The nurse is caring for a patient with a history of heart disease has developed hypokalemia. An ECG is ordered and the nurse notes an elongated Q-T interval that develops into torsades de pointes. Which of the following interventions are appropriate for the nurse to perform in this situation? Select all that apply.
a. Administer intravenous magnesium sulfate
b. Administer intravenous procainamide
c. Prepare to assist with cardiac defibrillation
d. Call the rapid response team
e. Prepare to assist with external cardiac pacing
a. Administer intravenous magnesium sulfate
c. Prepare to assist with cardiac defibrillation
d. Call the rapid response team
rationale: "Call the rapid response team", "Prepare to assist with cardiac defibrillation" and "Administer intravenous magnesium sulfate" are correct. Torsades de pointes is a potentially life-threatening condition that can develop after a noted prolonged Q-T interval. It is considered a medical emergency that requires quick action by the nurse. A rapid response should be initiated by the nursing staff because this alerts the provider and other staff members to the situation so the best team to handle this emergency are present. Magnesium sulfate is the first line medication given, 1-2 g over 30-60 seconds, repeated every 5-15 minutes. If the rhythm does not correct from the magnesium sulfate, the team will prepare to defibrillate the patient.
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a. Lordosis. b. Scoliosis. c. Ankylosis. d. Kyphosis.
The pediatric nurse listens to a 9-year-old child read to his 6-year-old roommate. What action by 9-year-old child leads the nurse to question possible dyslexia?
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A patient and his family are excited that he is transferring from the critical care unit to the intermediate care unit. However, they are also fearful of the change in environment and nursing staff
To reduce relocation stress, the nurse can: (Select all that apply.) a. ask the nurses on the intermediate care unit to give the family a tour of the new unit. b. contact the intensivist to see if the patient can stay one additional day in the critical care unit so that he and his family can adjust better to the idea of a transfer. c. ensure that the patient will be located near the nurse's station in the new unit. d. invite the nurse who will be assuming the patient's care to meet with the patient and family in the critical care unit prior to transfer.
A client in labor has begun mouth breathing. Which nursing intervention will be most helpful during this time?
a. Encouraging the woman to concentrate on a focal point b. Offering the woman sips of water or ice chips c. Providing the woman with a warmed bedpan d. Providing the woman with 2 liters of oxygen per mask