When auscultating the apical pulse of a client who has atrial fibrillation, the nurse would expect to hear a rhythm that is characterized by:
A. The presence of occasional coupled beats.
B. Long pauses in an otherwise regular rhythm.
C. A continuous and totally unpredictable irregularity.
D. Slow but strong and regular beats.
Correct Answer: C. A continuous and totally unpredictable irregularity.
In atrial fibrillation, multiple ectopic foci stimulate the atria to contract. The AV node is unable to transmit all of these impulses to the ventricles, resulting in a pattern of highly irregular ventricular contractions. Due to its rhythm irregularity, blood flow through the heart becomes turbulent and has a high chance of forming a thrombus (blood clot), which can ultimately dislodge and cause a stroke. Atrial fibrillation is the leading cardiac cause of stroke.
Option A: The most common sensation associated with PVCs is that of a skipped heartbeat followed by a fluttering sensation. Patients commonly present complaining of heart palpitations. The vast majority of patients are entirely asymptomatic as there are no associated symptoms with the palpitations.
Option B: In the presence of a pause, one should exclude premature complexes with compensatory pause. If the ectopic beat failed to reset the sinus node, the premature complex would be followed by a compensatory pause, i.e. the R-R interval after the premature complex is longer than the R-R interval between normal sinus beats.
Option D: Having bradycardia means that the heart beats very slowly. For most people, a heart rate of 60 to 100 beats a minute while at rest is considered normal. If the heart beats less than 60 times a minute, it is slower than normal. For some people, a slow heart rate does not cause any problems. It can be a sign of being very fit. Healthy young adults and athletes often have heart rates of less than 60 beats a minute.
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