be seen first because beta blockers can lower blood pressure further, possibly leading to hypotension or dizziness.

B. A hypertensive client with a blood pressure of 156/90 mm Hg is stable and does not require immediate intervention.

C. While pain medication is important, it is not as urgent as addressing a client with low blood pressure and a medication that can worsen the condition.

D. The client who just had captopril can wait to use the bathroom, as the priority is addressing their blood pressure and captopril's effect.

A. Na + 134 B. K+ 6.1 C. K+ 2.1 D. Mg+ 18

Correct Answer is C

Explanation

A. Mild hyponatremia (Sodium < 135 mEq/L) typically does not produce distinctive ECG changes. This value is unlikely to correlate with the presence of U waves.

B. Hyperkalemia (Potassium > 5.0 mEq/L) is associated with peaked T waves, widened QRS complexes, and flattened or absent P waves, not U waves.

C. Hypokalemia (Potassium < 3.5 mEq/L) is the primary cause of U waves. A potassium level of 2.1 mEq/L is significantly low and can result in ECG changes, including U waves, ST segment depression, and prolonged QT intervals. These changes reflect altered ventricular repolarization.

D. Hypermagnesemia (Magnesium > 2.5 mEq/L) can cause ECG changes such as prolonged PR and QRS intervals, bradycardia, and heart block. However, such an extreme magnesium level of 18 mEq/L would cause severe toxicity and is not associated with U waves.

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A nurse is assessing clients on a medical-surgical unit. Which client would the nurse identify as being at greatest risk for atrial fibrillation?

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