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The nurse is caring for a 56-year-old male who presents with dizziness with standing and other positional changes. He also states that he has gained 4 pounds in the last 2 weeks, with increased edema in his bilateral lower extremities. The client’s past medical history is significant for non-ischemic cardiomyopathy and systolic heart failure with implantable cardioverter-defibrillator, anxiety, depression, and benign prostatic hyperplasia. The nurse assesses and monitors the client over the course of an hour, documents the nurses’ notes, and reviews the client’s medication record.

 

Nurses’ Notes

0800: Client reports dizziness with standing and other positional changes, 4-pound weight gain, and increased bilateral lower extremity edema. 

0900: Reassessed client, who is now in acute distress. The client appears short of breath with worsening bilateral lower extremity edema and jugular vein distention. Endorses dizziness and lightheadedness at rest. Vital signs are reassessed. 

0915: EKG shows regular faster heart rate at 179 beats per minute, identical QRS complexes with 200 millisecond duration, and no visible P waves. 

 

Medication Administration Record

Metoprolol tartrate 25 mg by mouth daily

Escitalopram 20 mg by mouth daily

Ferrous sulfate 325 mg by mouth daily

Atorvastatin 40 mg by mouth daily

Aspirin 81 mg by mouth daily

Sotalol 80 mg by mouth twice daily

 

Vital Signs 0800 0900
Temperature (F/C) 98.6° F (37.0° C) 98.6° F (37.0° C)
Heart rate (beats/minute) 66 179
Respirations (breaths/minute) 20 28
Blood pressure (mmHg) 101/69 mmHg 89/44
Oxygen saturation (SpO2) 98% (Room Air) 95% (Room Air)
Pain 0/10 0/10

 

 

 

Which health care provider orders would the nurse anticipate? Select all that apply.

 

Continue sotalol treatment.
Start amiodarone intravenous therapy for the first 24 hours.
Prepare for electrical cardioversion if client remains hemodynamically unstable.
Type and cross for 2 units packed red blood cells (RBCs).
Start intravenous Ringer’s lactate at 125 mL/hour.

 

 

SCIENCE
HEALTH SCIENCE
NURSING
PHARM NR 223