A client who is scheduled for a coronary arteriogram is admitted to the hospital on the day of the procedure. Which information is most important for the nurse to communicate to the provider before the procedure?

Client took metformin 500 mg by mouth this morning.

Sinus bradycardia with a rate of 56 on the monitor.

Client reports chest pain that occurred yesterday.

Blood glucose level 144mg/dL.

Answer and Explanation

The Correct Answer is A

A. Client took metformin 500 mg by mouth this morning: Metformin must be withheld before and for 48 hours after procedures involving iodinated contrast dye, such as a coronary arteriogram. Contrast can impair renal function, increasing the risk of lactic acidosis in clients taking metformin. The provider must be notified immediately.

B. Sinus bradycardia with a rate of 56 on the monitor: A heart rate of 56 bpm may be normal for some clients, especially those on beta-blockers. While it should be documented and monitored, it is not the priority concern prior to the procedure.

C. Client reports chest pain that occurred yesterday: Chest pain history is relevant but expected in clients undergoing coronary arteriography. Pain that occurred yesterday and is not current is less urgent than the metformin issue.

D. Blood glucose level 144 mg/dL: A glucose level of 144 mg/dL is mildly elevated but not critical in the context of this procedure. It does not pose the same immediate risk as contrast administration with recent metformin use.

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Correct Answer is ["A","D","E","F"]

Explanation

A. Skin petechiae: Small, pinpoint red or purple lesions on the skin, known as petechiae, are caused by embolic phenomena from vegetations on the heart valves. They are a classic peripheral manifestation of infective endocarditis and support the diagnosis.

B. Friction rub heart sounds: A friction rub is associated with pericarditis, not endocarditis. It occurs when the pericardial layers rub against each other and is not a typical finding in infective endocarditis.

C. Hypothermia: Infective endocarditis generally presents with fever due to systemic infection. Hypothermia is uncommon and would suggest another underlying condition rather than supporting endocarditis.

D. Fever: Fever is the most common systemic manifestation of infective endocarditis. It results from the body’s inflammatory response to bacterial infection of the endocardial surfaces. Persistent or intermittent fevers are characteristic of this condition.

E. New onset murmur: The development of a new heart murmur indicates valve damage or regurgitation caused by vegetations on the heart valves. This is a cardinal cardiovascular sign of infective endocarditis.

F. Splinter hemorrhages on fingernails: Linear, reddish-brown lesions under the fingernails are caused by small emboli from valvular vegetations. Splinter hemorrhages are a classic peripheral sign supporting the diagnosis of infective endocarditis.

A. To detect and treat ventricular tachycardia. B. To detect and treat bradycardia. C. To shock your heart if you have a heart attack at home. D. To monitor for normal sinus rhythm.

Correct Answer is A

Explanation

A. To detect and treat ventricular tachycardia: An AICD continuously monitors the heart’s rhythm and delivers an electrical shock or antitachycardia pacing when it detects life-threatening ventricular arrhythmias such as ventricular tachycardia or ventricular fibrillation. Its primary function is to prevent sudden cardiac death by restoring a normal rhythm during these events.

B. To detect and treat bradycardia: While some AICDs may have limited pacing capability, their main purpose is not to treat bradycardia. Bradycardia is more appropriately managed with a pacemaker rather than a defibrillating device.

C. To shock your heart if you have a heart attack at home: The AICD does not detect myocardial infarction itself. It responds to arrhythmias associated with sudden cardiac arrest, not the ischemic event of a heart attack, and cannot prevent or treat the infarction.

D. To monitor for normal sinus rhythm: Although the AICD continuously monitors the heart’s rhythm, its primary purpose is therapeutic intervention for dangerous arrhythmias, not passive rhythm monitoring. Monitoring is secondary to its life-saving function.

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A client who is scheduled for a coronary arteriogram is admitted to the hospital on the day of the procedure. Which information is most important for the nurse to communicate to the provider before the procedure?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Explanation

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Correct Answer is A

Explanation

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