A nurse in the emergency department is caring for a client who was injured in a motor-vehicle crash. The client reports dyspnea and severe pain. The nurse notes that the client's chest moves inward during inspiration and bulges out during expiration. The nurse should identify this finding as which of the following?

Choice A Reason: This choice is incorrect because laboratory testing of serum potassium upon admission is an appropriate prescription for a client who has acute heart failure following MI. Serum potassium is an electrolyte that affects the cardiac function and rhythm. A normal serum potassium range is 3.5 to 5 mEq/L, and an abnormal level can indicate hypokalemia or hyperkalemia, which can cause arrhythmias, muscle weakness, or paralysis. Therefore, monitoring serum potassium is important to detect and correct any electrolyte imbalance and prevent complications.

Choice B Reason: This choice is incorrect because bumetanide 1 mg IV bolus every 12 hr is an appropriate prescription for a client who has acute heart failure following MI. Bumetanide is a loop diuretic that helps to reduce fluid retention and edema by increasing the urine output and sodium excretion. It may be used for clients who have heart failure, hypertension, or renal impairment, but it can cause hypokalemia, hypotension, or dehydration.

Therefore, administering bumetanide as prescribed can help to improve the cardiac output and reduce the preload and afterload.

Choice C Reason: This choice is correct because 0.9% normal saline IV at 50 mL/hr continuous is an inappropriate prescription for a client who has acute heart failure following MI. 0.9% normal saline is an isotonic solution that contains the same concentration of solutes as blood plasma. It may be used for clients who have fluid loss, dehydration, or shock, but it can worsen fluid overload and pulmonary edema in clients who have acute heart failure. Therefore, clarifying this prescription with the provider is necessary to prevent further deterioration of the client's condition.

Choice D Reason: This choice is incorrect because morphine sulfate 2 mg IV bolus every 2 hr PRN pain is an appropriate prescription for a client who has acute heart failure following MI. Morphine sulfate is an opioid analgesic that helps to relieve pain and anxiety by binding to the opioid receptors in the brain and spinal cord. It may be used for clients who have moderate to severe pain, dyspnea, or chest discomfort, but it can cause respiratory depression, hypotension, or nausea. Therefore, administering morphine sulfate as prescribed can help to reduce the oxygen demand and improve the cardiac function.

Choice A Reason: This choice is incorrect because furosemide is a diuretic that helps to reduce fluid retention and edema. It may be used for clients who have heart failure or hypertension, but it does not treat pulmonary embolism.

Choice B Reason: This choice is correct because heparin is an anticoagulant that helps to prevent blood clots from forming or growing larger. It may be used for clients who have pulmonary embolism, which is a blockage of a pulmonary artery by a blood clot that usually originates from a deep vein thrombosis (DVT). Heparin can reduce the risk of complications such as pulmonary infarction or death.

Choice C Reason: This choice is incorrect because dexamethasone is a corticosteroid that helps to reduce inflammation and immune response. It may be used for clients who have allergic reactions, asthma, or autoimmune diseases, but it does not treat pulmonary embolism.

Choice D Reason: This choice is incorrect because epinephrine is a sympathomimetic that helps to stimulate the heart and blood vessels. It may be used for clients who have cardiac arrest, anaphylaxis, or severe asthma, but it does not treat pulmonary embolism.

Choice E Reason: This choice is incorrect because atropine is an anticholinergic that helps to block the effects of acetylcholine on the heart and smooth muscles. It may be used for clients who have bradycardia, atrioventricular block, or organophosphate poisoning, but it does not treat pulmonary embolism.