CH 27 Drugs for Dysrhythmias (E5)

A client experiencing a ventricular dysrhythmia has received a bolus of lidocaine. What is the recommended rate for continuous infusion of lidocaine IV now prescribed for this client? A) 0.27 to 0.75 mg/min B) 10 to 20 mg/min C) 1 to 4 mg/min D) 6 to 8 mg/min

1 to 4 mg/min

Which medication falls under pregnancy risk category D? A) Amiodarone B) Procainamide C) Lidocaine D) Verapamil

Amiodarone

Which class IV calcium channel blocker is exclusively administered to treat acute supraventricular tachycardia? A) bethanechol chloride B) chlorambucil C) diltiazem D) midazolam hydrochloride

diltiazem

What is the therapeutic range for digoxin? A) 1.0-2.5 ng/mL B) 20-30 ng/mL C) 300-500 ng/mL D) 0.5-0.8 ng/mL

0.5-0.8 ng/mL

A nurse is caring for a client who received IV verapamil to treat supraventricular tachycardia (SVT). The client's pulse rate is now 98/min and the blood pressure is 77/44 mmHg. The nurse should expect a prescription for which of the following IV medications? A) Calcium gluconate B) Sodium bicarbonate C) Potassium chloride D) Magnesium sulfate

Calcium gluconate

What must be taken before digoxin can be administered? A) Blood pressure B) Apical pulse C) Vital signs D) Temperature

Apical pulse

A nurse is preparing to administer propranolol to a client who has a dysrhythmia. Which of the following actions should the nurse plan to take? A) Hold propranolol for an apical pulse >100/min. B) Administer propranolol to increase the client's blood pressure. C) Assist the client when sitting up or standing after taking this medication. D) Check for hypokalemia frequently due to the risk for propranolol toxicity.

Assist the client when sitting up or standing after taking this medication

A nurse is assessing a client who has taken procainamide to treat dysrhythmias for the last 12 months. The nurse should assess the client for which of the following manifestations as an adverse effect of this medication? SELECT ALL THAT APPLY. A) HTN B) Widened QRS complex C) Narrowed QT interval D) Easy bruising E) Swollen joints

B, D, E

Antidysrhythmics: Long term suppression of dysrhythmias (atrial and ventricular); SVT, VT, Afib, Aflutter A) Class IA B) Class IB C) Class IC D) Class II E) Class III F) Class IV

Class IA

Antidysrhythmics: Short term suppression for ventricular dysrhythmias ONLY A) Class IA B) Class IB C) Class IC D) Class II E) Class III F) Class IV

Class IB

Antidysrhythmics: SVT A) Class IA B) Class IB C) Class IC D) Class II E) Class III F) Class IV

Class IC

Antidysrhythmics: Decreases HR; Afib, Aflutter, Parooxysmal SVT, HTN, Angina A) Class IA B) Class IB C) Class IC D) Class II E) Class III F) Class IV

Class II

Antidysrhythmics: Conversion of Afib; Recurrent Vfib and V-tachycardia. A) Class IA B) Class IB C) Class IC D) Class II E) Class III F) Class IV

Class III

Antidysrhythmics: Decreases HR; Decreases force of contraction; Afib, Aflutter, SVT, HTN, Angina A) Class IA B) Class IB C) Class IC D) Class II E) Class III F) Class IV

Class IV

A client is admitted to the emergency room with a ventricular dysrhythmia associated with an acute myocardial infarction. What assessment should the nurse make prior to administering a bolus of lidocaine IV? A) Assess for lidocaine administration in the client's history. B) Determine the client's ability to swallow. C) Assess the client's nutritional history for allergies. D) Determine if the client has had a reaction to local anesthesia.

Determine if the client has had a reaction to local anesthesia.

A client is receiving an antidysrhythmic medication intravenously. How often should the client's blood pressure be assessed? A) once per shift B) every 1 to 5 minutes C) every 15 minutes D) every 2 hours

every 1 to 5 minutes

What is a major effect of amiodarone when prescribed for ventricular fibrillation? A) It produces skeletal muscle relaxation. B) It decreases automaticity in the ventricles. C) It stimulates the sympathetic nervous system. D) It slows the process of repolarization.

It slows the process of repolarization.

Ms. Ferguson, aged 58, is admitted to the coronary care unit for treatment of an acute anterior myocardial infarction. That evening, she experiences frequent episodes of ventricular tachycardia with hypotension. The provider tells the nurse to prepare an IV bolus dose of lidocaine. Why is lidocaine administered intravenously at this time—and not orally? A) Lidocaine absorption is too erratic when administered orally. B) Lidocaine is inactivated by hydrochloric acid. C) Most of an absorbed oral dose of lidocaine undergoes first-pass metabolism in the liver. D) The onset of action for oral lidocaine is greater than 8 hours.

Most of an absorbed oral dose of lidocaine undergoes first-pass metabolism in the liver

A nurse is assessing a client who is taking amiodarone to treat atrial fibrillation. Which of the following findings is a manifestation of amiodarone toxicity? A) Light yellow urine B) Report of tinnitus C) Productive cough D) Blue-gray skin discoloration

Productive cough

Which of the following is the greatest complication of amiodarone? A) AV block B) Visual disturbances C) Pulmonary toxicity D) Sinus bradycardia

Pulmonary toxicity

Which assessment would be considered a priority for a client receiving amiodarone? A) urine outputs B) heart rate checks C) lung sounds D) muscle rigidity

heart rate checks

A nurse is assessing a client who is taking digoxin to treat heart failure. Which of the following findings is a manifestation of digoxin toxicity? A) Bruising B) Report of metallic taste C) Muscle pain D) Report of anorexia

Report of anorexia

In some cases, low-dose amiodarone may be used to prevent recurrence of what cardiac disorder? A) atrial fibrillation B) angina pectoris C) ventricular hypertrophy D) mitral valve regurgitation

atrial fibrillation

Mr. Conley, who is 53 years of age, is about to be discharged from the hospital after treatment for recurrent ventricular fibrillation. To prevent breakthrough ventricular ectopy, his prescriber orders amiodarone, 1000 mg PO daily as a loading dose for 2 weeks. What patient teaching implications are important regarding this loading dose? A) Most of the drug is destroyed in the GI tract and thus a large dose needs to be given. B) Males require large dosages because of their faster metabolic rate. C) A history of ventricular dysrhythmia necessitates a higher dose. D) The drug has a long serum half-life.

The drug has a long serum half-life.

A 48-year-old client with no known history of cardiovascular disease presents with atrial flutter. The client is prescribed propafenone PO 150 mg every 8 hours for 24 hours. What is the cardiac care nurse's priority assessment during this period? A) every 1-hour monitoring of potassium levels B) blood pressure monitoring every 10 minutes C) echocardiography D) continuous ECG monitoring

continuous ECG monitoring

A client is administered diltiazem IV, followed by propranolol IV. The nurse should assess for what potential side effect of this medication combination? A) hypertensive crisis B) anaphylaxis C) valve regurgitation D) impaired myocardial contractility

impaired myocardial contractility

The nurse should prepare to facilitate what intervention when a client is prescribed adenosine for the treatment of paroxysmal supraventricular tachycardia? A) cardiac catheterization B) inserting a central venous catheter C) Holter monitoring D) nonstress testing

inserting a central venous catheter

The clinical use of class III agents rather than class I agents is preferred for patients with heart disease because the class III agents are associated with A) less ventricular fibrillation B) increased mortality C) more sustained effects D) milder adverse effects

less ventricular fibrillation

A 59-year-old client with a history of coronary artery disease is undergoing cardiac catheterization. What drug should the nurse most likely prepare for administration when the client suddenly begins exhibiting ventricular tachycardia? A) lidocaine B) magnesium sulfate (MgSO4) C) digoxin D) epinephrine

lidocaine

The nurse should advocate for a lower-than-normal dose if the client prescribed quinidine has a history of what medical diagnosis? A) type 1 or type 2 diabetes B) primary hypertension C) liver disease D) chronic obstructive pulmonary disease

liver disease

The nurse's subsequent cardiac assessments and monitoring of a client prescribed disopyramide (procainamide) should be planned in the knowledge that this drug increases the client's risk for developing what health problem? A) new-onset chest pain B) mitral valve regurgitation C) acute renal failure D) new dysrhythmias

new dysrhythmias

Intravenous verapamil has been ordered immediately (STAT) in the treatment of a client experiencing supraventricular tachycardia. In order to ensure client safety, the nurse should be aware that concurrent use of which medication is absolutely contraindicated? A) sodium bicarbonate B) propranolol C) diltiazem D) lidocaine

propranolol

What is the mechanism of action for medications prescribed to treat a rapid dysrhythmia? A) reducing automaticity B) increasing conduction C) repolarizing myocardial cells D) reducing refractory period

reducing automaticity

A nurse is monitoring a patient who has been receiving quinidine in the critical care unit. The laboratory technician calls to report that the patient's serum quinidine level is 8 mcg/mL. The patient has also developed diarrhea. The priority action is to A) report the findings to the provider immediately B) administer the medication as ordered C) anticipate that the dosage of the medication will increase D) anticipate that the dosage of the medication will decrease

report the findings to the provider immediately

Oral quinidine is prescribed for a client with a diagnosis of chronic ventricular tachycardia without heart block. In order to assess for the safety and efficacy of this treatment, the nurse should prioritize which assessment? A) radial and brachial pulse B) level of consciousness C) serum drug levels D) blood pressure

serum drug levels

An adult client with a long-standing dysrhythmia has been taking oral propranolol for the last several months, resulting in acceptable symptom control. What is a priority teaching point for the nurse to communicate to this client? A) the need to measure his radial pulse for 1 minute prior to each dose of propranolol B) the importance of not stopping the medication abruptly C) the need to avoid taking over-the-counter antacids D) the need to limit his intake of high-potassium foods

the importance of not stopping the medication abruptly