An ECG has been ordered for a newly admitted patient.
What should the nurse do prior to electrode placement?

Choice A rationale:

Metoprolol (Lopressor) is a beta-blocker that primarily affects the heart and blood vessels. It does not have a direct effect on the visual system, and therefore, it is not associated with the green-yellow halo symptom.

Common side effects of metoprolol include:

Fatigue

Bradycardia (slow heart rate)

Hypotension (low blood pressure)

Dizziness

Cold extremities

Bronchospasm (narrowing of the airways)

Diarrhea

Tinnitus (ringing in the ears)

Decreased exercise tolerance

Glucose intolerance

Masking of hypoglycemia symptoms Choice B rationale:

Enalapril (Vasotec) is an angiotensin-converting enzyme (ACE) inhibitor that primarily affects the kidneys and blood vessels. It does not have a direct effect on the visual system, and therefore, it is not associated with the green-yellow halo symptom.

The most common side effect of enalapril is a dry cough. This cough is thought to be caused by an increase in bradykinin levels, which can lead to the constriction of bronchial smooth muscle.

Choice D rationale:

Furosemide (Lasix) is a loop diuretic that primarily affects the kidneys and fluid balance. It does not have a direct effect on the visual system, and therefore, it is not associated with the green-yellow halo symptom.

Toxicity with furosemide manifests as extensions of its diuretic activity. Signs and symptoms of overdose or toxicity include:

Dehydration

Reduced blood volume

Electrolyte imbalances, particularly hypokalemia (low potassium levels) Choice C rationale:

Digoxin (Lanoxin) is a cardiac glycoside that affects the heart's electrical activity and muscle contractions. It has a narrow therapeutic index, meaning that there is a small difference between the therapeutic dose and the toxic dose.

One of the most characteristic signs of digoxin toxicity is a visual disturbance known as the "green-yellow halo sign." This symptom is thought to be caused by the inhibition of an enzyme in the retina called Na+/K+-ATPase.

Other common signs and symptoms of digoxin toxicity include:

Nausea and vomiting

Anorexia (loss of appetite)

Fatigue

Headache

Confusion

Arrhythmias (irregular heartbeats)

Choice A rationale:

Sinus bradycardia with a heart rate of 48 is a potentially life-threatening condition that requires immediate assessment and intervention. The heart rate is significantly below the normal range of 60-100 beats per minute, which means that the heart is not pumping enough blood to meet the body's needs. This can lead to symptoms such as dizziness, lightheadedness, fatigue, shortness of breath, chest pain, and even syncope (fainting). In severe cases, it can progress to cardiac arrest and death.

The patient is awaiting pacemaker placement, indicating that the bradycardia is severe and not responding to other treatment measures. This further underscores the urgency of assessment and intervention.

The nurse needs to assess the patient immediately for signs of hemodynamic instability, such as hypotension, altered mental status, and decreased urine output. The nurse should also obtain a 12-lead ECG to confirm the diagnosis of sinus bradycardia and to rule out other potential causes of the bradycardia, such as AV block or medication effects.

Prompt intervention is crucial to prevent further deterioration of the patient's condition and to avoid potentially lifethreatening complications.

Choice B rationale:

Atrial fibrillation is a common heart rhythm disorder that is characterized by rapid and irregular beating of the heart's upper chambers (atria). It can cause symptoms such as palpitations, shortness of breath, fatigue, and lightheadedness.

Diltiazem is a calcium channel blocker that is often used to control the heart rate in patients with atrial fibrillation. While it is important to monitor patients who are newly started on diltiazem for potential side effects, such as hypotension and bradycardia, it is not as urgent as assessing a patient with severe sinus bradycardia.

Choice C rationale:

Thrombophlebitis is an inflammation of a vein that is often caused by a blood clot. It can cause pain, redness, swelling, and warmth in the affected area.

IV heparin is an anticoagulant medication that is used to prevent blood clots from forming or getting larger. While it is important to monitor patients who are receiving IV heparin for potential side effects, such as bleeding, it is not as urgent as assessing a patient with severe sinus bradycardia.

Choice D rationale:

End-stage, right-sided heart failure is a serious condition that is characterized by the inability of the heart to pump blood effectively from the right ventricle to the lungs. It can cause symptoms such as shortness of breath, fatigue, edema, and abdominal swelling.

Hospice care is a type of care that focuses on providing comfort and quality of life for patients who are nearing the end of life. While it is important to provide supportive care for patients who are on hospice care, it is not as urgent as assessing a patient with severe sinus bradycardia.