A nurse is teaching a client about risk factors for developing artrial flutter. Which of the following clients should the nurse understand is at highest risk for developing atrial flutter?

The client who is out of work and has been experiencing increased stress

The client who is recovering from recurrent illness that caused vomiting and diarrhea

The client whose mother and uncle were diagnosed with the same condition

The client who had a myocardial infarction and required stent placement

Answer and Explanation

The Correct Answer is D

A. The client who is out of work and has been experiencing increased stress: Emotional stress can contribute to transient increases in sympathetic activity, which may precipitate palpitations or arrhythmias in susceptible individuals. However, stress alone is not the strongest risk factor for sustained atrial flutter.

B. The client who is recovering from recurrent illness that caused vomiting and diarrhea: Electrolyte imbalances from vomiting or diarrhea (e.g., hypokalemia, hypomagnesemia) can trigger arrhythmias. While this increases risk temporarily, it is generally less significant than structural heart disease or myocardial injury.

C. The client whose mother and uncle were diagnosed with the same condition: A family history may indicate genetic susceptibility to some arrhythmias. However, atrial flutter is primarily associated with acquired heart disease rather than hereditary factors, so this patient is at moderate rather than highest risk.

D. The client who had a myocardial infarction and required stent placement: Myocardial infarction causes structural and electrical remodeling of atrial tissue, creating reentry circuits that predispose the patient to atrial flutter. This post-MI population has the highest risk among the options due to direct cardiac injury and conduction pathway disruption.

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Correct Answer is C

Explanation

A. Erythrocyte count: The red blood cell count reflects oxygen-carrying capacity and anemia but does not indicate platelet destruction or immune-mediated reactions. HIT specifically affects platelets, so monitoring erythrocytes would not detect this complication.

B. Fibrinogen degradation products: Fibrinogen degradation products (FDPs) are elevated in disseminated intravascular coagulation or significant clot breakdown. While they reflect fibrinolytic activity, they are not specific or sensitive for heparin-induced thrombocytopenia.

C. Activated partial thromboplastin time (aPTT): Although aPTT is used to monitor therapeutic anticoagulation during heparin infusion, frequent platelet counts are the most direct laboratory marker for HIT. Monitoring aPTT ensures the patient is within the therapeutic range, but detection of a sudden drop in platelet count is crucial for early recognition of HIT.

D. Prothrombin time (PT): PT evaluates the extrinsic coagulation pathway and is primarily used to monitor warfarin therapy. It is not sensitive to heparin therapy or the development of HIT, which involves immune-mediated platelet activation and thrombocytopenia rather than changes in PT.

A. Decrease in cardiac output B. Damage to the mitral valve C. Myocardial infarction D. Ventricular dysrhythmias

Correct Answer is D

Explanation

A. Decrease in cardiac output: A Swan-Ganz (pulmonary artery) catheter rarely causes an immediate decrease in cardiac output unless complications like arrhythmias or pulmonary artery rupture occur. Monitoring hemodynamics helps detect changes, but this is not the most common risk during insertion or removal.

B. Damage to the mitral valve: The catheter passes through the right atrium and right ventricle into the pulmonary artery, so the mitral valve is not in the pathway. Injury to the mitral valve is unlikely, making this a low-risk complication.

C. Myocardial infarction: Myocardial infarction is not a typical complication of Swan-Ganz catheterization unless coronary perfusion is severely compromised by another underlying condition. It is not directly caused by the catheter itself.

D. Ventricular dysrhythmias: As the catheter passes through the right ventricle, it can mechanically irritate the ventricular myocardium, leading to premature ventricular contractions, ventricular tachycardia, or other dysrhythmias. This is the most common and expected complication during insertion and removal, requiring continuous ECG monitoring.

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A nurse is teaching a client about risk factors for developing artrial flutter. Which of the following clients should the nurse understand is at highest risk for developing atrial flutter?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which laboratory information will the nurse monitor to detect heparin-induced thrombocytopenia (HIT) in a patient who is receiving a continuous heparin infusion?

Correct Answer is C

Explanation

Which complication does the nurse recognize as a risk for a patient during insertion and removal of a Swan-Ganz catheter?

Correct Answer is D

Explanation

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