The nurse suspects that the client has atrial fibrillation. Which assessment finding supports the nurse's conclusion?
1. Rapid, irregular heart rhythm of 130 to 150 beats/min
2. A regular rhythm fluctuating from 60 to 100 beats/min
3. Beats occurring before regularly expected cardiac contractions
4. Rate increases with inspiration and decreases with expiration
1
1. Atrial fibrillation is an irregular heart rhythm; the ventricular response can increase to more than 300 beats/min. The pulse deficit with atrial fibrillation is enormous and, usually, one third to one-half of the myocardial contractions actually perfuse blood to the extremities. The pulsations are irregular because fibrillation is electrical chaos in the atrium, the ventricular response is variable, and the number of beats perfused is variable. The only method of diagnosing atrial fibrillation is with an electrocardio-gram; without the electrocardiogram, the nurse can state the heart rhythm is irregular and at a specified rate.
2. A rhythm fluctuating between 60 and 100 beats/min cannot be regular.
3. Beats occurring too early in the cardiac cycle are premature.
4. A pulse fluctuating with breathing is called sinus arrhythmia.
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