A nurse is teaching a client with a new atrial fibrillation diagnosis on worsening signs and symptoms. The nurse should instruct the client to monitor for which of the following complications?

The correct answer is choice D: Prepare to administer supplemental O2 via nasal cannula.

Choice A rationale:

Atropine is used to treat bradycardia (slow heart rate), not atrial flutter with a rapid heart rate. Administering Atropine in this scenario could potentially worsen the patient’s condition by increasing the heart rate further.

Choice B rationale:

While reassessing the patient’s blood pressure is important, it is not the most immediate action. The patient’s current blood pressure is stable (118/64), and the priority is addressing the low oxygen saturation and high respiratory rate, which indicates respiratory distress.

Choice C rationale:

Adenosine is used to treat certain types of supraventricular tachycardia by temporarily slowing the heart rate, but it is not the first-line treatment for atrial flutter. Additionally, the patient’s blood pressure is stable, and there is no indication of hemodynamic instability that would necessitate immediate rate control.

Choice D rationale:

The patient’s oxygen saturation is 90%, which is below the normal range, and they are tachypneic with a respiratory rate of 26 breaths per minute. The first action should be to administer supplemental oxygen to improve oxygenation and prevent hypoxemia-related complications. Oxygen therapy can help stabilize the patient’s condition and improve oxygen saturation levels.

A. Docusate sodium 200 mg PO at bedtime:

This prescription seems appropriate. Docusate sodium is a stool softener commonly used to prevent or alleviate constipation. Taking it at bedtime can help ensure a regular bowel movement in the morning.

B. Meloxicam 15 mg PO daily:

This prescription is generally appropriate. Meloxicam is a nonsteroidal anti-inflammatory drug (NSAID) used for pain and inflammation. The daily dosing is common, but the nurse should assess for any contraindications or potential issues with the patient's renal function since NSAIDs can affect the kidneys.

C. Regular insulin 8 units subcutaneous before meals:

This prescription requires clarification. While the prescription indicates the correct medication and route (regular insulin subcutaneously), it lacks specificity regarding the timing in relation to meals. Regular insulin is typically given 30 minutes before meals to control postprandial blood glucose levels. The nurse should contact the provider to confirm the appropriate timing.

D. Fentanyl 25 mcg/hr transdermal patch:

This prescription seems appropriate. Fentanyl is a potent opioid analgesic, and a transdermal patch provides continuous pain relief over an extended period. The dose is specified in micrograms per hour (mcg/hr), which is a common method for administering continuous medications