Your client: Chester Payne Age: 78 years old Past medical history. History of persistent atrial fibrillation, hypertension, hyperlipidemia and osteoarthrosis. Yesterday: Client was admitted for a diagnosis of atrial fibrillation with rapid ventricular response (RVR). Later in the day, the client's heart rhythm was converted to normal sinus rhythm using intravenous medication therapy. 0900 today: Client is sitting up in the bedside recliner. Client reports "racing heartbeat" and feeling "like I can't get a good deep breath" Upon auscultation the nurse hears an irregular heart rhythm. Assessment is as follows: Neurological: Alert and oriented x 4 Eyes, Ear, Nose, and Throat (EENT): Normocephalic, denies sore throat, denies nasal congestion, denies vision changes. No swelling or drainage visualized. Pulmonary: Reports some shortness of breath (SOB), no cough. Lungs sound clear in all fields. Cardiovascular: Irregular heart rhythm auscultated. Denies chest pain. Skin is warm and dry to the touch. Capillary refill > 3 seconds. 2+ bilateral lower extremity edema. Peripheral pulse 1+ equal bilaterally. Jugular vein distention (JVD) is noted Gastrointestinal: Abdomen rounded and firm. Reports slight nausea, bowel sounds hypoactive x 4 quadrants. Reports bowel movement prior to admission. Genitourinary: Voiding clear yellow urine without issues as per client self-report. Musculoskeletal: Full range of motion against resistance. What is the next action the nurse should take?

A. Obtain manual blood pressure: Assessing the hemodynamic status is the priority when a client reports a racing heartbeat and shortness of breath. An irregular rhythm following conversion of atrial fibrillation requires immediate validation of perfusion and blood pressure stability. Manual measurement provides the most accurate clinical data for determining the severity of the cardiovascular change. B. Measure airflow via incentive spirometry: Incentive spirometry is used to prevent atelectasis and is not a diagnostic tool for acute shortness of breath or cardiac arrhythmias. It does not provide information regarding the underlying cause of the "racing heartbeat" or the irregular rhythm. Priority must be placed on cardiovascular assessment rather than routine respiratory exercises. C. Insert indwelling urinary catheter: There is no immediate clinical indication for an invasive urinary catheter based on the client's current symptoms of palpitations and dyspnea. While monitoring output is important in heart failure, it is secondary to stabilizing the client's heart rate and rhythm. Catheterization poses an unnecessary infection risk in this acute assessment phase. D. Assist the patient to get dressed to work with physical therapy: Engaging in physical exertion while experiencing tachycardia and shortness of breath is dangerous and contraindicated. The client's reports of a "racing heartbeat" and irregular rhythm indicate a potential relapse into atrial fibrillation with rapid response. Physical activity should be deferred until the client is hemodynamically stable.