A nurse on the cardiac care unit is caring for a client who is hemodynamically unstable. For which of the following dysrhythmias should the nurse plan for synchronized cardioversion?

Choice A reason: Maintaining the client on strict bed rest is no longer the standard of care. Early ambulation is encouraged once anticoagulation therapy is initiated, as prolonged immobility increases the risk of further clot formation and complications such as pulmonary embolism.

Choice B reason: Elevating the affected extremity is correct because it promotes venous return, reduces swelling, and decreases pain. This intervention helps prevent clot extension and supports circulation without increasing the risk of embolization.

Choice C reason: Applying cold compresses is not recommended. Cold therapy does not improve venous circulation and may cause vasoconstriction, worsening discomfort and impairing healing.

Choice D reason: Massaging the muscle of the affected extremity is contraindicated. Massage can dislodge the clot, leading to a life-threatening pulmonary embolism.

Choice A reason: Completing exercise at least 2 hours before bedtime is an evidence-based recommendation for promoting sleep. Exercise increases alertness and body temperature, which can interfere with sleep if performed too close to bedtime. Allowing a 2-hour window helps the body return to a restful state, making this the correct answer.

Choice B reason: Reading a book in bed when having difficulty sleeping is not recommended because it conditions the brain to associate the bed with wakefulness rather than sleep. Sleep hygiene practices emphasize using the bed only for sleep and intimacy to strengthen the association between bed and rest.

Choice C reason: While avoiding alcohol before bedtime is beneficial, the specific recommendation is to avoid alcohol altogether as it disrupts sleep cycles and reduces REM sleep. Alcohol may initially induce drowsiness but leads to fragmented sleep later in the night. The 3-hour timeframe is not a standard evidence-based guideline, making this choice incorrect.

Choice D reason: Keeping the bedroom at a cool temperature can promote sleep, but it is not the most direct or primary recommendation for difficulty falling asleep. While environmental adjustments are helpful, the strongest evidence supports timing of exercise as a key intervention. Thus, this option is supportive but not the best answer.