A client is to receive LR 1000 ml over 8 hours. The IV tubing drop rate is 60 gtts/ml. What is the correct rate (gtts/min)? DOCUMENT ANSWER AS: RATE gtts/min (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

A. Complete the remainder of the assessment: While ongoing assessment is important, the rhythm strip shows atrial flutter, a potentially unstable arrhythmia, and the client is experiencing symptoms (nausea after breakfast) which could suggest compromised cardiac output. Completing the remainder assessment delays the necessary intervention.

B. Obtain an order for adenosine IV: Adenosine is typically used for stable supraventricular tachycardia (SVT), not for atrial flutter, as it may not terminate the rhythm. It may slow conduction enough to better visualize flutter waves, but initiating it without a provider's order or further evaluation is inappropriate.

C. Notify the physician of the symptoms: The client’s rhythm strip shows atrial flutter with a rapid ventricular response and the patient is experiencing nausea, which could indicate decreased perfusion or early decompensation. Immediately notifying the provider is the safest and most appropriate action for further evaluation and treatment planning.

D. Administer the prescribed ACE inhibitor: ACE inhibitors are used for blood pressure control or heart failure management, not for acute rhythm disturbances. Administering it would not address the current rhythm or symptoms and could worsen hypotension if cardiac output is compromised.

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.