A nurse is assisting with obtaining an electrocardiogram (ECG) for a client who has atrial fibrillation. Which of the following actions should the nurse take? (Select all that apply.)

Inspect the electrode pads

Instruct the client not to talk during the test

Administer an analgesic prior to the procedure

Wash the skin with plain water before placing the electrodes

Keep the client NPO after midnight

Answer and Explanation

Correct Answer : A,B

Choice A: Inspecting the electrode pads is an action that the nurse should take. The electrode pads are adhesive patches that atach to the skin and connect to the ECG machine. The nurse should inspect the electrode pads for expiration date, cleanliness, and stickiness, and replace them if necessary. The nurse should also check for any signs of skin irritation or allergy from the electrode pads.

Choice B: Instructing the client not to talk during the test is an action that the nurse should take. Talking during the test can interfere with the ECG recording and cause artifacts or false readings. The nurse should instruct the client to remain still and quiet during the test, and avoid any movements or activities that can affect the heart rate or rhythm, such as coughing, deep breathing, or shivering.

Choice C: Administering an analgesic prior to the procedure is not an action that the nurse should take. An analgesic is a pain reliever that can be given orally, intravenously, or topically. An analgesic is not necessary for an ECG, as it is a noninvasive and painless procedure. An analgesic can also alter the heart rate or rhythm and aﬀect the ECG results. The nurse should only administer an analgesic if prescribed by the provider for another reason.

Choice D: It is more common to use alcohol swabs, and not water, to clean the skin as they are better at removing oils and ensuring good adhesion of the electrodes.

Choice E: Keeping the client NPO after midnight is not an action that the nurse should take. NPO means nothing by mouth, which is a restriction of food and ﬂuids before certain procedures or surgeries. NPO is not required for an ECG, as it does not involve any anesthesia or sedation. The nurse should allow the client to eat and drink normally before and after the test, unless instructed otherwise by the provider.

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Correct Answer is D

Explanation

Choice A: Decreased specific gravity is not a finding of right-sided heart failure. Specific gravity is a measure of urine concentration, which can be aﬀected by ﬂuid intake, dehydration, kidney function, and diuretic use. Right-sided heart failure does not directly aﬀect urine concentration, but it can cause ﬂuid retention and edema in the body.

Choice B: Decreased brain natriuretic peptide (BNP) is not a finding of right-sided heart failure. BNP is a hormone that is released by the heart when it is stretched or overloaded. BNP helps to lower blood pressure and reduce ﬂuid volume by increasing urine output and dilating blood vessels. BNP levels are elevated in both left-sided and right- sided heart failure, as the heart is under increased pressure and volume.

Choice C: Increased pulmonary artery wedge pressure (PAWP) is not a finding of right-sided heart failure. PAWP is a measure of the pressure in the left atrium, which reﬂects the pressure in the pulmonary capillaries. PAWP is elevated in left-sided heart failure, as the blood backs up in the lungs due to impaired left ventricular function. PAWP is normal or low in right-sided heart failure, as the blood backs up in the systemic circulation due to impaired right ventricular function.

Choice D: Elevated central venous pressure (CVP) is a finding of right-sided heart failure. CVP is a measure of the pressure in the right atrium, which reﬂects the pressure in the systemic venous system. CVP is elevated in right-sided heart failure, as the blood backs up in the body due to impaired right ventricular function. CVP can cause jugular venous distension, hepatomegaly, splenomegaly, ascites, and peripheral edema.

A. To slow the response of the ventricles to the fast atrial impulses B. To dissolve clots in the bloodstream C. To reduce the risk of stroke in clients who have atrial fibrillation D. To convert atrial fibrillation to sinus rhythm

Correct Answer is C

Explanation

Choice A Reason: This is incorrect because dabigatran does not aﬀect the electrical activity of the heart or the conduction system. It does not slow down the ventricular response to the atrial impulses.

Choice B Reason: This is incorrect because dabigatran does not dissolve existing clots in the bloodstream. It only prevents new clots from forming.

Choice C Reason: This is correct because dabigatran reduces the risk of stroke in clients who have atrial fibrillation by preventing clot formation and reducing blood viscosity. Dabigatran is an anticoagulant medication that prevents the formation of blood clots in the heart and blood vessels. Atrial fibrillation is a condition where the atria beat irregularly and rapidly, which can cause blood to pool and clot in the heart chambers. These clots can travel to the brain and cause a stroke. Dabigatran reduces the risk of stroke by preventing clot formation and reducing blood viscosity.

Choice D Reason: This is incorrect because dabigatran does not restore normal sinus rhythm in clients who have atrial fibrillation. It does not aﬀect the heart rate or rhythm.

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A nurse is assisting with obtaining an electrocardiogram (ECG) for a client who has atrial fibrillation. Which of the following actions should the nurse take? (Select all that apply.)

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