You receive a patient in the Emergency Department whose EKG reveals atrial fibrillation with rapid ventricular response (RVR). What is the priority in managing a patient in this rhythm?
Managing chest pain.
Educating patient on medication adherence.
Rate control.
Anticoagulation.
The Correct Answer is C
Choice A rationale
While chest pain (angina) is a serious complication often associated with reduced cardiac output from the rapid rate, especially in those with underlying coronary artery disease (CAD), managing the underlying rate is the most direct way to improve myocardial oxygen supply and demand balance, which is the cause of the pain.
Choice B rationale
Educating the patient is crucial for long-term management and preventing recurrence but is not the immediate, priority action for a patient presenting with an unstable, rapid ventricular response that significantly impairs cardiac output and could lead to cardiogenic shock or heart failure.
Choice C rationale
In atrial fibrillation with rapid ventricular response (RVR), the heart rate often exceeds 100 bpm, reducing the time for diastolic filling and thus significantly decreasing stroke volume and cardiac output. Therefore, the priority is to administer rate-controlling medications (e.g., beta-blockers, calcium channel blockers) to slow the ventricular response and stabilize hemodynamics.
Choice D rationale
Anticoagulation is essential to prevent systemic embolization and stroke risk due to stasis and clot formation in the fibrillating atria. However, it addresses a long-term risk and is not the immediate, life-saving priority over controlling the dangerously rapid heart rate that acutely compromises perfusion. —.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
ST-segment elevation on an ECG indicates acute myocardial injury, often progressing to an ST-elevation myocardial infarction (STEMI). Leads II, III, and aVF view the inferior wall of the left ventricle, which is typically supplied by the Right Coronary Artery (RCA). This finding localizes the area of infarction to the heart's inferior surface.
Choice B rationale
Prinzmetal's (variant) Angina is a type of chest pain caused by coronary artery spasm, leading to transient myocardial ischemia. While it can cause temporary ST-segment elevation during an episode, these changes resolve quickly once the spasm ceases, unlike the persistent elevation seen in a full-blown acute STEMI.
Choice C rationale
Myocardial ischemia (inadequate blood flow) is usually characterized by ST-segment depression or T-wave inversion. ST-segment elevation specifically indicates myocardial injury (a more severe, evolving stage) or infarction, meaning the patient is past the stage of "ischemia only.”.
Choice D rationale
A permanent pacemaker is used to treat symptomatic bradyarrhythmias or certain heart blocks, not acute STEMI. ST-segment elevation in the inferior leads is a sign of an acute coronary syndrome requiring urgent treatment like percutaneous coronary intervention (PCI) or fibrinolytic therapy, not pacing.
Correct Answer is C
Explanation
Choice A rationale
Young age is typically a factor that favors traditional open-heart surgery for valve replacement. Younger patients have a longer life expectancy, and a surgical valve has historically been considered more durable than TAVR devices, which have uncertain long-term durability and may require future interventions.
Choice B rationale
A low surgical risk profile generally makes the patient a better candidate for traditional open-heart surgery (SAVR). SAVR allows for direct visualization, precise placement, and is associated with very low risk in this patient group, whereas TAVR is typically reserved for those who cannot tolerate the risks of SAVR.
Choice C rationale
A high surgical risk (e.g., due to advanced age, severe comorbidities like renal failure or severe lung disease) is the primary indication making TAVR the more suitable option. TAVR is a minimally invasive procedure performed via a catheter, which significantly reduces the trauma, recovery time, and overall risk of major complications compared to open-heart surgery.
Choice D rationale
TAVR currently only uses bioprosthetic (tissue) valves, which do not require lifelong anticoagulation but have a limited lifespan. Preference for a mechanical valve (which requires anticoagulation but is very durable) would necessitate traditional open-heart surgery, not TAVR. —.
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