A nurse is reviewing a client's cardiac monitor. Which of the following findings should the nurse identify as an indication for synchronized cardioversion?

A. Stop the infusion: Acute hemolytic reactions can occur within minutes of starting a transfusion and are life-threatening. Symptoms such as chills, lower back pain, and nausea indicate a potential reaction, requiring immediate discontinuation of the transfusion to prevent further hemolysis and organ damage.

B. Collect a urine sample: A urine sample helps detect hemoglobinuria, a sign of red blood cell destruction, but it is not the priority. The infusion must be stopped first to prevent further complications before obtaining a urine sample for analysis.

C. Check the client's vital signs: Monitoring vital signs is essential, but the priority is stopping the transfusion to halt the reaction. Vital signs should be checked after discontinuing the infusion to assess the severity of the reaction and guide further interventions.

D. Administer oxygen to the client: Oxygen may be needed if respiratory distress occurs, but stopping the transfusion is the first step to prevent continued exposure to the incompatible blood product. Oxygen therapy should be implemented based on the client's condition after discontinuing the infusion.

• Pain level: The client's reported pain level decreased from 7 to 5 after receiving nitroglycerin and oxygen therapy. A reduction in pain indicates that the treatment is effective and the client's condition is improving.
• Heart rate: The heart rate decreased from 120/min to 100/min between assessments, suggesting improved cardiac function and stability. A lower heart rate can indicate a better response to treatment and improved hemodynamic status.
• Blood pressure: The blood pressure improved from 176/82 mm Hg to 110/62 mm Hg, indicating a more stable hemodynamic status. However, it is important to ensure that the blood pressure does not drop too low; overall, the trend suggests an improvement in circulation.
• Oxygenation saturation: The oxygen saturation improved from 89% on room air to 93% after oxygen therapy was initiated. An increase in oxygen saturation indicates improved respiratory function and effective oxygenation, which is critical for recovery in clients with cardiac issues.

• Urinary output: There is no documented information regarding the client's urinary output in the provided data, making it difficult to assess improvement in this area. Monitoring urinary output is essential for evaluating kidney function and fluid balance, but it cannot be determined from the available information.
• Echocardiogram results: The echocardiogram results indicated a myocardial infarction, which does not show improvement but rather confirms the severity of the client's condition. While treatment may address the effects of the infarction, the diagnosis itself indicates ongoing concern.
• Respiratory rate: The respiratory rate remained at 22/min, which is still elevated. While it is unchanged, an improvement would typically be reflected by a decrease in the respiratory rate, indicating better respiratory status. The persistent elevated rate suggests that further monitoring and interventions may still be needed.