You receive a call to a skilled nursing facility for an elderly man with generalized weakness. The patient's nurse tells you that he has not eaten anything in the past 18 hours. She presents you with his chart, which states that he has a history of atrial fibrillation, congestive heart failure, and hypertension. His medications include Vasotec, digoxin, and warfarin. As you apply the cardiac monitor, your partner takes the patient's vital signs, which reveal a blood pressure of 136/76 mm Hg, a rapid and irregular pulse, and respirations of 22 breaths/min. The ECG reveals atrial fibrillation with a variable rate between 110 and 130 beats/min, and a 12-lead ECG tracing reveals the same. After applying supplemental oxygen, you should:
A) start an IV line set to keep the vein open, administer diltiazem, and transport.
B) place him in a position of comfort and transport with continuous monitoring.
C) establish an IV, administer Versed, and perform synchronized cardioversion.
D) establish IV access, give a beta blocker to slow his heart rate, and transport.
Answer: A) start an IV line set to keep the vein open, administer diltiazem, and transport.
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