The nurse notes premature ventricular contractions (PVCs) while suctioning a patient's endotracheal tube. Which action by the nurse is a priority?
a. Decrease the suction pressure to 80 mm Hg.
b. Document the dysrhythmia in the patient's chart.
c. Stop and ventilate the patient with 100% oxygen.
d. Give antidysrhythmic medications per protocol.
ANS: C
Dysrhythmias during suctioning may indicate hypoxemia or sympathetic nervous system stimulation. The nurse should stop suctioning and ventilate the patient with 100% oxygen. Lowering the suction pressure will decrease the effectiveness of suctioning without improving the hypoxemia. Because the PVCs occurred during suctioning, there is no need for antidysrhythmic medications (which may have adverse effects) unless they recur when the suctioning is stopped and patient is well oxygenated.
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