While assessing the apical pulse of a 13-year-old, the rate is 88 beats/minute, and the rhythm is irregular. The heart rate is phasic with respirations, increasing during inspiration and decreasing with expiration. What action should the nurse take?

• A. Continue the cardiac examination.
• B. Inquire about daily caffeine intake.
• C. Re-assess the apical pulse in 15 minutes.
• D. Schedule a consultation with a cardiologist.

Answer: (B)

Respiratory sinus arrhythmia is a common, benign finding in children and adolescents. It occurs because the autonomic nervous system modulates heart rate with the breathing cycle, causing the rate to rise during inspiration and fall during expiration. An apical pulse of 88 beats per minute with an irregular rhythm that tracks the breathing pattern fits this pattern, especially in a 13-year-old, and does not indicate pathology at this time.

The appropriate course is to continue the cardiac examination and document the finding as sinus arrhythmia, while continuing to monitor for any new or persistent symptoms or signs of cardiac disease. There’s no need to pursue caffeine history or schedule a cardiology consult based on this presentation alone, unless the rhythm becomes abnormal outside the respiratory cycle or other concerning symptoms appear.