A patient's heart monitor shows HR 78 with progressive lengthening of the PR interval over time. What is the most appropriate action for the nurse to take next?

Rationale:
A. While an absent pulse can occur in extreme cases of poor perfusion, it is not typical in atrial fibrillation. In AFib, the heart still contracts, though irregularly, so the pulse is usually detectable.

B. A bounding pulse is strong, forceful, and easily palpable, often seen in conditions like hyperthyroidism, fever, or aortic regurgitation. AFib does not typically produce a bounding pulse; instead, the pulse may feel weak or variable due to irregular ventricular contractions.

C. A regular pulse indicates consistent rhythm and timing between beats. In atrial fibrillation, the atria fire chaotically, leading to an irregularly irregular pulse. A regular pulse is more characteristic of normal sinus rhythm or controlled atrial flutter.

D. Some clients with AFib may have a slower rate, especially if they are on rate-controlling medications (e.g., beta-blockers or calcium channel blockers). However, the hallmark of AFib is irregularity in rhythm, which should be the primary focus of assessment.

Rationale:

A. While continuous blood pressure monitoring is important in certain critical care settings, an AICD does not provide hemodynamic data. Its function is limited to detecting and correcting cardiac rhythm abnormalities.

B. An Automated Implantable Cardioverter Defibrillator (AICD) continuously monitors the heart’s electrical activity. When it detects life-threatening arrhythmias such as ventricular tachycardia (VT) or ventricular fibrillation (VF), it can deliver anti-tachycardia pacing or a high-energy shock to restore a normal sinus rhythm. This intervention significantly reduces the risk of sudden cardiac death, especially in patients with structural heart disease or a history of cardiac arrest.

C. Insulin delivery is performed via insulin pumps or injections, which are entirely unrelated to cardiac monitoring. Selecting this option reflects a misunderstanding of device functions.

D. Chemotherapy administration requires central venous access devices (e.g., port-a-caths or PICC lines) and is not related to cardiac rhythm management. An AICD does not provide intravenous drug delivery or medication therapy.