A patient receiving parenteral nutrition through a CVC begins to exhibit restlessness, rapid breathing, and distended neck veins. What is the best action for the nurse to take?
Monitor the client’s vital signs closely and observe for additional symptoms.
Stop the infusion and notify the healthcare provider.
Reduce the infusion rate and reassess after 10 minutes.
Administer oxygen and place the client in Trendelenburg's position.
The correct answer is to stop the infusion and notify the healthcare provider because the symptoms (restlessness, rapid breathing, and distended neck veins) could indicate a potential complication such as air embolism, fluid overload, or an embolic event. Stopping the infusion prevents further worsening of the condition, and notifying the healthcare provider ensures timely intervention. Administering oxygen and repositioning the client are important in managing suspected air embolism, but they should follow the action of stopping the infusion. Monitoring vital signs alone delays necessary immediate action, and reducing the infusion rate does not fully address the severity of the possible complication.
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