Progressive Care Nursing Certification (PCCN) Practice Exam

In a patient with mitral stenosis, which dysrhythmia is a significant concern for nurses?

1. Premature ventricular contractions

2. Junctional rhythm at 58 bpm

3. Second degree AV block Type I

4. Atrial fibrillation at 136 bpm

The correct answer is: Atrial fibrillation at 136 bpm

In patients with mitral stenosis, atrial fibrillation is a significant concern due to the relationship between the two conditions. Mitral stenosis can lead to increased pressure within the left atrium, causing atrial enlargement and increasing the risk of developing atrial fibrillation. Atrial fibrillation typically results in an irregular and often rapid heart rate, which can significantly compromise hemodynamics. When atrial fibrillation occurs, it can lead to a decrease in cardiac output, especially in patients with mitral stenosis, as the loss of the atrial contraction contributes to ineffective ventricular filling. Furthermore, with the presence of stagnant blood flow in the left atrium due to the stenotic valve, there exists a heightened risk of thrombus formation, which can lead to systemic embolism, including strokes. The rapid heart rate observed, indicated as 136 bpm in this scenario, can exacerbate these risks, resulting in increased myocardial oxygen demand and further complicating the patient's clinical condition. Therefore, monitoring and managing atrial fibrillation becomes crucial in patients with mitral stenosis to reduce the risk of serious complications. In contrast to the other options, which either may not have as profound an effect on hemodynamics or are less directly related to the specific