A nurse is caring for a client scheduled to undergo an esophagogastroduodenoscopy. What action should the nurse take in preparation for the procedure?

Choice A rationale

Starting chest compressions is not the first action to take when a client’s cardiac monitor shows ventricular tachycardia. While chest compressions are a part of cardiopulmonary resuscitation (CPR), they are not the initial response to ventricular tachycardia.

Choice B rationale

Immediate defibrillation is the priority action when a client’s cardiac monitor shows ventricular tachycardia. Ventricular tachycardia is a life-threatening condition where the heart

beats too fast to effectively pump blood to the body. Defibrillation delivers an electrical shock to the heart, which aims to restore a normal heart rhythm.

Choice C rationale

Providing pulmonary ventilation is not the first action to take when a client’s cardiac monitor shows ventricular tachycardia. While ventilation is important, it is not the immediate priority in this situation.

Choice D rationale

Checking for a palpable pulse is not the first action to take when a client’s cardiac monitor shows ventricular tachycardia. While it is important to assess the client’s pulse, the priority is to restore a normal heart rhythm through defibrillation.

Choice A rationale

Fever is not typically a sign of fluid overload. It’s more commonly associated with a transfusion reaction, which could indicate an immune response to the transfused blood.

Choice B rationale

Dyspnea, or difficulty breathing, can be a sign of fluid overload. When the body has too much fluid, it can put pressure on the lungs, making it harder to breathe.

Choice C rationale

Pruritus, or itching, is not typically a sign of fluid overload. It may be a sign of an allergic reaction to the transfusion.

Choice D rationale

Bradycardia, or a slow heart rate, is not typically a sign of fluid overload. In fact, tachycardia, or a fast heart rate, is more common as the heart works harder to pump the excess fluid.