Galen NUR 242 Exam 2 () |
Med-Surg Nursing | (A+ Guarantee) |
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DOMAIN 1: CARDIAC DYSRHYTHMIAS & ATRIAL
FIBRILLATION
Question 1
Which action by the nurse is most important when preparing for
cardioversion of a client with atrial fibrillation?
• A) Ensure the client has been NPO for at least 8 hours
• B) Set synchronizer switch on defibrillator to the "on" position
• C) Administer intravenous push of adenosine
• D) Place the defibrillator pads in an anterior-posterior position
✅ Correct Answer: B
Rationale: The synchronizer switch must be turned "on" to ensure the
defibrillator delivers the shock on the R wave of the QRS complex. If
the shock is delivered on the T wave, it can induce ventricular
fibrillation, a life-threatening dysrhythmia .
,Question 2
Which assessment finding by the nurse caring for a client with new-
onset atrial fibrillation would be most important to communicate to the
health care provider?
• A) Heart rate of 110-120 beats per minute
• B) Blood pressure of 130/85 mmHg
• C) Sudden vision change
• D) Reports of mild chest discomfort
✅ Correct Answer: C
Rationale: Sudden vision changes in a client with atrial fibrillation may
indicate an embolic stroke affecting the ophthalmic artery or visual
cortex of the brain. This is a medical emergency requiring immediate
intervention. While heart rate and blood pressure abnormalities also
require attention, they are not as urgent as potential stroke symptoms .
Question 3
A client who has atrial fibrillation with rapid ventricular response is
started on a continuous heparin infusion. Which clinical finding enables
the nurse to conclude that the heparin therapy is effective?
• A) The client's heart rate decreases to 80-90 beats per minute
• B) An activated partial thromboplastin time (aPTT) is twice the
usual value
• C) The client reports no chest pain or shortness of breath
• D) The client's blood pressure returns to baseline
✅ Correct Answer: B
,Rationale: Heparin is an anticoagulant used to prevent clot formation in
clients with atrial fibrillation. Therapeutic effectiveness is monitored by
aPTT levels. A therapeutic aPTT is typically 1.5 to 2.5 times the normal
control value, indicating adequate anticoagulation to prevent thrombus
formation without excessive bleeding risk .
Question 4
When treating clients for osteoporosis, which medication has a side
effect of atrial fibrillation when infused too quickly?
• A) Alendronate (Fosamax)
• B) Raloxifene (Evista)
• C) Zoledronic acid (Reclast)
• D) Denosumab (Prolia)
✅ Correct Answer: C
Rationale: Zoledronic acid, a bisphosphonate used to treat osteoporosis,
can cause atrial fibrillation as an adverse effect when infused too
rapidly. It should be administered as a slow intravenous infusion over at
least 15 minutes and clients should be well-hydrated before
administration .
Question 5
After the home health nurse obtains a radial pulse rate of 136
beats/minute in a client with chronic atrial fibrillation, which action
would the nurse take next?
, • A) Document the finding and reassess in 4 hours
• B) Notify the health care provider immediately
• C) Take the client's apical pulse for a full minute
• D) Administer the client's PRN beta-blocker
✅ Correct Answer: C
Rationale: In atrial fibrillation, the radial pulse may not accurately
reflect the apical pulse due to a pulse deficit (difference between apical
and radial rates). The nurse should first assess the apical pulse for a full
minute to obtain an accurate heart rate before making any clinical
decisions or notifying the provider .
Question 6
Which finding for a client who has a diagnosis of paroxysmal atrial
fibrillation is most important to report quickly to the health care
provider?
• A) Fatigue after minimal exertion
• B) Occasional palpitations lasting 5-10 minutes
• C) Right arm weakness
• D) Mild shortness of breath when climbing stairs
✅ Correct Answer: C
Rationale: Right arm weakness is a focal neurological deficit that
suggests an embolic stroke. Clients with atrial fibrillation are at high risk
for thromboembolic events because blood pools in the atria and can form
clots that travel to the brain. Any unilateral weakness requires immediate
evaluation .
Med-Surg Nursing | (A+ Guarantee) |
DOMAIN 1: CARDIAC DYSRHYTHMIAS & ATRIAL
FIBRILLATION
Question 1
Which action by the nurse is most important when preparing for
cardioversion of a client with atrial fibrillation?
• A) Ensure the client has been NPO for at least 8 hours
• B) Set synchronizer switch on defibrillator to the "on" position
• C) Administer intravenous push of adenosine
• D) Place the defibrillator pads in an anterior-posterior position
✅ Correct Answer: B
Rationale: The synchronizer switch must be turned "on" to ensure the
defibrillator delivers the shock on the R wave of the QRS complex. If
the shock is delivered on the T wave, it can induce ventricular
fibrillation, a life-threatening dysrhythmia .
,Question 2
Which assessment finding by the nurse caring for a client with new-
onset atrial fibrillation would be most important to communicate to the
health care provider?
• A) Heart rate of 110-120 beats per minute
• B) Blood pressure of 130/85 mmHg
• C) Sudden vision change
• D) Reports of mild chest discomfort
✅ Correct Answer: C
Rationale: Sudden vision changes in a client with atrial fibrillation may
indicate an embolic stroke affecting the ophthalmic artery or visual
cortex of the brain. This is a medical emergency requiring immediate
intervention. While heart rate and blood pressure abnormalities also
require attention, they are not as urgent as potential stroke symptoms .
Question 3
A client who has atrial fibrillation with rapid ventricular response is
started on a continuous heparin infusion. Which clinical finding enables
the nurse to conclude that the heparin therapy is effective?
• A) The client's heart rate decreases to 80-90 beats per minute
• B) An activated partial thromboplastin time (aPTT) is twice the
usual value
• C) The client reports no chest pain or shortness of breath
• D) The client's blood pressure returns to baseline
✅ Correct Answer: B
,Rationale: Heparin is an anticoagulant used to prevent clot formation in
clients with atrial fibrillation. Therapeutic effectiveness is monitored by
aPTT levels. A therapeutic aPTT is typically 1.5 to 2.5 times the normal
control value, indicating adequate anticoagulation to prevent thrombus
formation without excessive bleeding risk .
Question 4
When treating clients for osteoporosis, which medication has a side
effect of atrial fibrillation when infused too quickly?
• A) Alendronate (Fosamax)
• B) Raloxifene (Evista)
• C) Zoledronic acid (Reclast)
• D) Denosumab (Prolia)
✅ Correct Answer: C
Rationale: Zoledronic acid, a bisphosphonate used to treat osteoporosis,
can cause atrial fibrillation as an adverse effect when infused too
rapidly. It should be administered as a slow intravenous infusion over at
least 15 minutes and clients should be well-hydrated before
administration .
Question 5
After the home health nurse obtains a radial pulse rate of 136
beats/minute in a client with chronic atrial fibrillation, which action
would the nurse take next?
, • A) Document the finding and reassess in 4 hours
• B) Notify the health care provider immediately
• C) Take the client's apical pulse for a full minute
• D) Administer the client's PRN beta-blocker
✅ Correct Answer: C
Rationale: In atrial fibrillation, the radial pulse may not accurately
reflect the apical pulse due to a pulse deficit (difference between apical
and radial rates). The nurse should first assess the apical pulse for a full
minute to obtain an accurate heart rate before making any clinical
decisions or notifying the provider .
Question 6
Which finding for a client who has a diagnosis of paroxysmal atrial
fibrillation is most important to report quickly to the health care
provider?
• A) Fatigue after minimal exertion
• B) Occasional palpitations lasting 5-10 minutes
• C) Right arm weakness
• D) Mild shortness of breath when climbing stairs
✅ Correct Answer: C
Rationale: Right arm weakness is a focal neurological deficit that
suggests an embolic stroke. Clients with atrial fibrillation are at high risk
for thromboembolic events because blood pools in the atria and can form
clots that travel to the brain. Any unilateral weakness requires immediate
evaluation .
