Please identify the following heart rhythm:

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 it's important to assess for potential causative factors of premature ventricular contractions (PVCs), such as caffeine intake, it's not the immediate priority in this scenario.

The nurse's primary focus should be on assessing the patient's hemodynamic stability and oxygenation status, as frequent PVCs can compromise cardiac function and lead to serious complications.

Assessment of causative factors can be done subsequently, once the patient's immediate physiological needs have been addressed.

Choice B rationale:

The patient's subjective experience of palpitations or fluttering is valuable information, but it doesn't provide objective data about their cardiovascular status.

The nurse needs to prioritize objective assessment of vital signs, such as blood pressure and oxygen saturation, to evaluate the patient's hemodynamic stability and oxygenation.

Subjective symptoms can be further explored after obtaining objective data.

Choice D rationale:

Precipitating factors, such as infection, can contribute to PVCs, but they are not the immediate priority in this case.

The nurse's focus should be on assessing the patient's current cardiovascular status and ensuring their stability.

Investigation of potential precipitating factors can be done later, as part of a comprehensive assessment and management plan.

Choice C rationale:

Blood pressure and oxygen saturation are the most crucial parameters to assess in a patient with frequent PVCs.

Here's why:

Blood pressure: PVCs can disrupt the normal rhythm of the heart, potentially leading to a decrease in cardiac output and hypotension.

Hypotension can compromise perfusion to vital organs, such as the brain and kidneys, and can be a sign of hemodynamic instability.

Therefore, it's essential to monitor the patient's blood pressure closely.

Oxygen saturation: PVCs can also impair the heart's ability to pump blood effectively, which can lead to decreased oxygen delivery to the tissues.

This can result in hypoxemia, which can further worsen cardiac function and cause other complications.

Monitoring oxygen saturation using pulse oximetry is crucial to ensure adequate oxygenation.