Pharm PrepU

A nurse is caring for a patient receiving digoxin for ventricular arrhythmia. Which apical pulse rate indicates that the nurse should withhold the drug and report to the health care provider immediately?

58 beats/minute

A patient receives lidocaine IV. The nurse would expect the drug to exert its effects for how long?

10 to 20 minutes

The primary health care provider prescribes sotalol (Betapace) 80 mg BID orally. The drug is available in 40 mg tablets. The nurse will administer how many tablets in 24 hours?

4

A client receives lidocaine by intramuscular injection. The nurse would expect the drug to begin to exert its therapeutic effects within which time frame?

5 to 10 minutes

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?

1 to 4 mg/min

A client is prescribed sotalol. Which instruction would be most important?

"Be sure to take the drug on an empty stomach."

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?

"The dysrhythmia you have isn't interfering with getting oxygen to your body tissues so there is no need to treat it."

A client is admitted to the emergency department with a ventricular dysrhythmia associated with an acute myocardial infarction. What assessment should the nurse make prior to administering a bolus of lidocaine IV?

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

When educating a group of nursing students on the mechanism of the action of various anti-arrhythmic drugs, the nurse identifies which drugs as inhibiting the beta-adrenergic receptors of the heart and the kidney?

Acebutolol

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

A patient develops supraventricular tachycardia. Vagal maneuvers were tried but were unsuccessful. Drug therapy is initiated. Which agent would the nurse expect to be used?

Adenosine

When teaching a group of students about antiarrhythmic therapy, the instructor determines that the teaching was successful when the students identify what as the goal of antiarrhythmics?

Altered 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?

Apprehension

A client receiving warfarin is prescribed disopyramide. The nurse would monitor for signs and symptoms of what as most important?

Bleeding

Which statement would be true about the mechanism of action of class II antiarrhythmic agents?

Block the stimulation of the adrenergic receptors

When describing the action of class II antiarrhythmics, which would the nurse include?

Blockage of beta receptors in the heart and kidneys

A patient with type 1 diabetes is prescribed acebutolol. What would be most important to monitor?

Blood glucose levels

The nurse would instruct a client receiving acebutolol about which adverse effect?

Bronchospasm

A client with diabetes is given a prescription for propranolol (Inderal) to treat a cardiac arrhythmia. Which instruction by the nurse would be most appropriate?

Check blood glucose once or twice daily.

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.)

Chest pain Dyspnea Heart palpations

A nurse is preparing to administer flecainide. The nurse identifies this drug as being classified as which type of antiarrhythmic?

Class IC

The nurse is visiting the home of a client who is prescribed antidysrhythmic medication. The nurse will teach the client to report which possible adverse effect?

Dizziness

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.

The nurse is assessing a client and suspects that the client is experiencing a dysrhythmia. What client assessments would support this condition? (Select all that apply.)

Hypotension Mental confusion Shortness of breath

There are four primary classes of antidysrhythmic drugs. What class consists primarily of potassium channel blockers?

III

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

The nurse is administering quinidine to a client who is also taking digoxin. The nurse will assess this client for which important adverse effect?

Increased digoxin level

A client is to receive esmolol. The nurse would expect to administer this agent by which route?

Intravenous

A patient is prescribed esmolol for treatment of supraventricular tachycardia. The nurse would expect to administer this drug by which route?

Intravenous

What is the rationale for administering adenosine as a bolus?

It has an exceptionally short half-life.

A client is admitted to the emergency department in ventricular fibrillation. The client is administered amiodarone hydrochloride (Cordarone). What is the major effect of this medication?

It slows the conduction through the AV node.

The teaching plan for a client taking amiodarone should include which instruction?

Use a reliable form of birth control while taking this medication.

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

A client is prescribed disopyramide. The nurse would expect to administer this drug by which route?

Oral

Which phase of the cardiac muscle action potential is affected by class I antiarrhythmics?

Phase 0

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

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.)

Premature ventricular contraction Atrial flutter Ventricular fibrillation

Which agent would be classified as a class Ia antiarrhythmic?

Procainamide

A client is receiving adenosine for treatment of supraventricular tachycardia. The nurse understands that this drug results in:

Prolonged refractory period

What important information should be included in a client's education about potential adverse effects of propranolol?

Propranolol may cause bronchial and laryngospasms.

A patient is receiving an intravenous infusion of amiodarone for treatment of ventricular fibrillation. Which is the most serious adverse effect of the medication?

Pulmonary toxicity

A patient, admitted to a health care facility with cardiac arrhythmia, is prescribed propranolol. Which factor should the nurse closely monitor as a part of the ongoing assessment during the therapy?

Pulse rate

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.

A client has been prescribed disopyramide (Norpace) to treat a tachydysrhythmia. Which factor would necessitate that the dose be reduced?

Renal impairment

Which factor would necessitate a reduction in the dosage of disopyramide?

Renal impairment

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?

Respiratory assessment

Any part of the heart's conduction system can spontaneously start an impulse, but the sinoatrial node normally has the fastest automaticity rate, serving as the pacemaker site. What does initiation of an electrical impulse depend predominantly on the movement of? (Select all that apply.)

Sodium and calcium ions into a myocardial cell. Potassium ions out of a myocardial cell.

A client diagnosed with a dysrhythmia has not responded appreciably to treatment with oral propranolol. When the medication is discontinued, what instruction should the nurse provide the client to maximize safety?

Taper down the propranolol dose over a period of 2 weeks.

Propranolol is ordered for a client who has a cardiac arrhythmia. It will be important for the nurse to determine if the person has a history of:

hypersensitivity to beta blockers.

In some cases, low-dose amiodarone may be used to prevent recurrence of what cardiac disorder?

atrial fibrillation

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

A nurse is the cardiac care unit is preparing to hang an intravenous dose of dofetilide (Tikosyn) for a client who has just been admitted. What is the most likely goal of this intervention?

To convert the client's atrial fibrillation to normal sinus rhythm

When describing the drugs classified as class IV antiarrhythmics, the nurse would identify these as:

calcium channel blockers.

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?

continuous ECG monitoring

The health care provider orders quinidine for a client who is receiving a common treatment for atrial fibrillation. The nurse would monitor this client for:

digoxin toxicity.

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.

The nurse should advocate for a lower-than-normal dose if the client prescribed quinidine has a history of what medical diagnosis?

liver disease

What is the primary goal of antidysrhythmic drug therapy for a client who has been successfully cardioverted?

maintenance of normal sinus rhythm (NSR)

The nurse's subsequent cardiac assessments and monitoring of a client prescribed disopyramide should be planned in the knowledge that this drug ncreases the client's risk for developing what health problem?

new dysrhythmias