A nurse is caring for a client who is taking clozapine. Which of the following findings should the nurse report to the provider?

Rationale:

A. Cardioversion therapy: There is no evidence of arrhythmias requiring cardioversion, such as atrial fibrillation or ventricular tachycardia. The client’s rhythm disturbances are not documented, and this is not relevant to their current clinical condition.

B. Relaxation techniques: The client has a long-standing history of generalized anxiety disorder and is exhibiting current anxiety with fear of dying. Incorporating relaxation strategies can reduce cardiac workload, support mental health, and prevent future anxiety-related complications.

C. Potential pacemaker placement: There is no indication of conduction delays, bradyarrhythmias, or heart block that would warrant pacemaker therapy. The client's vital signs and cardiac history do not support this as a current or anticipated need.

D. Blood pressure management: Although BP is currently stable, the client is post-MI with a history of hyperlipidemia and smoking. Ongoing BP control reduces strain on the heart and is vital to secondary prevention of cardiac events and stroke recurrence.

E. Meal planning ideas: The client is dissatisfied with the hospital diet and has no structured dietary practices at home. Providing cardiac-healthy meal planning strategies can improve lipid profile, manage weight, and prevent diet-related risk factor escalation.

F. Nitroglycerin self-administration: The client recently used nitroglycerin effectively for chest pain relief. Education on proper use, frequency, and when to seek emergency care is essential to empower the client in self-management and prevent complications.

G. Physical activity recommendations: The client currently avoids exercise due to fatigue but requires guided activity to support cardiac recovery. Tailored recommendations from rehab experts can improve endurance, reduce fatigue, and promote cardiovascular fitness safely.

H. Smoking cessation program: Although smoking less frequently, the client is still actively smoking. Smoking is a significant modifiable risk factor for recurrent MI and COPD exacerbation. A structured cessation program supports long-term abstinence and respiratory health.

Rationale:

A. Select a site on the client’s dominant arm: While either arm can be used, the nondominant arm is typically preferred to reduce interference with daily activities. Using the dominant arm may be more uncomfortable for the client post-insertion.

B. Elevate the client’s arm prior to insertion: Elevating the arm can reduce venous filling, making veins less visible and harder to access. Instead, the arm should be in a dependent position to encourage venous distension.

C. Apply a tourniquet below the venipuncture site: The tourniquet must be applied 10 to 15 cm (4 to 6 inches) above the intended insertion site to promote vein engorgement and visibility, not below it.

D. Choose a vein that is palpable and straight: A vein that is straight and palpable is ideal for IV insertion because it offers a predictable path and is less likely to be damaged during catheter advancement, reducing complications.