Atrial fibrillation is characterized by a disorganization of electrical activity in the atria due to multiple ectopic foci. It results in loss of effective atrial contraction and places the client at risk for embolic stroke due to thrombi formed in the atria from stasis of blood. During atrial fibrillation, the atrial rate may be increased to 350-600/min. The ventricular response (pulse rate) can vary. The higher the ventricular rate, the more likely the client will have symptoms of decreased cardiac output (ie, hypotension). Ventricular rate control is a priority in clients with atrial fibrillation. This client has an irregular heart rate of 140/min and is not currently hypotensive. However, if the high ventricular response is allowed to continue, it is likely that the client will begin to show signs and symptoms of decreased cardiac output such as hypotension. Therefore, giving the client diltiazem (a calcium channel blocker) is the priority as its purpose is to decrease the ventricular response rate to <100/min. Other medications such as beta blockers (metoprolol) or digoxin may also be used to control the ventricular rate.
(Option 2) Anticoagulants (eg, rivaroxaban [Xarelto], dabigatran [Pradaxa], apixaban [Eliquis], and warfarin) are used for long-term prevention of atrial thrombus and embolic complications. This is not a priority.
(Option 3) The HCP will investigate possible causes of the atrial fibrillation; one of these is an overactive thyroid gland (hyperthyroidism). The thyroid function test would be useful for confirmation, but it is not a priority.
(Option 4) An echocardiogram can be obtained once the rate is controlled, but it is not a priority.
Educational objective: Ventricular rate control is a priority in the client with atrial fibrillation; therefore, the nurse should administer the medication (diltiazem, metoprolol, or digoxin) that will accomplish this first.
Atrial fibrillation is characterized by a disorganization of electrical activity in the atria due to multiple ectopic foci. It results in loss of effective atrial contraction and places the client at risk for embolic stroke due to thrombi formed in the atria from stasis of blood. During atrial fibrillation, the atrial rate may be increased to 350-600/min. The ventricular response (pulse rate) can vary. The higher the ventricular rate, the more likely the client will have symptoms of decreased cardiac output (ie, hypotension). Ventricular rate control is a priority in clients with atrial fibrillation. This client has an irregular heart rate of 140/min and is not currently hypotensive. However, if the high ventricular response is allowed to continue, it is likely that the client will begin to show signs and symptoms of decreased cardiac output such as hypotension. Therefore, giving the client diltiazem (a calcium channel blocker) is the priority as its purpose is to decrease the ventricular response rate to <100/min. Other medications such as beta blockers (metoprolol) or digoxin may also be used to control the ventricular rate.
(Option 2) Anticoagulants (eg, rivaroxaban [Xarelto], dabigatran [Pradaxa], apixaban [Eliquis], and warfarin) are used for long-term prevention of atrial thrombus and embolic complications. This is not a priority.
(Option 3) The HCP will investigate possible causes of the atrial fibrillation; one of these is an overactive thyroid gland (hyperthyroidism). The thyroid function test would be useful for confirmation, but it is not a priority.
(Option 4) An echocardiogram can be obtained once the rate is controlled, but it is not a priority.
Educational objective: Ventricular rate control is a priority in the client with atrial fibrillation; therefore, the nurse should administer the medication (diltiazem, metoprolol, or digoxin) that will accomplish this first.
