NUR 311 Exam 3 Questions and
Complete Solutions
What teaching does the nurse include for a patient with atrial fibrillation who has a new
prescription for warfarin?
A."It is important to consume a diet high in green leafy vegetables."
B."You would take aspirin or ibuprofen for headache."
C."Report nosebleeds to your provider immediately."
D."Avoid caffeinated beverages." ✅•C
•A nosebleed could be indicative of excessive dosing of warfarin. Warfarin is an
anticoagulant and causes decreased ability for blood to clot.Green leafy vegetables are
high in vitamin K, which may antagonize the effects of warfarin; these vegetables would
be eaten in moderate amounts. Aspirin and nonsteroidal anti-inflammatory agents may
prolong the prothrombin time and the international normalized ratio, causing
predisposition to bleeding. These agents would be avoided. It is not necessary to avoid
caffeine because this does not affect clotting; however, green tea may interfere with the
effects of warfarin.
•How does the nurse recognize that atropine has produced a positive outcome for the
patient with bradycardia?
A.The patient states he is dizzy and weak.
B.The nurse notes dyspnea.
C.The patient has a heart rate of 42 beats/min.
D.The monitor shows an increase in heart rate. ✅•D
•An expected outcome after the administration of atropine is an increased heart rate. By
definition, the bradydysrhythmia has resolved when the heart rate is greater than 60
beats/min.Dizziness and weakness indicate symptoms of decreased cerebral perfusion
and intolerance to the bradydysrhythmia. Dyspnea indicates intolerance to the
bradydysrhythmia. A heart rate of 42 beats/min after atropine has been given indicates
that bradycardia is unresolved.
•The nurse is caring for a patient with atrial fibrillation (AF). In addition to an
antidysrhythmic, what medication does the nurse plan to administer?
A.Heparin
B.Atropine
C.Dobutamine
D.Magnesium sulfate ✅•A
•The nurse plans to administer heparin in addition to the antidysrhythmic. AF is the loss
of coordinated atrial contractions that can lead to pooling of blood, resulting in thrombus
formation. The patient is at high risk for pulmonary and systemic embolism. Heparin and
other anticoagulants (e.g., enoxaparin [Lovenox], warfarin [Coumadin], and novel oral
anticoagualants, when nonvalvular, such as dabigatran [Pradaxa], rivaroxaban [Xarelto],
apixaban [Eliquis], or edoxaban [Savaysa]) are used to prevent thrombus development
,in the atrium, leading to the risk of embolization (i.e., stroke).Atropine is used to treat
bradycardia and not rapid heart rate associated with AF. Dobutamine is an inotropic
agent used to improve cardiac output; it may cause tachycardia, thereby worsening
atrial fibrillation. Although electrolyte levels are monitored in clients with dysrhythmia,
magnesium sulfate is not used unless depletion is noted.
•The nurse is caring for a patient who has developed a bradycardia. Which possible
causes does the nurse investigate? Select all that apply
A.Bearing down for a bowel movement
B.Patient stating that he just had a cup of coffee
C.Patient becoming emotional when visitors arrived
D.Diltiazem (Cardizem) administered 1 hour ago ✅•AD
•Valsalva maneuvers such as bearing down for a bowel movement or gagging may
cause excessive vagal (parasympathetic) stimulation to the heart leading to decreased
rate of sinus node discharge - causing bradycardia. Calcium channel blockers such as
diltiazem may cause bradycardia. Caffeine intake results in an increased heart rate.
Stress, such as an emotional encounter, can result in tachycardia.
•Which risk factors are known to contribute to atrial fibrillation? Select all that apply
A.Use of beta-adrenergic blockers
B.Excessive alcohol use
C.Advancing age
D.High blood pressure
E.Palpitations ✅•BCD
•Risk factors contributing to atrial fibrillation include excessive alcohol use, advancing
age, and hypertension. Other risk factors involve previous ischemic stroke, transient
ischemic attack or other thromboembolic event, coronary heart disease, diabetes
mellitus, heart failure, mitral valve disease, obesity, and chronic kidney disease. The
incidence of atrial fibrillation also occurs more often in those of European ancestry and
African Americans. Beta-adrenergic blocking agents, which reduce heart rate, are used
to treat atrial fibrillation. Palpitations are a symptom of atrial fibrillation, rather than a risk
or a cause.
•The nurse is caring for a patient with advanced heart failure who develops asystole.
The nurse corrects the graduate nurse when the graduate offers to perform which
intervention?
A.Defibrillation
B.Cardiopulmonary resuscitation (CPR)
C.Administration of epinephrine
D.Administration of oxygen ✅•A
•Defibrillation interrupts the heart rhythm and allows normal pacemaker cells to take
over. In asystole, there is no rhythm to interrupt. Therefore, this intervention is not used.
If drug therapy fails to restore effective rhythm, CPR is initiated. Epinephrine is used to
increase heart rate in asystole. Hypoxia may be a cause of cardiac arrest, so the
administration of oxygen would be appropriate.
, •The nurse is caring for a patient with acute coronary syndrome (ACS) and atrial
fibrillation who has a new prescription for metoprolol. Which monitoring is essential
when administering the medication?
A.ST segment
B.Heart rate
C.Troponin
D.Myoglobin ✅•B
•The monitoring of the patient's heart rate is essential. The effects of metoprolol are to
decrease heart rate, blood pressure, and myocardial oxygen demand.ST segment
elevation is consistent with MI; it does not address monitoring of metoprolol. Elevation in
troponin is consistent with a diagnosis of MI, but does not address needed monitoring
for metoprolol. Elevation in myoglobin is consistent with myocardial injury in ACS, but
does not address needed monitoring related to metoprolol.
•The nurse is caring for a patient with unstable angina whose cardiac monitor shows
ventricular tachycardia. Which action is appropriate to implement first?
A.Defibrillate the patient at 200 joules.
B.Check the patient for a pulse.
C.Cardiovert the patient at 50 joules.
D.Give the patient IV lidocaine. ✅•B
•The nurse needs to first assess the patient to determine stability before proceeding
with further interventions. If the patient has a pulse and is relatively stable, elective
cardioversion or antidysrhythmic medications may be prescribed. The drug of choice for
stable ventricular tachycardia with a pulse is amiodarone. If the patient is pulseless or
nonresponsive, the patient is unstable and defibrillation is used and not cardioversion.
Also, if the patient is pulseless, lidocaine may be given after defibrillation.
•The nurse is teaching a group of teens about prevention of heart disease. Which point
is most important for the nurse to emphasize?
A.Reduce abdominal fat.
B.Avoid stress.
C.Do not smoke or chew tobacco.
D.Avoid alcoholic beverages. ✅•C
•The most important point for the nurse to emphasize when teaching a group of teens
about heart disease prevention is not to smoke or chew tobacco. Tobacco exposure,
including secondhand smoke, reduces coronary blood flow, causing vasoconstriction,
endothelial dysfunction, and thickening of the vessel walls. Smoking also increases
carbon monoxide and decreases oxygen. Because it is highly addicting, beginning
smoking in the teen years may lead to decades of exposure. Teens are not likely to
experience metabolic syndrome from obesity but are very likely to use tobacco.
Avoiding stress is a less modifiable risk factor, which is less likely to cause heart
disease in teens. The risk of smoking outweighs the risk of alcohol use.
Prompt pain management with myocardial infarction is essential for which reason?
A.The discomfort will increase client anxiety and reduce coping.
B.Pain relief improves oxygen supply and decreases oxygen demand.
