am i correct on this coronary angiogram question?

[jchan0425]

if you were caring for mr meyer immediately post coronary angiogram, you would:

1. assess pt vitals signs, neurovascular obs on both legs, palpate femoral artery assessing for haematoma development, continuous cardiac monitoring, administer pain relief, position the patient in semi- recumberent position to facilitate breathing as he has had a general anaesthetic[jc1] .

2. assess pt vitals signs, neurovascular obs on both legs, position the patient supine, assess for bleeding from the femoral artery and ensure adequate fluid intake to facilitate excretion of dye.

3. assess pt vitals signs, neurovascular obs on leg of the femoral artery[jc2] used to insert pulmonary arterial catheter[jc3] , position the patient in supine position and assess for bleeding from the femoral artery.

4. assess pt vitals signs, neurovascular obs on both legs, position the patient supine, assess for bleeding from the femoral vein[jc4] , ensure adequate fluid intake to facilitate excretion of dye, continuous cardiac monitoring and administer pain relief prn.

[jc1]usually not require

[jc2]pulmonary arterial catheter insert into the femoral vein

[jc3]its purpose is diagnostic; it is used to detect heart failure or sepsis, monitor therapy, and evaluate the effects of drugs.

[jc4]femoral artery

this is a very tricky i am choosing number 2 as my answer am i correct?

[jchan0425]

BUT, #4 says to assess vein, when it was an artery that was punctured....!!

yea, makes it more confusing

[jchan0425]

:down:

This is how question is being asked on NCLEX Exam, every option seems right but the option #2 said assessment and fluid intake to help in excretion of the dye. But option #4 said assess the femoral vein for bleeding, offer fluid to excrete the dye,place pt on cardiac monitor to detect irregular dysrrthymia and offer the pt pain mediation to relief post- op pain.

#4 is complete intervention while option #2 is an incomplete intervention.:up:

#1 DISTRACTOR:down:

#2 INCOMPLETE:nono:

#3 DISTRACTOR:down:

#4 COMPLETE:up:

Number 2 is incomplete but you can't say it is wrong, Number 4 is complete but you can't say it is correct...

sigh, the lecturers set up the questions without processing in the brain:madface:

[Do-over, ASN, RN]

Did the question specifcally state it was for coronary arteries? I know that is what the OP stated, if so, then I think it would be 2. Otherwise, I think 4.

[KAYBDT6, BSN, RN]

BUT, #4 says to assess vein, when it was an artery that was punctured....!!

I think you're reading too much into the question. From my own understanding either of the vein or artery can be used. The surgeon might use either an artery or a vein from a pt. The answer still remain #4:up:

[vmoh18]

#4 is the correct choice. The surgeon can use a vein or artery to do the procedure.

[Do-over, ASN, RN]

Well, if the angiogram is for the coronary arteries the catheter has to go into the artery to reach the left heart... Correct?

[Virgo_RN, BSN, RN]

#1 is incorrect. The patient should be positioned supine, and the patient will not undergo general anesthesia for this procedure.

#2 is correct but incomplete. There is no mention of continuous cardiac monitoring or pain relief.

#3 is incorrect because a pulmonary arterial catheter is not introduced in this procedure.

#4 is incorrect because even though a venous sheath is sometimes used in this procedure, it would be in addition to an arterial sheath, not in lieu of it. You would still have an arteriotomy to monitor, and an arteriotomy has a higher risk for bleeding due to the higher pressure within the vessel compared to a venous puncture.

#2 isn't complete, but it is the best answer of those you have been given to choose from.

[Virgo_RN, BSN, RN]

Well, if the angiogram is for the coronary arteries the catheter has to go into the artery to reach the left heart... Correct?

Yes. Since the coronary arteries branch off the ascending aorta just distal to the aortic valve at the aortic root, the catheter tip needs to be positioned adjacent to the ostia for the dye to enter the coronary circulation. Therefore, an arterial access is needed.