A nurse is preparing a client for a scheduled Percutaneous Coronary Intervention (PCI). Which statement made by the client should the nurse report to the Primary Healthcare Provider (PHCP)?
“I am allergic to shellfish.”.
“I may feel a warm sensation during the procedure.”.
“I get anxious when I am in closed spaces.”.
“I took my metformin this morning.”.
The Correct Answer is A
Choice A rationale
A patient’s allergy to shellfish may indicate a potential allergy to iodine, which is often used as a contrast dye in a Percutaneous Coronary Intervention (PCI) procedure. This is because shellfish and iodine can both contain a substance called tropomyosin, which can trigger allergic reactions. If a patient with an iodine allergy is exposed to the contrast dye, they could experience an allergic reaction, which could range from mild (rashes, hives) to severe (anaphylaxis, a life-threatening reaction that requires immediate medical attention)1.
Therefore, it’s crucial for the nurse to report this information to the Primary Healthcare Provider (PHCP) to prevent any potential allergic reactions during the procedure.
Choice B rationale
It’s normal for patients to feel a warm sensation during the PCI procedure. This is due to the injection of the contrast dye into the body, which can create a feeling of warmth or flushing. This sensation is temporary and usually subsides shortly after the injection. Therefore, this statement by the patient does not need to be reported to the PHCP as it is a normal part of the procedure.
Choice C rationale
Feeling anxious in closed spaces, or claustrophobia, may not directly impact the PCI procedure. However, it’s important for the healthcare team to be aware of this so they can provide appropriate support and interventions to help manage the patient’s anxiety. This could include explaining the procedure thoroughly to the patient, using relaxation techniques, or providing a mild sedative if necessary and appropriate.
Choice D rationale
Metformin is a medication used to manage blood sugar levels in patients with type 2 diabetes. While it’s important for the healthcare team to be aware of all medications a patient is taking, taking metformin on the morning of the procedure does not typically need to be reported to the PHCP. However, in some cases, the PHCP may advise the patient to stop taking metformin temporarily before certain procedures to reduce the risk of lactic acidosis, a rare but serious complication. Therefore, while this statement by the patient is important, it may not need to be reported to the PHCP unless the patient was specifically instructed to stop taking the medication before the procedure.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Stable angina is characterized by chest pain that occurs with exertion and is relieved by rest. If a patient with angina pectoris is experiencing chest pain at rest and needs to take three nitroglycerin pills to relieve the pain, this is not typical of stable angina.
Choice B rationale
A full-blown acute myocardial infarction (MI), or heart attack, typically presents with severe chest pain, shortness of breath, and other symptoms. While chest pain at rest could be a symptom of an MI, other symptoms would likely be present.
Choice C rationale
Unstable angina is characterized by chest pain that occurs at rest, is severe and prolonged, and is not relieved by nitroglycerin. Therefore, a patient with angina pectoris who is experiencing chest pain at rest and needs to take three nitroglycerin pills to relieve the pain could be experiencing unstable angina.
Choice D rationale
Pulmonary embolus, a blockage in one of the pulmonary arteries in the lungs, typically presents with sudden-onset shortness of breath, chest pain that may become worse upon deep breathing or coughing, and other symptoms. Chest pain at rest could be a symptom of a pulmonary embolus, but other symptoms would likely be present.
Correct Answer is C
Explanation
Choice A rationale
This sequence is incorrect because it suggests that blood goes from the lungs to the pulmonary artery, which is not accurate. The pulmonary artery carries deoxygenated blood from the heart to the lungs.
Choice B rationale
This sequence is incorrect because it suggests that blood goes from the pulmonary vein to the lungs, which is not accurate. The pulmonary vein carries oxygenated blood from the lungs to the heart.
Choice C rationale
This sequence correctly describes the direction of blood flow through the heart and lungs. Deoxygenated blood enters the right atrium, goes to the right ventricle, then is sent to the lungs via the pulmonary artery. After picking up oxygen in the lungs, the blood returns to the heart via the pulmonary vein, entering the left atrium, then the left ventricle, from where it is pumped out to the rest of the body.
Choice D rationale
This sequence is incorrect because it suggests that blood goes from the pulmonary vein to the pulmonary artery, which is not accurate. The pulmonary vein carries oxygenated blood from the lungs to the heart, and the pulmonary artery carries deoxygenated blood from the heart to the lungs.
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