The house supervisor has notified the charge nurse on the intensive care unit (ICU) that a bed is needed for an admission from the emergency department. All ICU beds are currently full. Which client should the charge nurse consider as most appropriate for transfer out of the ICU?

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11ecbb05_c963_20bd_b433_4f072b43f326_MD0009_00 Occasional premature ventricular contractions (PVCs) are common dysrhythmias that may be precipitated by several factors, including electrolyte imbalances (eg, potassium), stimulants (eg, caffeine, nicotine), and stress. Occasional PVCs typically do not cause hemodynamic instability. The client who is stable one day post extubation can be safely transferred to a telemetry or medical-surgical unit, where the occasional PVCs may be further investigated and treated (Option C). (Option A) Sinus tachycardia may not present an immediate risk of hemodynamic instability; however, the client who recently underwent arterial sheath removal may be tachycardic due to bleeding. This client requires further investigation and continuous monitoring, and is not appropriate for transfer. (Option B) The client with atrial fibrillation and rapid ventricular response has decreased cardiac output and may progress to hemodynamic instability. Treatment goals include reducing the ventricular rate to <100/min with medications (eg, diltiazem), preventing thrombotic events (eg, ischemic stroke) with anticoagulants (eg, warfarin), and possibly conversion to normal sinus rhythm with antiarrhythmics (eg, amiodarone). This client is not the best choice for transfer. (Option D) Complete heart block (ie, third-degree atrioventricular block) requires temporary pacing followed by permanent pacemaker insertion. This client, who is at risk for severe bradycardia and hemodynamic instability, should not be transferred. Educational objective: Occasional premature ventricular complexes are common dysrhythmias and usually do not cause hemodynamic instability. Clients with atrial fibrillation and rapid ventricular response, complete heart block, or other threats to cardiovascular stability require continuous observation in the intensive care unit.

The House Supervisor Has Notified the Charge Nurse on the Intensive