A patient with acute coronary syndrome is ordered Heparin sodium 1100 units/hour by continuous intravenous infusion. The pharmacy delivers the following solution: Heparin 25,000 units mixed in 500 ml of DSW. What is the rate (in ml/hr) that the nurse will set the infusion pump to deliver the ordered dose? Calculate and fill in the blank (Round the final answer to the nearest whole number).

A. Reinsert the tube into the chest tube insertion site: Reinserting a chest tube that has become dislodged is outside the scope of nursing practice and risks introducing infection and causing further trauma. Re-insertion must be performed by a qualified provider using sterile technique under appropriate conditions.

B. Insert the end of the chest tube in a container of sterile water: Placing the end of a dislodged chest tube into sterile water is appropriate only if the tube has disconnected from the drainage system but remains in the patient’s chest. In this scenario, the tube is lying on the floor, indicating it has been removed from the patient, so this action is not appropriate.

C. Auscultate the lung sounds in bilateral lung fields: Assessing lung sounds is important, but it is not the first priority. When a chest tube becomes dislodged from the patient, there is an immediate risk of air entering the pleural space and causing a tension pneumothorax. The insertion site must be addressed before further assessment.

D. Apply a sterile dressing to the chest tube insertion site: The priority is to immediately cover the insertion site with a sterile occlusive dressing (often taped on three sides) to prevent air from entering the pleural cavity and causing a life-threatening tension pneumothorax. This intervention directly addresses the most immediate physiological threat.

A. Administer amiodarone 150 mg IV: Amiodarone is used to treat ventricular arrhythmias such as ventricular tachycardia or fibrillation. Second-degree Mobitz type II block is a conduction failure at the level of the His-Purkinje system, leading to dropped QRS complexes and bradycardia, not a tachyarrhythmia requiring antiarrhythmic therapy.

B. Begin transcutaneous pacing: Mobitz type II block is a high-grade AV block with a significant risk of progressing to complete heart block. The patient is hypotensive and symptomatic (confused, lethargic), indicating poor perfusion. Immediate transcutaneous pacing is recommended to maintain adequate heart rate and cardiac output until a more permanent solution, such as transvenous pacing, is established.

C. Begin cardioversion: Cardioversion is indicated for unstable tachyarrhythmias with a pulse, such as atrial fibrillation with rapid ventricular response or ventricular tachycardia with a pulse. This patient has a bradyarrhythmia due to AV block, so cardioversion would not correct the underlying conduction defect.

D. Administer nitroglycerine 5 mcg/min IV: Nitroglycerin reduces preload and can lower blood pressure. Given the patient’s hypotension (84/52 mmHg), administering nitroglycerin would worsen perfusion and does not address the underlying conduction abnormality causing the syncopal episode.