A client is prescribed diltiazem for the treatment of a cardiac disorder. Which finding would require the nurse to hold the ordered dose and notify the provider for further orders?

A. Heart rate 46 beats per minute: Diltiazem is a calcium channel blocker that slows conduction through the AV node and decreases heart rate. A heart rate below 50 bpm is considered bradycardia and may be exacerbated by diltiazem, increasing the risk of symptomatic hypotension, dizziness, or syncope. The nurse should hold the dose and notify the provider. B. EKG shows atrial fibrillation with rapid ventricular response: Diltiazem is often prescribed to control ventricular rate in atrial fibrillation with RVR. In this context, the medication is appropriate, and the nurse would generally administer as ordered while monitoring vital signs and rhythm. C. Client reports feeling palpitations and dizziness: While these symptoms warrant assessment, they are nonspecific. The nurse would evaluate for hemodynamic instability, but a documented bradycardia takes precedence as a reason to withhold the dose. D. Blood pressure 198/102: Diltiazem can be used to lower elevated blood pressure in certain situations. Unless there is evidence of hypotension or other contraindications, elevated blood pressure alone is not a reason to hold the medication; in fact, the dose may help manage hypertension.