MANAGEMENT OF ATRIAL FIBRILLATION FOR APRNs Self-Assessment Answers and Rationales
1. The correct answer is B. Rationale: The loss of atrial kick is an immediate response to AF. Atrial kick will contribute 20% to cardiac output. She does not have diastolic dysfunction on the echo. The pulmonary vascular congestion is a result of backward flow to the lungs. High blood pressure is a chronic condition that can cause structural heart disease, yet will not cause acute HF symptoms. 2. The correct answer is B. Rationale: Recall the time in AF from the case study. She reported 2 weeks of symptoms. Paroxysmal AF terminates spontaneously or with intervention within 7 days of onset. Persistent AF is continuous AF that is sustained >7 days. Long-standing persistent is continuous AF of >12 months duration. Permanent AF is classified when the provider and patient decide to cease further treatments to restore or maintain SR. 3. The correct answer is D. Rationale: Structural changes to the heart can be seen on the 12 lead ECG. The presence of biphasic p waves indicates atrial enlargement, left ventricular hypertrophy is seen with long-standing HTN, and indicated by increased amplitude of QRS complexes. The bundle branch block indicates structural changes which can lead to conduction issues as well. 4. The correct answer is D. Rationale: The risk score for thromboembolism is 4 for acute heart failure, HTN, age, and female sex. 5. The correct answer is B. Rationale: Based on her CHA 2 DS 2 ‑VASc score, the patient should be placed on anticoagulation to protect her from
thromboembolism/stroke. The HAS-BLED score would determine the risk of bleeding. 6. The correct answer is B. Rationale: Warfarin has a delayed therapeutic effect since it inhibits the synthesis of vitamin K clotting factors. Both clopidogrel and aspirin have antiplatelet effects, yet are not considered anticoagulants. 7. The correct answer is B. Rationale: Afterload is the load during systole on the left ventricle. Increased afterload is seen in patients with high blood pressure, aortic stenosis, and other conditions that impede ventricular ejection. Preload would be manifested with signs and symptoms of volume overload. Contractility can be affected, yet she has no indication of systolic heart failure. Long-standing fast heart rates can cause cardiomyopathy. 8. The correct answer is C. Rationale: TEE is used to evaluate for atrial thrombus (particularly in the left atrial appendage) as well as to guide cardioversion (if thrombus is seen, cardioversion should be delayed). 9. The correct answer is B. Rationale: Amiodarone would be the best agent for conversion to NSR since it has the least proarrhythmic potential. Flecainide is used when no structural heart disease is present. Both diltiazem and digoxin are used for rate control. 10. The correct answer is B. Rationale: Dabigatran is a direct thrombin inhibitor. The other choices are considered factor Xa inhibitors.
Course Code: ANCCUS02AF
EliteLearning.com/Nursing
Book Code: AUS3024
Page 67
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