An order to start a heparin drip is received from a physician. The order is for 1,000 units heparin per hour. The solution strength is 20,000 units in 500 ml. D5NS. What should the electronic pump be set for?

A. Administration of oxygen is contraindicated in clients who are using bronchodilators: Oxygen therapy is not contraindicated with bronchodilators. In fact, bronchodilators and oxygen are commonly used together to relieve airway obstruction and improve gas exchange in COPD.

B. High oxygen concentrations will cause coughing and dyspnea: While oxygen therapy can sometimes dry airways or cause minor irritation, coughing and dyspnea are not direct effects of high oxygen concentration. Dyspnea in COPD is due to impaired gas exchange and airflow limitation.

C. Increased oxygen use will cause the client to become dependent on the oxygen: Oxygen therapy does not create physical dependence. Clients with COPD may require long-term oxygen due to disease progression, but this is related to their chronic hypoxemia rather than dependency.

D. High oxygen concentration may inhibit the hypoxic stimulus to breathe: Clients with COPD often rely on hypoxemia as their primary drive to breathe, since chronic CO₂ retention blunts the normal hypercapnic drive. Administering high oxygen concentrations can suppress this hypoxic drive, leading to hypoventilation and CO₂ narcosis.

A. Place the client on seizure precautions: The presentation of eyes rolling back and jaw locking is consistent with an acute dystonic reaction, not seizure activity. Seizure precautions would not address the immediate pathophysiologic cause.

B. Notify the physician: Informing the provider is important, but it is not the priority. Acute dystonia is a medical emergency that requires rapid intervention to relieve painful and potentially dangerous muscle contractions before further communication with the provider.

C. Administer Benadryl/diphenhydramine IM immediately as prescribed: Diphenhydramine, an antihistamine with anticholinergic properties, rapidly relieves acute dystonia caused by antipsychotic medications. Prompt treatment prevents airway compromise and reduces client distress.

D. Advocate for a decrease in the antipsychotic medication: Medication adjustment may be needed long-term, but reducing the antipsychotic dosage does not resolve the immediate dystonic crisis. The client first requires urgent pharmacologic intervention.