Practice Question
A nurse is caring for a client in the emergency department (ED).
Answer Choices:
Rationale:
Condition: Atrial fibrillation (AFib)
💎 The telemetry description of an irregular tachycardia with unclear/absent P waves is classic for AFib—atria are fibrillating, not contracting effectively.
💎 Loss of organized atrial contraction causes stasis of blood in the left atrial appendage, predisposing to thrombus formation and embolic events.
💎 Clients commonly report palpitations (“fluttering/racing”), dizziness, and shortness of breath, reflecting reduced cardiac output from rapid, irregular ventricular response.
💎 AFib can be paroxysmal or new-onset; confirming it early enables time-sensitive decisions about rate control, rhythm control, and anticoagulation.
💎 Recognizing AFib promptly is essential because it carries a substantial stroke risk without appropriate management.
Actions:
Administer an anticoagulant
💎 In AFib, disorganized atrial activity leads to blood stasis, especially in the left atrial appendage, greatly increasing the risk of ischemic stroke.
💎 Starting an anticoagulant (e.g., heparin acutely, then warfarin or a DOAC for long-term prevention) reduces thromboembolism risk.
💎 Anticoagulation is also critical before and after cardioversion, when transient stunning of the atria can release pre-existing thrombi.
💎 The choice of agent is guided by renal function, bleeding risk, and planned procedures; nurses ensure bleeding precautions and patient education.
💎 Early initiation aligns with risk stratification tools (e.g., CHA₂DS₂-VASc) to prevent devastating neurologic outcomes.
Obtain a 12-lead ECG
💎 A 12-lead ECG definitively characterizes the rhythm (AFib with rapid ventricular response vs other SVTs) and documents the baseline rate and QRS/QT intervals before therapy.
💎 It screens for ischemia, pre-excitation, conduction disease, and guides safe selection of rate/rhythm-control medications.
💎 Having a clear baseline allows clinicians to assess response to treatments (e.g., beta-blocker or calcium-channel blocker) and identify evolving issues.
💎 An ECG also helps determine need and timing for possible cardioversion and whether further imaging (e.g., TEE) is warranted.
💎 Rapid acquisition supports time-critical decisions in symptomatic AFib.
Parameters:
Manifestations of stroke
💎 AFib markedly elevates risk for cerebral emboli; early recognition of focal neurologic deficits (facial droop, unilateral weakness, aphasia, visual changes, acute confusion) enables urgent stroke protocols.
💎 Frequent neuro checks detect subtle changes that may otherwise be missed in a noisy ED setting.
💎 Prompt detection preserves eligibility for time-dependent interventions and reduces long-term disability.
💎 Monitoring also guides the urgency of escalating anticoagulation and imaging.
💎 Educating the client/family about stroke warning signs supports rapid reporting.
PTT/INR
💎 If using unfractionated heparin, monitor aPTT to maintain a therapeutic range (≈1.5–2.5× control) and avoid under- or over-anticoagulation.
💎 If using warfarin, target INR 2.0–3.0 for most AFib indications; trend daily initially to reach and maintain therapeutic effect.
💎 Baseline and serial coagulation labs also inform bleeding risk and the need to adjust doses or hold therapy.
💎 While DOACs often don’t require routine lab titration, the nurse still reviews renal/hepatic function and bleeding signs.
💎 Vigilant lab monitoring ensures the benefit of stroke prevention while minimizing hemorrhagic complications.
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This question is from Custom NAS 2700 Week 7 which contains 20 questions.
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Question Details
- Category: RN Nursing Exam(s)
- Subcategory: ATI Exam(s)
- Domain: RN Custom Exam(s)
- Answer Choices: 0