A 47-year-old female client tells the nurse that her heart feels ...

[krzymel]

A 47-year-old female client tells the nurse that her heart feels as though it is racing. The client's pulse is 160 beats per minute.
 
  The nurse knows that a vagal response will stimulate the parasympathetic nervous system to slow the heart rate and instructs the client to:
  1. Bear down as though she is having a bowel movement
  2. Take a hot shower
  3. Take a cold bath
  4. Hold her breath

Question 2

During pretesting for an elective surgery, it is discovered that the older adult client has atrial fi-brillation. The nurse knows that this is a common dysrhythmia in older people and can cause:
 
  1. Fatigue, a fluttering in the chest, or shortness of breath if the ventricular response is rapid
  2. Acute loss of pulse and respiration
  3. Severe hypotension and loss of pulse and consciousness
  4. Dizziness, syncope, or chest pain

[JCABRERA33]

Answer to Question 1

ANS: 1
Paroxysmal supraventricular tachycardia is a sudden rapid onset of tachycardia originating above the AV node. It often begins and ends spontaneously. Sometimes excitement, fatigue, caffeine, smoking, or alcohol use precipitates paroxysmal supraventricular tachycardia. When needed, treatment includes vagal stimulation such as carotid sinus massage or Valsalva maneuver to de-crease the ventricular response. A hot shower would cause the heart to beat faster in order to cool down the body. A cold bath could cause additional stress and would not be appropriate. Holding the breath will increase the heart rate as it compensates for the lack of oxygen intake and buildup of carbon dioxide.

Answer to Question 2

ANS: 1
There is a loss of the atrial kick (portion of the cardiac output squeezed in the ventricles with a coordinated atrial contraction), pooling of blood in the atria, and development of microemboli. The client often complains of fatigue, a fluttering in the chest, or shortness of breath if the ven-tricular response is rapid. It is a commonly occurring dysrhythmia in the aging and older adult. Acute loss of pulse and respiration is indicative of ventricular fibrillation. Immediate defibrilla-tion is needed after assessment of ABCs of CPR. Ventricular tachycardia results in decreased cardiac output due to decreased ventricular filling time and often leads to severe hypotension and loss of pulse and consciousness. Sinus bradycardia may present signs and symptoms of re-duced cardiac output such as dizziness, syncope, or presence of chest pain.