A nurse cares for a client who manifests Ventricular Tachycardia on a cardiac monitor. Which action should the nurse take first?

Rationale:

A. While pneumonia can cause fever, fatigue, and chest discomfort, it is less likely to cause severe pedal edema, irregular heart rhythms, or palpitations. The presence of edema and irregular heart sounds points toward a cardiac origin rather than a primary pulmonary infection.

B. Fatigue, chest discomfort, irregular heart sounds, pedal edema, and low blood pressure are classic signs of heart failure, particularly in a young adult who may have acute or chronic cardiac dysfunction. Heart failure can also contribute to the development of arrhythmias.

C. COPD primarily presents with chronic cough, dyspnea, and sputum production. While it can strain the heart over time, COPD alone would not account for the acute irregular heart rate, edema, and chest discomfort in this patient.

D. The irregular heart rate (HR 112 bpm) and irregular heart sounds are indicative of atrial fibrillation, which is common in patients with underlying heart disease or heart failure. Atrial fibrillation can also worsen cardiac output, contributing to edema and fatigue.

E. Pulmonary embolism typically presents with acute dyspnea, pleuritic chest pain, tachypnea, and sometimes hemoptysis. Edema and irregular heart rhythms are not primary features, making this less likely than heart failure and atrial fibrillation.

Rationale:
A. An ACE inhibitor used in heart failure, captopril reduces afterload, decreases blood pressure, and improves cardiac output. It is safe for clients with asthma because it does not cause bronchoconstriction. Nurses should monitor for side effects like cough or hyperkalemia, but respiratory status is typically not affected.

B. A non-selective beta-blocker, carvedilol blocks both beta-1 and beta-2 receptors, which can trigger bronchospasm in clients with asthma or reactive airway disease. In these patients, a cardioselective beta-blocker (e.g., metoprolol or atenolol) is preferred to reduce the risk of respiratory compromise. Clarification is needed to ensure safe management of heart failure without exacerbating asthma.

C. This nitrate reduces preload through venous dilation, helping relieve heart failure symptoms. It is generally safe for clients with asthma because it does not affect bronchial smooth muscle. Nurses should monitor for headache, hypotension, and dizziness as common side effects.

D. An inhaled corticosteroid indicated for asthma management, fluticasone reduces airway inflammation and prevents asthma exacerbations. It is safe to use in clients with heart failure and does not interact adversely with cardiac medications.