The nurse is providing discharge instructions to a 76-year-old male client with chronic atrial fibrillation who has a CHA2DS2-VASC score of 2. Which medication would the nurse identify as most likely to be prescribed for the client?

Propranolol

Procainamide

Aspirin

Warfarin

Answer and Explanation

The Correct Answer is D

A. Propranolol: This is a beta-blocker, which may be used to control heart rate, but it does not address the risk of thromboembolism in atrial fibrillation.

B. Procainamide: This is an antiarrhythmic used for rhythm control, but it does not address stroke prevention in atrial fibrillation.

C. Aspirin: Although aspirin is sometimes used for stroke prevention, it is generally less effective than anticoagulation therapy in clients with higher CHA2DS2-VASC scores.

D. Warfarin: A CHA2DS2-VASC score of 2 indicates a moderate risk for stroke, and warfarin (or another anticoagulant) is indicated to reduce the risk of thromboembolic events.

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Correct Answer is C

Explanation

A. Call the physician: While notifying the physician is important, it is not the immediate priority in a life-threatening situation like ventricular fibrillation.

B. Administer oxygen: Administering oxygen is helpful, but the immediate priority in ventricular fibrillation is to initiate life-saving measures.

C. Initiate cardiopulmonary resuscitation (CPR): Ventricular fibrillation is a life-threatening emergency, and initiating CPR immediately is crucial to restore circulation and improve chances of survival.

D. Give a dose of epinephrine: Epinephrine is part of the advanced cardiac life support (ACLS) protocol, but it should be administered after initiating CPR and defibrillation.

A. The client's head should be turned to the side with the head of the bed elevated 60 degrees. B. The client's head should be placed on a flat pillow with the foot of the bed higher than the head. C. The client should be placed in dorsal recumbent with the head placed on pillows for comfort. D. The head of the bed should be elevated 30 degrees with the head in neutral midline position.

Correct Answer is D

Explanation

A. The client's head should be turned to the side with the head of the bed elevated 60 degrees. Elevating the head of the bed too high can cause a decrease in venous return, which can increase intracranial pressure.

B. The client's head should be placed on a flat pillow with the foot of the bed higher than the head. This position would not help with reducing intracranial pressure and may worsen it.

C. The client should be placed in dorsal recumbent with the head placed on pillows for comfort. This position does not provide optimal head elevation to decrease intracranial pressure.

D. The head of the bed should be elevated 30 degrees with the head in neutral midline position. A head elevation of 30 degrees with the head in a neutral midline position is ideal for promoting venous drainage from the brain, which helps reduce intracranial pressure.

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The nurse is providing discharge instructions to a 76-year-old male client with chronic atrial fibrillation who has a CHA2DS2-VASC score of 2. Which medication would the nurse identify as most likely to be prescribed for the client?

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