Coronary Angiography (10 Questions)

1. M. Guy Tremblay, 58 years old, is admitted for a scheduled elective coronary angiography due to chronic stable angina. During the admission interview, M. Tremblay mentions that last year at a dinner party, he developed hives and difficulty breathing after eating shrimp scampi. He has no other known medical history.

Medical Orders:
*NPO since midnight.
*IV Normal Saline at 75 mL/hr.
*Coronary Angiography scheduled for 10:00.
*Obtain informed consent.

Question:
Based on the patient's statement, what is the nurse’s priority action? *

Document the allergy and proceed with the informed consent process.

Instruct the patient that he cannot have the procedure because the contrast dye is fatal for him.

Administer a PRN dose of Epinephrine prior to sending the patient to the lab.

Notify the cardiologist immediately to receive orders for corticosteroid and antihistamine premedication.

2. Mme. Lise Gagnon, 65 years old, has Type 2 Diabetes and is scheduled for a coronary angiography this morning. She asks the nurse if she should take her morning medications. The nurse reviews her medication administration record (MAR) and notes she takes Metformin (Glucophage) 500 mg PO BID. Her Creatinine level is 110 µmol/L (borderline high).

Medical Orders:
*Coronary Angiography today.
*Hold insulin sliding scale while NPO.

Question:
What is the appropriate nursing instruction regarding Metformin? *

"Take the Metformin with a small sip of water to keep your blood sugar stable."

"Skip the Metformin this morning, and you may resume it immediately when you return from the procedure."

"Do not take the Metformin today, and you will need to hold this medication for 48 hours after the procedure."

"Take a double dose today to protect your kidneys from the dye."

3. M. Robert Roy, 60 years old, returned to the unit 30 minutes ago following a femoral approach coronary angiography. He calls the nurse stating, "I feel something warm and wet trickling down my leg." Upon lifting the sheet, the nurse observes a golf-ball-sized, firm swelling at the puncture site and bright red blood on the thigh.

Medical Orders:
*Bed rest with right leg straight for 6 hours.
*Vital signs q15min x 4, then q1h.
*IV Normal Saline at 100 mL/hr.

Question:
What is the nurse’s first intervention? *

Check the patient's blood pressure and heart rate.

Place a sandbag over the site and call the physician.

Draw a circle around the hematoma to monitor its growth.

Apply firm manual pressure 2 cm above the insertion site immediately.

4. Mme. Claire Dubé, 72 years old, had a diagnostic catheterization via the right femoral artery 2 hours ago. During the neurovascular check, the nurse notes that the right foot is cool to the touch and pale. The patient reports numbness in her toes. The nurse attempts to palpate the right pedal pulse but cannot find it, although it was present and graded 2+ before the surgery.

Medical Orders:
*Monitor neurovascular status of affected limb q15min.
*Keep affected leg straight.

Question:
What is the nurse’s interpretation and priority action? *

This is a normal vasospasm from the procedure; apply a warm blanket to the foot.

Use a Doppler; if a sound is heard, no further action is required.

This indicates an acute arterial occlusion.

Elevate the leg on two pillows to improve venous return.

5. M. Pierre Fortin, 68 years old, is 1 hour post-femoral angiography. He complains of a persistent, dull ache in his lower back and right flank. The nurse checks the groin insertion site, which is soft, dry, and intact with no hematoma. However, the patient appears anxious and diaphoretic.

Medical Orders:
*Vital signs q15min.
*Encourage PO fluids.
*IV Bolus 500 mL Normal Saline PRN for Hypotension (SBP < 90).

The nurse checks vitals: BP 88/50, HR 118, RR 24.

Question:
What complication should the nurse suspect? *

Acute Tubular Necrosis due to contrast dye.

Severe back pain from lying flat in bed.

Retroperitoneal Hemorrhage.

Vagal reaction to bladder distension.

6. Mme. Valérie Turcotte, 54 years old, had a coronary angiogram via the right radial artery (wrist). A compression device (TR Band) is in place. She calls the nurse complaining of severe numbness and tingling in her right thumb and index finger. The nurse observes that the fingers are dusky (blue) and cool.

Medical Orders:
*Wean TR Band air by 3 mL every 15 minutes starting 2 hours post-op.
*Check CMS (Circulation, Motion, Sensation) q15min.

Question:
What is the nurse’s priority action? *

Administer the prescribed analgesic for hand pain.

Elevate the arm on a pillow and wait for the scheduled weaning time.

Apply a warm compress to the fingers.

Remove a small amount of air (1-2 mL) from the TR Band.

7. Mme. Sophie Bouchard, 70 years old, is resting comfortably 4 hours post-angiography. Her vital signs are stable. She asks the nurse, "Why do I have to keep this IV running and drink all this water? I just want to sleep."

Medical Orders:
*IV Normal Saline 100 mL/hr x 6 hours.
*Encourage oral intake of fluids.
*Monitor urine output.

Question:
What is the best explanation by the nurse? *

"It is to keep your blood pressure up because the medication lowers it."

"The fluids help prevent clots from forming at the catheter site."

"The dye used during the procedure can be hard on your kidneys; the fluids help flush it out of your body."

"You lost a lot of blood during the procedure, so we need to replace it."

8. M. Michel Caron, 55 years old, is having his femoral arterial sheath removed by the nurse (specialized competency). During the compression, M. Caron complains of nausea and feeling faint. The nurse glances at the monitor.

Assessment:
*BP drops from 130/80 to 80/50.
*HR drops from 80 to 45 bpm.
*Patient is yawning and pale.

Medical Orders:
*Remove sheath when Activated Clotting Time < 150 seconds.
*Atropine 0.5 mg IV PRN for symptomatic bradycardia.
*IV fluid bolus 500 mL PRN for hypotension.

Question:
What is the nurse’s priority action? *

Increase the manual pressure on the groin.

Sit the patient upright to relieve the nausea.

Place the patient in Trendelenburg and administer Atropine IV PRN.

Call a Code Blue immediately.

9. M. Jean-Paul Cote, 62 years old, returned 1 hour ago from a femoral angiography. He rings the bell and asks to sit on the side of the bed to eat his lunch because he is worried about choking.

Medical Orders:
*Strict bed rest for 6 hours.
*Keep right leg straight.
*Diet as tolerated.

Question:
What is the correct nursing intervention? *

Allow him to sit on the edge of the bed but support his right leg on a stool.

Explain that he must remain flat or with the head of bed elevated no more than 30 degrees.

Assist him to a high-Fowler’s position (90 degrees) in bed.

Tell him he must miss lunch until the 6 hours are over.

10. M. Sylvain Lavoie, 59 years old, is being discharged the morning after his femoral angiogram. He works in a warehouse and asks about his activity restrictions.

Medical Orders:
*Discharge home.
*Resume medications.
*Follow up with Cardiologist in 1 week.

Question:
Which instruction should the nurse include in the discharge teaching? *

"You may take a warm bath tonight to soothe the groin muscle."

"You can return to lifting heavy boxes at work tomorrow."

"Avoid heavy lifting (more than 10 lbs), straining, or vigorous exercise for at least 5-7 days."

"Remove the dressing immediately and scrub the site vigorously to prevent infection."