A nurse is caring for a client who is scheduled for a mastectomy. The client tells the nurse,
"I'm not sure I want to have a mastectomy." Which of the following statements should the nurse make?

This is because the client is experiencing bradycardia, which is a slow heart rate of less than 60/min. Bradycardia can cause decreased cardiac output, which can lead to symptoms such as tremors, fainting, dizziness, chest pain, shortness of breath, and hypotension. Some causes of bradycardia are sinus node dysfunction, atrioventricular block, medication side effects, hypothyroidism, hypothermia, and increased vagal tone.

The nurse should anticipate administering atropine sulfate, which is an anticholinergic drug that blocks the action of the vagus nerve on the heart and increases the heart rate and conduction. Atropine sulfate is the first-line drug for symptomatic bradycardia and can be given intravenously or intramuscularly. The nurse should monitor the client's vital signs, cardiac rhythm, and response to the medication. The nurse should also prepare for other interventions, such as transcutaneous pacing or permanent pacemaker insertion, if atropine sulfate is ineffective or contraindicated.

A complete AV block (also called third-degree AV block) is a type of heart block in which there is no electrical communication between the atria and ventricles. This means that the atria and ventricles beat independently of each other, resulting in a slow and irregular pulse. A complete AV block can cause symptoms such as dizziness, fainting, chest pain, shortness of breath, and heart failure.

A permanent pacemaker is a device that sends electrical impulses to the heart to regulate its rhythm and prevent bradycardia (slow heart rate). A permanent pacemaker is indicated for clients with complete AV block and rates slower than 40/min or symptomatic bradycardia.

The other options are not indications for a permanent pacemaker. Vasovagal bradycardia is a temporary drop in heart rate and blood pressure caused by a stimulus that triggers the vagus nerve, such as pain, stress, or straining.

It usually resolves on its own or with simple measures, such as lying down or elevating the legs. Sinus tachycardia is a normal increase in heart rate in response to physical or emotional stress, such as exercise, fever, or anxiety. It usually does not require treatment unless it is caused by an underlying condition or causes symptoms.

Asymptomatic second-degree AV block is a type of heart block in which some of the electrical impulses from the atria are blocked from reaching the ventricles. It may not cause any symptoms or affect the overall heart rate. It may be benign or transient, or it may progress to a more serious type of heart block. It may require monitoring or medication, but not a permanent pacemaker unless it causes symptomatic bradycardia.