A client in the coronary care unit is receiving a diltiazem infusion for atrial fibrillation. The nurse observes on the cardiac monitor that the client's heart rate has converted to sinus bradycardia at a rate of 50 beats/minute. Which nursing action should be performed first?

Apply transcutaneous pacemaker pads.

Place the client in Trendelenberg position.

Call the doctor for an order to decrease the infusion rate.

Administer a dose of atropine.

Answer and Explanation

The Correct Answer is C

A. Apply transcutaneous pacemaker pads: While this is a potential intervention for symptomatic or severe bradycardia unresponsive to medications, it is premature as a first step in this scenario. The client is stable with a heart rate of 50 bpm and no mention of hemodynamic compromise.

B. Place the client in Trendelenburg position: This position is used to improve venous return in hypotensive patients, but there is no evidence of hypotension or poor perfusion. It is not an appropriate response to mild bradycardia in this context.

C. Call the doctor for an order to decrease the infusion rate: Diltiazem is a calcium channel blocker that slows AV node conduction, potentially causing bradycardia. Since the heart rate has dropped to 50 bpm, the most appropriate first action is to contact the provider to adjust the infusion rate, which may be too high for the client’s current rhythm.

D. Administer a dose of atropine: Atropine is used for symptomatic bradycardia. If the client is asymptomatic and the bradycardia is mild and medication-induced, adjusting or discontinuing the offending agent should be attempted before administering atropine.

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Correct Answer is C

Explanation

A. BP 105/70 manually & flat neck veins: This blood pressure is within a low-normal range, and flat neck veins suggest no evidence of right-sided heart failure or cardiac tamponade. Though the patient needs evaluation, these findings are not emergent.

B. Equal breath sounds with a respiratory rate of 28: A mildly elevated respiratory rate can indicate distress, but equal breath sounds suggest the absence of pneumothorax or hemothorax. While the patient is symptomatic, this finding alone doesn't demand the most urgent intervention.

C. Distended neck veins & muffled heart sounds: These are classic signs of cardiac tamponade, a life-threatening emergency that can occur due to pacemaker lead perforation. This condition results in fluid accumulation in the pericardial sac, impairing cardiac output and requiring immediate intervention such as pericardiocentesis.

D. Heart rate 105 & respiratory rate of 28: These are signs of physiological compensation and indicate stress or early decompensation. However, without signs like neck vein distention or muffled heart sounds, they are less critical than the findings in option C.

A. Diaphoresis, hypertension B. Palpitations, shortness of breath C. Systolic murmur, severe anxiety D. Visual changes, anorexia

Correct Answer is B

Explanation

A. Diaphoresis, hypertension: While diaphoresis may occur in response to the discomfort or anxiety caused by a rapid heart rate, hypertension is not a typical feature of atrial flutter. The rapid ventricular response can more often lead to hypotension if cardiac output is compromised.

B. Palpitations, shortness of breath: These are hallmark symptoms of rapid atrial flutter. Palpitations result from the fast, irregular atrial contractions, while shortness of breath may occur due to decreased cardiac output and poor ventricular filling during rapid rates.

C. Systolic murmur, severe anxiety: Atrial flutter is not typically associated with a systolic murmur unless there is a pre-existing valvular condition. Anxiety may be present but is a nonspecific response and not as directly linked to atrial flutter as palpitations and dyspnea.

D. Visual changes, anorexia: These symptoms are not characteristic of atrial flutter. Visual changes may occur with severe hypotension or embolic events, and anorexia may be seen in chronic illness, but neither is directly tied to the acute presentation of atrial flutter.

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WBC	8.5
Hemoglobin	17g/dL
Hematocrit	54%
BUN	28mg/dL
Creatinine	1.1 mg/dL
Potassium	4.9 mEq/L

Potassium 2.8 mEq/L
Sodium 133 mEq/L
Chloride 90 mEq/L
Glucose 200 mg/dl
Magnesium 2.5 mg/dL
Calcium 8.0 mg/dL

A client in the coronary care unit is receiving a diltiazem infusion for atrial fibrillation. The nurse observes on the cardiac monitor that the client's heart rate has converted to sinus bradycardia at a rate of 50 beats/minute. Which nursing action should be performed first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client who was discharged from the hospital 2 days ago after having a permanent pacemaker placed presents to the emergency department with sharp chest pain and difficulty breathing. Which assessment findings require the highest priority intervention?

Correct Answer is C

Explanation

Which physical assessment findings would the nurse anticipate for a client with rapid atrial flutter?

Correct Answer is B

Explanation

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