Chapter 45
The nurse is preparing discharge teaching for a client prescribed chronic antiarrhythmic medication therapy. Which signs/symptoms should be reported to the health care provider immediately? (Select all that apply.) Nausea Heart palpations Chest pain Diarrhea Dyspnea
Chest pain Dyspnea Heart palpations
Which adverse effect might occur in a client receiving milrinone?
Hypotension
A female patient diagnosed with chronic atrial flutter has been prescribed verapamil in conjunction with digoxin to control ventricular rate. To enhance the therapeutic effect of the drug, the nurse will instruct the patient to:
avoid grapefruit and grapefruit juice.
Which class IV calcium channel blocker is exclusively administered to treat acute supraventricular tachycardia? diltiazem midazolam hydrochloride chlorambucil bethanechol chloride
diltiazem
A client has been prescribed disopyramide (Norpace) to treat a tachydysrhythmia. Which factor would necessitate that the dose be reduced? Immobility Hypertension Renal impairment Chronic diarrhea
renal impairment
A client, diagnosed with a cardiac dysrhythmia, will not require medication therapy. The client expresses concern about the lack of proposed treatment. What response should the nurse provide to best address the client's concern? "You can be assured your cardiologist will prescribe medication therapy if the dysthymia gets progressively worse." "The dysrhythmia you have isn't interfering with getting oxygen to your body tissues so there is no need to treat it." "Dysrhythmias that cause tachycardia are the only that can be treated with medications." "If the dysrhythmia causes bradycardia, you will be prescribed medication."
"The dysrhythmia you have isn't interfering with getting oxygen to your body tissues so there is no need to treat it."
A patient receives lidocaine IV. The nurse would expect the drug to exert its effects for how long? 10 to 20 minutes 30 to 40 minutes 60 to 90 minutes 90 to 120 minutes
10-20 mins
After teaching group of students about antiarrhythmic agents, the instructor determines that the teaching was successful when the students identify which of the following as examples of class III antiarrhythmics? Select all that apply. Amiodarone Dofetilide Sotalol Ibutilide Flecainide Verapamil
Amiodarone, dofetilide, Sotalol, Ibutilide
The nurse would instruct a client receiving acebutolol about which adverse effect? Bronchospasm Hypertension Improved exercise tolerance Increased libido
Bronchospasm
A client diagnosed with chronic atrial fibrillation is concerned about not being prescribed medication to manage the situation. Upon what information should the nurse base his/her response to the client's concern? Drug treatment is believed to increase the risk of death in clients diagnosed with chronic atrial fibrillation. Additional medications are given as tachydysrhythmias increase in frequency and severity. Attempts to pharmacologically manage this dysrhythmia are unlikely to be beneficial. Medications are commonly prescribed to control only significant dysrhythmias.
Drug treatment is believed to increase the risk of death in clients diagnosed with chronic atrial fibrillation.
The nurse is administering intravenous amiodarone to a patient in the emergency department. Which task would the nurse need to prioritize? Monitoring the patient's blood pressure Giving drinks to the client Explaining the treatment to the patient's family Checking the patient's urine output
Increased digoxin level
What is the rationale for administering adenosine as a bolus?
It has an exceptionally short half-life.
the nurse is administering lidocaine to a client and anticipates a reduced dosage if the client also has which conditions? (Select all that apply.)
Liver disorders Right-sided heart failure
The health care provider has ordered quinidine for a 12-year-old child. The nurse expects to administer this medication in what form? Oral IV IM SC
Oral
A patient is admitted to the cardiology unit of a health care facility for ventricular arrhythmia. In which condition can an anti-arrhythmic drug be safely administered? Aortic stenosis Premature ventricular contraction Third-degree heart block Severe congestive heart failure
PVC
What is the safest precaution to take when administering an antiarrhythmic drug intravenously (IV)? Choose the BEST response. Relocate the client's room next to the nurse's station. Place the client on a cardiac monitor. Count the apical pulse before administration. Administer the drug through new IV line.
Place the client on a cardiac monitor counting the apical pulse before is appropriate, but being on a cardiac monitor (EEG) continuously through IV treatment allows the continued assessment and documentation of the heart rhythms.
A patient is admitted to the cardiology unit of a health care facility for ventricular arrhythmia. In which condition can an anti-arrhythmic drug be safely administered?
Premature ventricular contraction
A patient is admitted to the cardiology unit of a health care facility for ventricular arrhythmia. In which condition can an anti-arrhythmic drug be safely administered? Third-degree heart block Aortic stenosis Severe congestive heart failure Premature ventricular contraction
Premature ventricular contraction
An instructor is preparing a teaching plan for a class about the types of arrhythmias. Which would the instructor include as arising from stimulation of an ectopic focus? (Select all that apply.) Ventricular fibrillation Heart block Atrial flutter Tachycardia Premature ventricular contraction
Premature ventricular contraction Atrial flutter Ventricular fibrillation
Which is true in regards to the drug propranolol (Inderal)? (Select all that apply.) Propranolol is a class III anti-arrhythmic. Propranolol acts by blocking beta-adrenergic receptors of the heart and kidney. Propranolol reduces the release of renin. Propranolol increased excitability of the heart. Propranolol has membrane stabilizing effects.
Propranolol acts by blocking beta-adrenergic receptors of the heart and kidney. Propranolol reduces the release of renin. propranolol has membrane stabilizing effects
After reviewing antiarrhythmic drugs, a group of nursing students demonstrate understanding of the drugs when they identify which as a class II antiarrhythmic? Select all that apply. Acebutolol Propranolol Amiodarone Ibutilide Verapamil
Propranolol, Acebutolol
A client has been prescribed disopyramide (Norpace) to treat a tachydysrhythmia. Which factor would necessitate that the dose be reduced? Immobility Renal impairment Chronic diarrhea Hypertension
Renal impairment
Which factor would necessitate a reduction in the dosage of disopyramide?
Renal impairment
Which factor would necessitate a reduction in the dosage of disopyramide? Immobility Chronic diarrhea Hypertension Renal impairment
Renal impairment
A client has been prescribed disopyramide (Norpace) to treat a tachydysrhythmia. Which factor would necessitate that the dose be reduced?
Renal impairment Disopyramide is excreted in the kidneys and the liver in almost equal proportions. The dose must be reduced in renal insufficiency based on creatinine clearance.
Which physiological conditions are common triggers for the development of cardiac arrhythmias? Select all that apply. Respiratory distress Potassium imbalance Decreased blood volume Metabolic acidosis Faulty sinoventricular node
Respiratory distress, potassium imbalance, metabolic acidosis, and faulty sinoventricular node
What do class IB anti-arrhythmics result in? (Select all that apply.)
Shortening of the action potential duration Depression of cardiac conduction
A nurse is preparing an in-service presentation about arrhythmias. As part of the presentation, the nurse is planning to include factors that contribute to arrhythmias. Which would the nurse include? (Select all that apply.) Accumulation of waste products Electrolyte imbalances Structural damage to conduction pathways Drug effects Increased oxygen delivery to cells Alkalosis
accumulation of waste, electrolyte imbalances, drug effects, structural damage to conduction pathways
After successful treatment for a myocardial infarction, a 69-year-old man has developed a ventricular arrhythmia. His care team has opted for treatment with a Class II antiarrhythmic. The nurse would understand that this client is likely to be prescribed: acebutolol. lidocaine. amiodarone. verapamil.
acebutolol
The nurse is caring for a client who is receiving lidocaine. What type of arrhythmia is this class of drugs used to treat? Ventricular tachycardia Acute ventricular arrhythmias Atrial fibrillation Acute atrial arrhythmias
acute ventricular arrhythmias
An antiarrhythmic drug is prescribed for a client whose apical pulse rate is 100. What is the nurse's best action? Hold the medication. Administer the medication with water. Notify the primary care provider. Perform an electrocardiogram (ECG).
administer the medication with water
When describing the action of antiarrhythmics, which effect would most likely be included? Reduction of peripheral resistance Enhancement of automaticity Alteration in conductivity Reduction in cardiac output
alteration in conductivity
A 68-year-old client is treated with lidocaine for frequent premature ventricular contractions after a myocardial infarction. The nurse needs to assess this client frequently for adverse reactions that are dose related. What is the most common mild adverse effect of lidocaine therapy? Mood changes Double vision Hallucinations Apprehension
apprehension
A female patient diagnosed with chronic atrial flutter has been prescribed verapamil in conjunction with digoxin to control ventricular rate. To enhance the therapeutic effect of the drug, the nurse will instruct the patient to: take the medication with meals. avoid fresh fruit. take an aspirin every day. avoid grapefruit and grapefruit juice.
avoid grapefruit and grapefruit juice.
When describing the action of class II antiarrhythmics, which would the nurse include? Membrane stabilization with depression of phase 0 action potential Blockage of beta receptors in the heart and kidneys Blockage of potassium channels during phase 3 action potential Interference with calcium ion movement across the membrane
blockage of beta receptors in the heart and kidneys
The nurse notes that a client's current medications include both diltiazem for a dysrhythmia and nitroglycerin. The nurse should recognize the need to closely monitor the which client assessment datum?
blood pressure
A breast-feeding woman is prescribed a Class 3 antiarrhythmic. What information should the nurse provide to the client regarding the safety of the breast-feeding while taking this medication?
breast-feeding should be discontinued and other forms of feeding should be utilized
Which best describes the action of class II antiarrhythmics? Competitive block beta receptor sites in the heart and kidneys Block potassium channels slowing the outward movement of potassium Block the movement of calcium ions across the cell membrane Block sodium channels in the cell membrane during an action potential
competitively blocks beta receptor sites in the heart and kidneys
An adult 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? blood pressure monitoring every 10 minutes echocardiography continuous ECG monitoring every 1-hour monitoring of potassium levels SUBMIT ANSWER
continuous ECG monitoring
Which of the following antiarrhythmics would have little effect on the duration of the action potential? Propranolol Flecainide Procainamide Lidocaine
flecainide
An ED patient presents with dyspnea, tachycardia, and chest pain. The patient has a history of cardiomyopathy. The nursing assessment reveals hypotension with an apical pulse of 134 bpm. What would the nurse conclude might be causing the symptoms? Inadequate cardiac output Asthma attack Adequate cardiac output Hypokalemia
inadequate cardiac output
A 70-year-old woman with a history of atrial fibrillation takes digoxin and verapamil to control her health problem. Verapamil achieves a therapeutic effect by: inhibiting the movement of calcium ions across the cardiac muscle cell membrane. blocking adrenergic receptors and producing antisympathetic effects. weakening diastolic depolarization and the action potential duration. decreasing sodium and potassium conduction.
inhibiting the movement of calcium ions across the cardiac muscle cell membrane.
A patient is prescribed esmolol for treatment of supraventricular tachycardia. The nurse would expect to administer this drug by which route? Intravenous Oral Intramuscular Subcutaneous
intravenous
The primary health care provider prescribes a class I sodium channel blocker to be given intravenously. Which drug would the nurse most likely administer? lidocaine disopyramide flecainide mexiletine
lidocaine
What is the primary goal of antidysrhythmic drug therapy for a client who has been successfully cardioverted
maintenance of normal sinus rhythm (NSR)
What is the primary goal of antidysrhythmic drug therapy for a client who has been successfully cardioverted? maintenance of normal sinus rhythm (NSR) proof of increased cardiac contractility suppression of original dysrhythmia increase in blood pressure
maintenance of normal sinus rhythm (NSR)
The nurse is administering intravenous amiodarone to a patient in the emergency department. Which task would the nurse need to prioritize? Checking the patient's urine output Monitoring the patient's blood pressure Giving drinks to the client Explaining the treatment to the patient's family
monitoring the pt's BP
When describing the effects of antiarrhythmics, which is associated with all antiarrhythmic medications? Select all that apply. New arrhythmias Worsen existing arrhythmias Increased blood pressure Increased blood glucose Increased body temperature
new arrhthmias, worsen existing arrhthmias, increased BP
A client is started on antiarrhythmic therapy to treat atrial fibrillation. The nurse caring for this client knows which occurrence is a potential side effect of this medication? Malignant hyperthermia Shortness of breath Other arrhythmias Angina
other arrhythmias
A patient with cardiac arrhythmia is prescribed verapamil. Which of the following possible adverse effects should the nurse inform the patient about? Diarrhea Hyperactivity Peripheral edema Hypertension
peripheral edema
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? sodium bicarbonate propranolol diltiazem lidocaine
propranolol beta blockers are always contraindicated in those taking verapamil!
A client has a complex cardiac history that includes recurrent ventricular fibrillation. After the failure of more conservative treatments, the care team has introduced oral amiodarone. What assessments should be prioritized by the nurse who is providing care for this client? Orientation and cognition Neurological assessment Active and passive range of motion Respiratory assessment
respiratory assessment
Which would be a contraindication for the use of a class II antiarrhythmic? Sinus bradycardia Diabetes Thyroid dysfunction Hepatic dysfunction
sinus bradycardia
Before the administration of any anti-arrhythmic, what should the nurse's pre-assessment of the client's general condition include? (Select all that apply.) Skin color Blood glucose Input and output Orientation Level of consciousness
skin color, orientation, level of consciousness
A client is admitted with arrhythmias and placed on cardiac monitoring and prescribed an antiarrhythmic. Which finding on ongoing assessment should the nurse immediately notify the primary health care provider? Select all that apply. Sudden change in mental state A pulse rate of 100 bpm Dry mouth and gums Increased restlessness
sudden change in mental state