Which client in a cardiac step-down unit would the nurse monitor most closely for the development of cerebral vascular accident (CVA) or stroke?
1. An 80-year-old client whose cardiac monitor reveals bradycardia with a rate of 58
2. A 56-year-old client with a PR interval of 0.22 seconds
3. A 37-year-old client with recent-onset atrial fibrillation
4. A 63-year-old client with occasional premature ventricular contractions (PVCs)
Correct Answer: 3
Rationale 1: Bradyarrhythmias are common in older adults, and a heart rate of 58 is not the most significant indicator of risk of stroke.
Rationale 2: Prolongation of the PR interval is not normal but is not a precursor of stroke.
Rationale 3: Atrial fibrillation slows the movement of blood through the chambers of the heart and may result in clot formation. If a clot is ejected from the heart into the systemic circulation, a stroke may occur.
Rationale 4: Occasional PVCs are common and are not a precursor of stroke.
Global Rationale: Atrial fibrillation slows the movement of blood through the chambers of the heart and may result in clot formation. If a clot is ejected from the heart into the systemic circulation, a stroke may occur. Bradyarrhythmias are common in older adults, and a heart rate of 58 is not the most significant indicator of risk of stroke. Prolongation of the PR interval is not normal but is not a precursor of stroke. Occasional PVCs are common and are not a precursor of stroke.
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