Which of the following are the most common manifestations of COPD?

Choice A rationale: Witness the client’s signature on the informed consent form

Before undergoing a cardiac catheterization, the client must provide informed consent, which includes understanding the nature of the procedure, its risks, and potential complications. The nurse's role is to witness the signature, ensuring the client has signed willingly and understands what was discussed by the provider.

Choice B rationale: Inform the client of the risks of the procedure

While education is an essential part of nursing care, informing the client of the risks falls under the responsibility of the primary health care provider. Nurses can reinforce information, but the initial discussion about risks must come from the provider.

Choice C rationale: Obtain the client’s vital signs

Monitoring vital signs before the procedure is essential to establish a baseline. Since this client has tachycardia, elevated blood pressure, and possible myocardial infarction, ensuring stable parameters before catheterization is critical for assessing procedural risks.

Choice D rationale: Confirm the client’s allergies

Confirming allergies is crucial because contrast dye is often used during cardiac catheterization. Allergic reactions to iodine-based contrast agents can be severe. Ensuring there are no contrast dye or medication allergies before the procedure helps prevent complications.

Choice E rationale: Mark the surgical site

Cardiac catheterization is a non-surgical procedure, performed through a vascular access site, typically the femoral or radial artery. Site marking is unnecessary for this procedure, as it is not an open surgery requiring clear identification of an incision site.

Choice A rationale

First-degree heart block is characterized by a prolonged PR interval (greater than 0.20 seconds) due to a delay in the conduction of the electrical impulse from the atria to the ventricles. The ECG strip described lacks identifiable P waves and a measurable PR interval, thus ruling out first-degree heart block. The QRS duration is within the normal range (0.06-0.10 seconds), which is also inconsistent with higher-degree AV blocks that might show a widened QRS complex if a ventricular escape rhythm is present.

Choice B rationale

Supraventricular tachycardia (SVT) is characterized by a rapid heart rate (typically greater than 150 beats per minute) originating above the ventricles. While the rhythm might be regular or slightly irregular depending on the specific type of SVT, P waves are usually present, although they may be abnormal in morphology or hidden within the T wave. The ECG description indicates an irregular rhythm and the absence of identifiable P waves, making SVT an unlikely diagnosis.

Choice C rationale

Sinus bradycardia is defined by a slow heart rate (less than 60 beats per minute) originating from the sinoatrial (SA) node. The rhythm is regular, and P waves are present, preceding each QRS complex with a normal PR interval (0.12-0.20 seconds). The client's heart rate is 92 beats per minute, which is within the normal range (60-100 beats per minute), and the rhythm is irregular with no discernible P waves, thus excluding sinus bradycardia.

Choice D rationale

Atrial fibrillation (A-fib) is a common arrhythmia characterized by rapid, disorganized electrical activity in the atria, leading to an irregularly irregular ventricular response. The ECG findings of an irregular rhythm, the absence of identifiable P waves (replaced by fibrillatory waves, which are not explicitly mentioned but implied by the lack of P waves), and a normal QRS duration (indicating normal ventricular depolarization) are classic characteristics of atrial fibrillation. The heart rate can vary in A-fib; a rate of 92 beats per minute falls within a controlled ventricular response in the context of this arrhythmia.