ch 45 PrepU

The nurse is teaching a client who is receiving quinidine about foods to avoid. The client demonstrates the need for additional teaching when he identifies the need to avoid which of the following?

Apple juice

The nurse is administering quinidine to a client who is also taking digoxin. The nurse will assess this client for which most 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

Lidocaine (Xylocaine) is available in a variety of dosage forms. How should a nurse administer lidocaine to a client with a ventricular arrhythmia? (Choose one)

Intravenously

A client with diabetes is given a prescription for propranolol (Inderal) to treat a cardiac arrhythmia. What should the patient be told? (Choose one)

Check blood glucose once or twice daily

A client is released from the hospital after a myocardial infarction. The physician prescribes a class II beta-adrenergic blocker drug. Why does the physician choose this drug?

It is effective in reducing mortality after myocardial infarction.

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

It slows the conduction through the AV node.

Ms. Hall is started on quinidine therapy. What type of arrhythmia would the nurse be using quinidine to treat?

Junctional arrhythmia

A patient receiving warfarin is prescribed disopyramide. The nurse would monitor for signs and symptoms of which of the following 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

A patient with type 1 diabetes is prescribed acebutolol. Which of the following would be most important to monitor?

Blood glucose levels

The nurse would instruct a client receiving acebutolol about which of the following adverse effects?

Bronchospasm

When describing the drugs classified as class IV antiarrhythmics, the nurse would identify these as which of the following?

Calcium channel blockers

Flecainide (Tambocor) is classified as which type of antiarrhythmic? (Choose one)

Class IC

Which best describes the action of class II antiarrhythmics?

Competitive block beta receptor sites in the heart and kidneys

A patient is admitted to the emergency room with a ventricular dysrhythmia associated with an acute myocardial infarction. The physician has ordered a bolus of lidocaine IV. What assessment should the nurse make prior to administering this medication?

Determine if the patient has had a reaction to local anesthesia

The health care provider orders quinidine for a client who is receiving digoxin. The nurse would monitor this client for which of the following?

Digoxin toxicity

A patient is diagnosed with acute supraventricular tachycardia. Which of the following class IV calcium channel blockers are administered intravenously to treat acute supraventricular tachycardia?

Diltiazem (Cardizem)

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 heart disease is prescribed an antiarrhythmic drug. Further teaching is needed when the client makes which of the following statements?

"I know I must take my medication every day to be cured."

A client is admitted to the critical care unit after experiencing a myocardial infarction and subsequent serious dysrhythmias. He is treated successfully for ventricular dysrhythmia, and the physician orders continuous IV therapy. What may cause further development of dysrhythmias?

Electrolyte imbalances

A client is prescribed propranolol (Inderal). Which condition in the client's history may affect the treatment regimen?

Elevated glucose

Mr. Franks, a 68-year-old male, is treated with lidocaine for frequent premature ventricular contractions after a myocardial infarction. The nurse knows that she needs to assess Mr. Franks frequently for adverse reactions that are dose related. What are the most common mild adverse effects of lidocaine therapy?

Fatigue

The nurse is preparing to administer quinidine intravenously. At what rate will the nurse administer this medication?

1 mL/min

A physician has ordered lidocaine IV for a patient with a ventricular dysrhythmia. The nurse has administered a bolus of lidocaine. What is the recommended rate for continuous infusion of lidocaine IV?

1-4 mg/min

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

10 to 20 minutes

A patient is receiving procainamide intravenously. The nurse understands that the initial dose should run over which time frame?

25 to 30 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 nurse is caring for a patient receiving digoxin for ventricular arrhythmia. Which of the following apical pulse rates indicates that the nurse should withhold the drug and report to the health care provider immediately?

58 beats/minute

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

Acebutolol

Which arrhythmia would the nurse identify as being related to an alteration in conduction through the heart muscle?

Heart block

An antiarrhythmic drug is prescribed for a client whose apical pulse rate is 100. What is the nurse's best action?

Administer the medication with water.

You are caring for a client who is receiving lidocaine, a Class 1B antiarrhythmic drug. What type of arrhythmia is this class of drugs used to treat?

All acute ventricular arrhythmias

When describing the action of antiarrhythmics, which effect would most likely be included?

Alteration in conductivity

Your ED patient presents with dyspnea, tachycardia, and chest pain. He has a history of cardiomyopathy. Your assessment reveals hypotension with an apical pulse of 134 bpm. What would you conclude might be causing the symptoms?

Inadequate cardiac output

A clinic nurse is following a 62-year-old woman who is taking quinidine for a cardiac arrhythmia. What nursing action will address the most common adverse effects of quinidine therapy?

Monitor the patient for signs and symptoms of GI upset

You are administering intravenous amiodarone to a patient in the emergency department. Which of the following tasks would you 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

Ms. Smith is started on antiarrhythmic therapy to treat atrial fibrillation. As the nurse caring for Ms. Smith, you know that which occurrence is a potential side effect of this medication?

Other arrhythmias

A patient with cardiac arrhythmia is prescribed verapamil. Which of the following possible adverse effects should the nurse inform the patient about?

Peripheral edema

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

Phase 0

When describing the action of dofetilide, the nurse understands that the drug affects which phase of the action potential?

Phase 3

What is the safest precaution to take when administering an antiarrhythmic drug intravenously (IV)?

Place the client on a cardiac monitor.

A patient is admitted to the cardiology unit of a health care facility for ventricular arrhythmia. In which of the following conditions can an anti-arrhythmic drug be safely administered?

Premature ventricular contraction

Which of the following agents 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 which of the following?

Prolonged refractory period

A patient with a cardiac arrhythmia is admitted to a healthcare facility. The patient is also experiencing myocardial infarction. Which of the following drugs is the healthcare provider most likely to prescribe for the patient?

Propranolol

Which one of the following antidysrhythmic drugs is also used to treat a myocardial infarction?

Propranolol (Inderal)

Your patient, a 68-year-old man, is being discharged status post-atrial flutter cardioversion to NSR. His cardiologist has prescribed propranolol to maintain NSR. What important information should be included in your patient education about potential adverse effects?

Propranolol may cause sexual dysfunction.

What is a life-threatening risk associated with the use of amiodarone?

Pulmonary toxicity

Your patient is receiving an intravenous infusion of amiodarone for treatment of ventricular fibrillation. Which of the following 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 of the following factors should the nurse closely monitor as a part of the ongoing assessment during the therapy?

Pulse rate

A patient on anti-arrhythmic drug therapy complains of nausea, vomiting, abdominal pain, diarrhea, and a ringing sensation in the ears. Which of the following drugs should the nurse consider as the cause for these adverse effects?

Quinidine

A patient has been prescribed disopyramide (Norpace) to treat a tachydysrhythmia. Which of the following factors would necessitate that the dose be reduced?

Renal impairment

Which of the following factors would necessitate a reduction in the dosage of disopyramide?

Renal impairment

A patient has a complex cardiac history that includes recurrent ventricular fibrillation. After the failure of more conservative treatments, his care team has introduced oral amiodarone. What assessments should be prioritized by the nurse who is providing care for this patient?

Respiratory assessment

Which of the following would be a contraindication for the use of a class II antiarrhythmic?

Sinus bradycardia

A 75-year-old client presents to his physician with a cardiac dysrhythmia. The physician chooses to treat the dysrhythmia because of what symptoms?

Symptoms related to circulatory impairment

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

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

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

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

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 patient is likely to be prescribed

acebutolol.

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.

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

hypersensitivity to beta blockers.

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.

Which of the following medications are Class II antiarrhythmics? (Select all that apply)

• Acebutolol (Sectral) • Propranolol (Inderal)

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

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

The physician has prescribed quinidine. The nurse knows this drug is used for what physiologic effects on the heart? (Select all that apply.)

• It reduces automaticity. • It prolongs the refractory period.

All antiarrhythmic medications can cause which of the following? (Select all that apply)

• New arrhythmias • Worsen existing arrhythmias • Increased blood pressure

An instructor is preparing a teaching plan for a class about the types of arrhythmias. Which of the following would the instructor include as arising from stimulation of an ectopic focus? Select all that apply.

• Premature ventricular contraction • Atrial flutter • Ventricular fibrillation

Which of the following is true in regards to the drug propranolol (Inderal)? Select all that apply:

• Propranolol acts by blocking beta-adrenergic receptors of the heart and • Propranolol reduces the release of renin. • Propranolol has membrane stabilizing effects.

The nurse should monitor a client receiving lidocaine (Xylocaine) IV closely for which of the following? Select all that apply:

• Respiratory depression • Mental status changes • Convulsions • Bradycardia

Which of the following would be a contraindication for using a class IV antiarrhythmic? Select all that apply.

• Sick sinus syndrome • Heart block • Heart failure • Hypotension

The nurse should report which of the following electrocardiogram (ECG) changes to the physician? Select all that apply:

• Tachycardia • Prolongation of PR interval • Prolongation of QT interval • Widening of the QRS complex • Bradycardia

A nurse is assigned to care for a patient who has to be administered an antiarrhythmic drug. Under what conditions is the use of this drug contraindicated in the patient? Select all that apply.

• The patient has hypotension • The patient has aortic stenosis • The patient has cardiogenic shock

A cardiovascular assessment before administration of an antiarrhythmic medication includes which of the following? Select all that apply.

• Vital signs • Client's general status • Subjective symptoms • Apical pulse