The nurse is preparing to insert a peripherally inserted central catheter (PICC) into the right upper extremity. The goal of the procedure is for the tip to terminate in which location?

The 3.2 kg patient with persistent pulmonary hypertension of the newborn (PPHN) has the following order: Infuse norepinephrine 0.05 mcg/kg/min IV and titrate q15 minutes by 0.05 mcg/kg/min to maintain mean arterial pressure between 45 and 55 mm Hg. Overnight, the norepinephrine had been titrated to 0.25 mcg/kg/min for persistent hypotension. At 0900, the MAP rose to 62 mm Hg and the nurse decreased the infusion from 0.25 mcg/kg/min to 0.20 mcg/kg/min. At 0905, the patient’s blood pressure fell to 42 mm Hg. Which action does the nurse take first?

The patient is being treated with intravenous quinidine for malaria that was contracted while in Africa. Several hours after administration of the medication, the patient develops palpitations and dizziness. Electrocardiogram shows tachycardia and twisting of the QRS complexes around an isoelectric line. Which best describes the most likely etiology of this patient’s arrhythmia?