A nurse is monitoring a patient who is receiving an IVinfusion of normal saline. The patient is apprehensive andpresents with a pounding headache, rapid pulse rate, chills,and dyspnea. What would be the nurse’s priority interventionrelated to these symptoms?a. Discontinue the infusion immediately, monitor vitalsigns, and report findings to primary care providerimmediately.b. Slow the rate of infusion, notify the primary care providerimmediately and monitor vital signs.c. Pinch off the catheter or secure the system to prevent entryof air, place the patient in the Trendelenburg position, andcall for assistance.d. Discontinue the infusion immediately, apply warm, moistcompresses to the site, and restart the IV at another site.
A nurse is monitoring a patient who is receiving an IV
infusion of normal saline. The patient is apprehensive and
presents with a pounding headache, rapid pulse rate, chills,
and dyspnea. What would be the nurse’s priority intervention
related to these symptoms?
a. Discontinue the infusion immediately, monitor vital
signs, and report findings to primary care provider
immediately.
b. Slow the rate of infusion, notify the primary care provider
immediately and monitor vital signs.
c. Pinch off the catheter or secure the system to prevent entry
of air, place the patient in the Trendelenburg position, and
call for assistance.
d. Discontinue the infusion immediately, apply warm, moist
compresses to the site, and restart the IV at another site.
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