A patient who is admitted with shortness of breath has a tracing with atrial fibrillation at 140 beats/minute of unknown duration. The nurse begins oxygen per nasal cannula and establishes a saline lock. Which should the nurse prepare to implement next?
Transvenous pacemaker placement.
Heparin infusion.
Lidocaine IVPB.
Sedation for cardioversion.
The Correct Answer is B
A. Transvenous pacemaker placement: A pacemaker is indicated for bradyarrhythmias or heart blocks, not for tachyarrhythmias like atrial fibrillation. This patient’s rapid atrial fibrillation does not warrant pacing and requires rate control and anticoagulation instead.
B. Heparin infusion: In new-onset atrial fibrillation of unknown duration, anticoagulation is essential to prevent thromboembolism, especially before attempting cardioversion. Heparin is typically initiated to reduce stroke risk while further evaluation is performed.
C. Lidocaine IVPB: Lidocaine is an antiarrhythmic used mainly for ventricular arrhythmias such as ventricular tachycardia or fibrillation. It is not effective for atrial fibrillation and is not part of AF management protocols.
D. Sedation for cardioversion: Cardioversion may be appropriate, but not until thrombus risk is evaluated and anticoagulation is established. In AF of unknown duration, immediate cardioversion is avoided unless the patient is unstable, to prevent embolic complications.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Fever of 102.2°F (39°C): A fever may suggest an infectious process such as pneumonia but is not a hallmark of pulmonary edema. While infection can exacerbate heart failure, the presence of fever alone does not indicate pulmonary fluid accumulation.
B. Hacking, dry cough: A dry cough may be an early symptom of left-sided heart failure, but it is nonspecific and does not confirm pulmonary edema. As fluid accumulates, the cough becomes productive and is accompanied by other symptoms like dyspnea and crackles.
C. Peripheral pitting edema: Peripheral edema is more closely associated with right-sided heart failure. Although some clients with left-sided failure can develop right-sided symptoms, peripheral edema does not directly signal pulmonary congestion or edema.
D. Bilateral crackles in all lung fields: Crackles heard throughout the lung fields indicate fluid in the alveoli, a defining feature of pulmonary edema. This finding signifies worsening left-sided heart failure and impaired gas exchange, requiring prompt medical intervention.
Correct Answer is D
Explanation
A. Urinary output: Although decreased cardiac output can affect renal perfusion and lower urine output, it is not the immediate assessment after a sudden change in heart rate and pulse quality. Urine output trends over hours, not minutes, making it less useful for acute evaluation.
B. Pedal pulses: Pedal pulses assess peripheral circulation but are not as responsive to acute changes in central perfusion. Diminished pedal pulses may suggest poor perfusion, but the sudden rise in heart rate with weak radial pulse should prompt central hemodynamic assessment first.
C. Heart sounds: Heart sounds provide information about valve function and rhythm but may not detect subtle changes in perfusion status. While auscultation is important, it does not immediately quantify the impact of tachycardia and diminished pulse strength on blood pressure and perfusion.
D. Blood pressure: Assessing blood pressure is the most direct and immediate way to evaluate hemodynamic stability in the setting of sudden tachycardia with a weak pulse. Hypotension may indicate decreased cardiac output or early shock, requiring prompt recognition and intervention.
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