The nurse is caring for a client with suspected infectious endocarditis. Which information obtained in the health history could contribute to the development of this problem?

A. Radiofrequency ablation: This is used to treat tachyarrhythmias such as atrial fibrillation, atrial flutter, or supraventricular tachycardia (SVT). The ECG shown does not demonstrate any tachycardic rhythm rather, it shows a bradyarrhythmia with dropped QRS complexes, which suggests a conduction block, not a reentrant circuit.

B. Administration of amiodarone: Amiodarone is primarily used for ventricular arrhythmias or atrial fibrillation. It is not effective in treating bradyarrhythmias or heart blocks such as those seen in this rhythm strip.

C. Insertion of a pacemaker: The rhythm strip shows intermittent dropped QRS complexes with consistent P waves—this is indicative of second-degree AV block, Mobitz II. This type of conduction block can progress to complete heart block and is often treated with the insertion of a permanent pacemaker to maintain cardiac output.

D. Administration of adenosine: Adenosine is used to terminate SVT by temporarily blocking AV node conduction. It is contraindicated in heart blocks, especially Mobitz II or third-degree AV block, because it can worsen the block and cause asystole.

A. Presence of fine tremors: Fine tremors are not a typical sign of worsening heart failure. They may be associated with medications (like bronchodilators or lithium), metabolic issues, or neurologic disorders, but not directly with heart failure decompensation.

B. Heart rate 50 per minute: Bradycardia may be notable, especially in the context of beta-blocker therapy, but a heart rate of 50 bpm in a stable patient is not necessarily a sign of worsening heart failure unless accompanied by symptoms like dizziness or hypotension.

C. +1 peripheral edema: Mild peripheral edema is often chronic and common in older adults with heart failure. It does not reliably indicate worsening status unless there is a significant increase in edema or associated weight gain and pulmonary symptoms.

D. Increased confusion: Older adults are more susceptible to changes in cognitive function due to decreased cardiac output in worsening heart failure. New or worsening confusion in older adults is a key sign of decreased cerebral perfusion and may signal worsening heart failure. It can also indicate hypoxia or electrolyte imbalance, making it a critical finding that warrants immediate evaluation.