The nurse is conducting patient teaching about cholesterol levels.

When discussing the patient’s elevated LDL and lowered HDL levels, which statement by the patient indicates an understanding of the significance of these levels?

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:

While educating the patient about the pathophysiology of acute coronary artery disease (ACAD) is important, it is not the priority intervention during an acute episode.

The patient is likely experiencing significant discomfort and anxiety, and their ability to process information may be impaired.

Providing immediate relief of symptoms and stabilizing the patient's condition take precedence over education at this time.

Choice B rationale:

Supplemental oxygen may be beneficial for patients with ACAD, but it is not the highest priority intervention.

Oxygen therapy can improve oxygen saturation levels in the blood, but it does not directly address the underlying issue of coronary artery occlusion.

It is important to administer nitroglycerin first to dilate the coronary arteries and improve blood flow to the heart muscle.

Choice C rationale:

Sublingual nitroglycerin is a vasodilator that relaxes and widens blood vessels, improving blood flow to the heart muscle.

It is a first-line medication for the treatment of acute angina (chest pain) and is often used in the setting of ACAD.

Nitroglycerin can rapidly relieve chest pain and other symptoms of ischemia, such as shortness of breath, and can help prevent further damage to the heart muscle.

Choice D rationale:

Staying with the patient to decrease anxiety is important, but it is not the priority intervention.

While providing emotional support can help to calm the patient and reduce stress, it does not directly address the underlying issue of myocardial ischemia.

It is crucial to administer nitroglycerin to dilate the coronary arteries and improve blood flow to the heart muscle.