A nurse is caring for a 62-year-old female client on the telemetry unit.

A nurse is assisting with obtaining an electrocardiogram (ECG) for a client who has atrial fibrillation. Which of the following actions should the nurse take to ensure a good ECG tracing? (Select all that apply.)

Choice A rationale

Palpitations, described as feeling the heart skip a beat, can be a symptom of various cardiac conditions, including arrhythmias, but are not singularly indicative of aortic stenosis. While aortic stenosis can lead to arrhythmias, palpitations are not the most specific or common initial complaint directly correlating with the physiological changes of a narrowed aortic valve.

Choice B rationale

Dyspnea on exertion, or shortness of breath with exercise, is a cardinal symptom of aortic stenosis. As the aortic valve narrows, the left ventricle must generate increasingly higher pressures to eject blood into the aorta. During exercise, cardiac output demands increase, and the stenosed valve restricts blood flow, leading to exertional dyspnea due to elevated left ventricular end-diastolic pressure and pulmonary congestion.

Choice C rationale

Pitting edema in the feet and ankles suggests fluid retention, which is a common manifestation of right-sided heart failure. While severe aortic stenosis can eventually lead to biventricular heart failure, peripheral edema is not typically the earliest or most specific symptom directly linked to the mechanical obstruction of the aortic valve itself. It is a later manifestation of cardiac decompensation.

Choice D rationale

Chest pain that resolves with rest is characteristic of stable angina, often caused by coronary artery disease. While patients with severe aortic stenosis can experience anginal chest pain due to increased myocardial oxygen demand from ventricular hypertrophy and reduced coronary perfusion, this symptom is not as specific to aortic stenosis as exertional dyspnea, which directly reflects the flow obstruction.

Choice A rationale:
Proper electrode placement is essential for obtaining an accurate ECG tracing. Misplaced electrodes can cause misinterpretation of the cardiac rhythm, particularly in clients with known arrhythmias like atrial fibrillation. Correct anatomical positioning of leads ensures reliable assessment of atrial and ventricular activity and allows accurate diagnosis and treatment planning by the provider.

Choice B rationale:
Ensuring the skin is clean and dry improves electrode adhesion and reduces electrical interference. Oily, sweaty, or moist skin increases resistance and results in artifact or poor-quality tracings. Cleaning the skin with alcohol and allowing it to dry before attaching electrodes minimizes artifact and enhances signal conduction between the skin and electrodes.

Choice C rationale:
Client movement during an ECG causes artifacts that may obscure the heart rhythm or mimic arrhythmias, complicating interpretation. Instructing the client to remain still ensures a clearer and more accurate representation of cardiac electrical activity. This is especially important when assessing for atrial fibrillation, where irregular rhythms must be clearly observed.

Choice D rationale:
Incorrect. Keeping the client NPO (nothing by mouth) is unnecessary for a standard ECG. ECG is a non-invasive procedure that does not require sedation, anesthesia, or fasting. Unless the client is scheduled for procedures requiring NPO status, food and fluids do not interfere with ECG testing or electrode function.

Choice E rationale:
Incorrect. Routine ECGs do not require sedation. The client is awake and cooperative, and sedation could mask symptoms, depress respiration, or alter heart rate, compromising the accuracy of the tracing. Sedation is only used during specific procedures (e.g., transesophageal echocardiogram or cardioversion), not standard surface ECG.