1. A client has developed atrial fibrillation, with a ventricular rate of 150 beatsmin. The nurse

• A client has developed atrial fibrillation, with a ventricular rate of 150 beats/min. The nurse

should assess the client for which associated signs or symptoms?

• Flat neck veins
• Nausea and vomiting
• Hypotension and dizziness
• Hypertension and headache

C rationale: the client with uncontrolled atrial fibrillation with a ventricular rate of more than 100 beats/min is at risk for low CO because of loss of atrial kick The nurse assess the client for palpitations, chest pain or discomfort, hypotension, pulse deficit, fatigue, weakness, dizziness, syncope, SOB, and distended neck veins.

• A nurse is watching a cardiac monitor, and a client’s rhythm suddenly changes. There are no P

waves; instead, there are fibrillatory waves before each QRS complex. How should the nurse correctly interpret the client’s heart rhythm?

• Atrial fibrillation
• Sinus tachycardia
• Ventricular fibrillation
• Ventricular tachycardia

A rationale: Atrial fibrillation is characterized by a loss of P waves and fibrillatory waves before each QRS complex. The atria quiver, which can lead to thrombus formation.

• A nurse is caring for a client receiving a heparin intravenous (IV) infusion. The nurse anticipates

that which laboratory study will be prescribed to monitor the therapeutic effect of heparin?

• Hematocrit

• Hemoglobin
• Prothrombin time
• Activated partial thromboplastin time

D rationale: the prothrombin time will assess for the therapeutic effect of warfarin sodium (Coumadin), and the activated partial thromboplastin time (aPTT) will assess the therapeutic effect of heparin. Hematocrit and hemoglobin values assess red blood cell concentrations. Baseline assessment, including an aPTT value, should be completed, as well as ongoing daily aPTT values while the client is taking heparin. Heparin doses are determined based on the result of aPTT.

• A client is started on a continuous infusion of heparin. Which finding does the nurse use to

conclude that the intervention is therapeutic?

• INR between 2 and 3
• PT is 2 ½ times the control value
• aPTT is 2 times the control value
• ACT is in the range of 70 and 120

C rationale: aPTT should be 1.5 to 2.5 the control for heparin therapy. INR and PT are used to evaluate therapeutic levels of warfarin (Coumadin). The ACT increase to a range of 150 to 200 when heparin reaches therapeutic levels.

• In addition to atrial fibrillation, what ventricular rhythm exhibited by a client does the nurse

determine may be converted to a sinus rhythm by cardioversion?

• Standstill
• Fibrillation
• Tachycardia with a pulse

• Frequent premature complexes

C rationale: cardioversion involves administration of precordial shock, which is synchronized with the R wave to interrupt the heart rate. It is used for atrial fibrillation, supraventricular tachycardia, and ventricular tachycardia with a pulse when pharmaceutical preparations fail. The heart is stopped by the electric stimulation, and it is hoped that the SA node will take over as pacemaker.A and B are not correct because there are no R waves, cardioversion should not be done.Premature ventricular complexes suggest an irritable myocardium and generally respond well to antidysrhythmic agents.

• A client with atrial fibrillation secondary to mitral stenosis is receiving a heparin sodium infusion

at 1000 units/hour and warfarin sodium (Coumadin) 7.5 mg at 5:00 pm daily. The morning laboratory results are as follows: activated partial thromboplastin time (aPTT) = 32 seconds; internationalized normalized ration (INR) = 1.3. The nurse should plan to take which action based on the client’s laboratory results?

• Collaborate with the health care provider (HCP) to discontinue the heparin infusion and

administer the warfarin sodium as prescribed.

• Collaborate with the HCP to obtain a prescription to increase the heparin infusion and

administer the warfarin sodium as prescribed.

• Collaborate with the HCP to withhold the warfarin sodium since the client is receiving a

heparin infusion and the aPTT is within therapeutic range.

• Collaborate with the HCP to continue the heparin infusion at the same rate and to discuss use

of dabigatran etexilate (Pradaxa) in place of warfarin sodium.

• Rationale – When a client is receiving warfarin (Coumadin) for clot prevention due to atrial

fibrillation, an INR of 2 to 3 is appropriate in most clients. Until the INR has reached a therapeutic range the client should be maintained on a continuous heparin infusion with the aPTT

ranging between 60 and 80 seconds. Therefore, the nurse should collaborate with the health care provider to obtain a prescription to increase the heparin infusion and to administer the warfarin as prescribed.

• The client has chronic atrial fibrillation. Which discharge teaching should the nurse discuss with

the client?

• Instruct the client to use a soft-bristle toothbrush
• Discuss the importance of getting a monthly partial thromboplastin time (PTT)
• Teach the client about signs of pacemaker malfunction
• Explain to the client the procedure for synchronized cardioversion

• Rationale – The client with chronic atrial fibrillation will be taking an anticoagulant to help

prevent clot formation. Therefore, the client is at risk for bleeding and should be instructed on using a soft-bristled toothbrush.

• The nurse is assisting with a synchronized cardioversion on a client in atrial fibrillation. When the

machine is activated, there is a pause. What action should the nurse take?

• Wait until the machine discharges
• Shout “all clear” and don’t touch the bed
• Make sure the client is all right
• Increase the joules and redischarge

• Rationale – Cardioversion involves the delivery of a timed electrical current. The electrical

impulse discharges during ventricular depolarization and therefore there might be a short delay. The nurse should wait until it discharges.