A client has a triple lumen subclavian central venous catheter (CVC) with D51/2NS infusing through one lumen (port) at 75 mL per hour. The nurse has an order to transfuse one unit of packed red blood cells (PRBCs). The nurse's safest action is to:

contact the prescriber to decrease the rate of the D51/2 NS during the blood transfusion

stop the D51/2NS, check the client's vitals & notify the prescriber.

Fluids cannot be given through a CVC.

Insert a 22 gauge peripheral IV to administer the transfusion

transfuse the unit of packed red blood cells through a separate lumen of the CVC

Answer and Explanation

The Correct Answer is E

A. contact the prescriber to decrease the rate of the D51/2NS during the blood transfusion: There's no need to alter the rate of maintenance fluids unless there's a fluid volume concern. Additionally, decreasing the rate would not address the need for a dedicated blood transfusion line if another lumen is available.

B. stop the D51/2NS, check the client's vitals & notify the prescriber: Stopping necessary fluids without cause may compromise fluid balance. Unless there's a compatibility issue or no other lumen, stopping the infusion is not the safest or most efficient action.

C. Fluids cannot be given through a CVC: Central venous catheters are routinely used for administering fluids, medications, and blood products, especially in critical care settings.

D. Insert a 22 gauge peripheral IV to administer the transfusion: While blood can be given through a peripheral IV, using an existing central venous catheter is safer and more efficient, especially when multiple lumens are available. Inserting a new IV unnecessarily increases infection and complication risks.

E. transfuse the unit of packed red blood cells through a separate lumen of the CVC: This is the safest and most appropriate action. Triple-lumen CVCs allow for simultaneous infusions through separate channels without mixing. Blood should be transfused through a dedicated lumen to avoid incompatibility or dilution by other fluids.

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Correct Answer is B

Explanation

A. Administer amiodarone IV push followed by a continuous infusion: Amiodarone is part of the Advanced Cardiac Life Support (ACLS) algorithm for ventricular fibrillation (VF) or pulseless ventricular tachycardia, but it should only be given after confirming the rhythm and initiating basic life support steps, including pulse check.

B. Establish unresponsiveness and check the carotid pulse: The rhythm strip shows ventricular fibrillation, a life-threatening arrhythmia. However, before initiating advanced interventions such as defibrillation, the nurse must first confirm the client is unresponsive and pulseless, which is the correct initial action according to ACLS protocols.

C. Immediately defibrillate the client using the synchronous mode: Defibrillation is the correct treatment for VF, but it must be done in unsynchronized mode. Additionally, it is not appropriate to defibrillate until pulselessness is confirmed. Synchronized mode is used for rhythms like unstable SVT or atrial fibrillation not VF.

D. Initiate a rapid response call and increase the monitor’s sensitivity: A rapid response team is called for deteriorating patients who are still responsive. If the client is unresponsive and pulseless, a code blue or cardiac arrest protocol should be initiated, not just a rapid response. Monitor sensitivity adjustments are irrelevant in a confirmed life-threatening rhythm.

A. Apply transcutaneous pacemaker pads. B. Place the client in Trendelenberg position. C. Call the doctor for an order to decrease the infusion rate. D. Administer a dose of atropine.

Correct Answer is C

Explanation

A. Apply transcutaneous pacemaker pads: While this is a potential intervention for symptomatic or severe bradycardia unresponsive to medications, it is premature as a first step in this scenario. The client is stable with a heart rate of 50 bpm and no mention of hemodynamic compromise.

B. Place the client in Trendelenburg position: This position is used to improve venous return in hypotensive patients, but there is no evidence of hypotension or poor perfusion. It is not an appropriate response to mild bradycardia in this context.

C. Call the doctor for an order to decrease the infusion rate: Diltiazem is a calcium channel blocker that slows AV node conduction, potentially causing bradycardia. Since the heart rate has dropped to 50 bpm, the most appropriate first action is to contact the provider to adjust the infusion rate, which may be too high for the client’s current rhythm.

D. Administer a dose of atropine: Atropine is used for symptomatic bradycardia. If the client is asymptomatic and the bradycardia is mild and medication-induced, adjusting or discontinuing the offending agent should be attempted before administering atropine.

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A client has a triple lumen subclavian central venous catheter (CVC) with D51/2NS infusing through one lumen (port) at 75 mL per hour. The nurse has an order to transfuse one unit of packed red blood cells (PRBCs). The nurse's safest action is to:

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The nurse observes the following rhythm of a client on the telemetry unit. Which action should be completed first?

Correct Answer is B

Explanation

A client in the coronary care unit is receiving a diltiazem infusion for atrial fibrillation. The nurse observes on the cardiac monitor that the client's heart rate has converted to sinus bradycardia at a rate of 50 beats/minute. Which nursing action should be performed first?

Correct Answer is C

Explanation

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