Which of the following statements is FALSE regarding Coronary Artery Disease (CAD)?

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)

Rationale for Choice A:

Monitoring the insertion site for hematoma and bleeding is crucial following cardiac angiogram with stent placement. Here's a detailed explanation:

Vascular Injury: The procedure involves accessing a major artery, usually the femoral artery in the groin. This creates a risk of bleeding or hematoma formation at the puncture site.

Anticoagulation: Patients often receive anticoagulant medications during and after the procedure to prevent blood clots from forming around the stent. These medications can increase the risk of bleeding.

Early Detection and Intervention: Prompt identification of bleeding or hematoma formation is essential to prevent complications such as hypotension, shock, or compartment syndrome.

Assessment: Regular assessment of the insertion site includes:

Visual inspection for swelling, bruising, or active bleeding.

Palpation for tenderness, firmness, or expanding hematoma.

Monitoring vital signs for tachycardia, hypotension, or signs of shock.

Interventions: If bleeding or hematoma is detected:

Apply direct pressure to the site.

Notify the healthcare provider immediately.

Implement additional measures as prescribed, such as reversal of anticoagulation or surgical intervention.

Rationale for Choice B:

Maintaining strict bedrest after cardiac angiogram with stent placement is no longer routinely recommended. Here's why:

Early Ambulation Benefits: Research has shown that early ambulation (usually within 6-8 hours) is associated with several benefits, including:

Reduced risk of deep vein thrombosis (DVT)

Improved circulation

Quicker recovery

Shorter hospital stays

Individualized Assessment: The decision regarding ambulation timing should be individualized based on patient factors such as:

Bleeding risk

Procedural complications

Overall health status

Comfort level

Balanced Approach: While early ambulation is encouraged, it's important to balance activity with rest to promote healing and prevent complications.

Rationale for Choice C:

Monitoring for dysrhythmias is essential following cardiac angiogram with stent placement due to several reasons:

Cardiac Irritation: The procedure involves manipulation of catheters and devices within the heart, which can potentially irritate the heart's electrical system.

Electrolyte Imbalances: Contrast dye used during the procedure can cause electrolyte imbalances, which can also trigger dysrhythmias.

Underlying Heart Disease: Patients undergoing angioplasty often have underlying heart disease, which already predisposes them to rhythm disturbances.

Early Detection and Intervention: Prompt identification of dysrhythmias allows for timely interventions to prevent hemodynamic instability, heart failure, or cardiac arrest.

Continuous Monitoring: Continuous ECG monitoring is typically used to detect dysrhythmias, and patients are closely observed for symptoms such as palpitations, lightheadedness, or chest pain.

Rationale for Choice D:

Assessing heart sounds is a crucial nursing intervention following cardiac angiogram with stent placement. Here's why:

Stent Placement Effects: The placement of a stent can alter blood flow patterns within the coronary arteries, which may be audible as changes in heart sounds.

Complication Detection: Heart sounds can provide valuable clues about potential complications such as:

Pericardial effusion (fluid around the heart)

Myocardial infarction (heart attack)

Valvular dysfunction

Baseline Assessment: It's important to establish a baseline assessment of heart sounds prior to the procedure to compare with post-procedure findings.

Regular Auscultation: Regular auscultation of heart sounds should be performed to monitor for changes and promptly report any concerns to the healthcare provider.