Chapter 27 Dysrhythmias

Lidocaine is the prototype of class IB antidysrhythmics used for treating serious ventricular dysrhythmias associated with what conditions?

Cardiac catheterization Cardiac surgery Digitalis-induced ventricular dysrhythmias

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

Normal sinus rythm

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

A nurse is required to monitor the blood concentration levels of the drug in a client receiving IV lidocaine for cardiac arrhythmia. Which blood concentration level should the nurse to report to the health care provider immediately?

6mcg he nurse should report to the health care provider immediately when the blood concentration level of lidocaine reaches 6 mcg/mL. Above a level of 6 mcg/mL, the risk of central nervous system and cardiac depression is significantly increased. Immediate reporting is needed as the dose of the drug may need to be changed.

What term is used to describe the heart's ability to independently generate an electrical impulse?

Automaticy

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

Block the stimulation of the adrenergic receptors Class II antiarrhythmic drugs block adrenergic receptors (beta-blockers), producing antisympathetic effects that slow the heart rate, lengthen the time needed for conduction, and increase the force of contraction. The effect seen with class II antiarrhythmic drugs is depression of phase 4 of depolarization.

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 client with impaired renal function is to receive dofetilide (Tikosyn) for conversion of atrial fibrillation. Which should the nurse do before administering the drug?

Check the client's creatinine level.

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

Class III

What class of antiarrhythmic agents does the nurse administer to slow the outward movement of potassium during phase 3 of the action potential?

Class III Amiodorone

The nurse is caring for a client receiving lidocaine IV. Which factor is most relevant to administration of this medication?

Presence of premature ventricular contractions (PVCs) on cardiac monitor

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

Elevated glucose

Verapamil (Calan) can produce which of the following effects on the cardiovascular system? Select all that apply:

Dilate coronary arteries. Dilate peripheral arteries. Slow conduction through the SA and AV nodes

The health care provider is discussing major risk factors for coronary artery disease (CAD) with a client. The most important information for the provider to include would be:

History of cigarette smoking and elevated blood pressure

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

IV

How long does amiodorone take to work?

Immediately

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

Intravenous Esmolol is available only for IV administration.

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

Intravenously The nurse should administer lidocaine intravenously for the treatment of ventricular arrhythmias.

Amiodarone is a potassium channel blocker that prolongs conduction in all cardiac tissues. What is another effect of amiodarone?

It decreases contractility of the left ventricle. It decreases heart rate.

Amidorone and dofetilide given together can cause?

Life threatening arrhythmia's

While lecturing on blood pressure, the nurse will emphasize that the body maintains its blood pressure by adjusting the cardiac output to compensate for changes in which physiologic process?

Peripheral Vascular Resistance

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, 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

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

Quinidine

How do you explain to her the recent changes in dysrhythmic therapy?

Recent changes include greater use of nonpharmacologic management of dysrhythmias.

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 Amiodarone has several adverse effects that are potentially fatal. Pulmonary toxicity is the most important of these serious adverse effects.

After teaching a group of students about the conduction system of the heart, the instructor determines that the teaching was successful when the students identify what as the origination of the impulse?

SA node

The electrical impulses flow in the following manner:

Sinoatrial node, the atrioventricular node, bundle of His, right and left bundle branches, and Purkinje fibers.

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

Sinus bradycardia Class II antiarrhythmics are contraindicated in sinus bradycardia but should be used cautiously in clients with diabetes, thyroid dysfunction, and hepatic dysfunction.

Before the administration of any anti-arrhythmic, what should the nurse's pre-assessment of the client's general condition include?

Skin color Orientation Level of consciousness

It is determined that a client's cardiac rhythm is being originated in the sinoatrial (SA) node. What mechanism is responsible for the triggering of this node?

Specialized cells within the node itself

You are teaching a client how to follow his antidysrhythmic drug regimen. Which of the following should you advise the client to report as a possible adverse effect of his therapy?

Syncope, dizziness or fainting spells. These symptoms may indicate drug-induced hypotension.

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.

What primary event has occurred when a client experiences an ectopic focus?

The location of the heart's functioning pacemaker is no longer the sinoatrial (SA) node

Ms. Case is admitted to the cardiac care unit because she developed premature ventricular contractions. What could be causes of this ectopic beats?

These ectopic pacemakers may result from hypokalemia, myocardial ischemia, emotional stress, or hypoxia.

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

Use a reliable form of birth control while taking this medication. Amiodarone is a pregnancy category D drug. Because of a specific enzyme reaction, grapefruit or its juice should not be taken with amiodarone or calcium channel blockers. Urinary retention is an adverse reaction and should be reported to the health care provider. Drowsiness may occur, and the client should be instructed not to drive and to avoid hazardous tasks if drowsy

The nurse is caring for a patient receiving intravenous lidocaine for treatment of dysrhythmia. Which of the following dysrhythmias is this patient most likely to have?

a class 1B antidysrhythmic drug, is used in the treatment of symptomatic PVC and ventricular tachycardia. It is used to prevent ventricular fibrillation. Drug treatment of asymptomatic PVC and nonsustained ventricular tachycardia is not recommended.

The nurse is administering lidocaine to a client with ventricular tachycardia. The nurse will need to observe for adverse effects, including

adverse effects of lidocaine include hypotension, aggravation of existing dysrhythmia, bradycardia, drowsiness, agitation, and muscle twitching.

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

bleeding

Arrhythmia may be triggered by which of the following? Select all that apply:

heart disease, a disorder that affects cardiovascular function, emotional stress, hypoxia, and electrolyte imbalances.

A patient presents at the clinic with shortness of breath, fatigue, and difficulty performing ADLs. The nurse notes bluish color around the patient's mouth and in the patient's nail beds. The nurse expects that the patient has:

heart failure.

the nurse is assessing a client and suspects that the client is experiencing a dysrhythmia. What client assessments would support this condition?

oliguria, hypotension, mental confusion or syncope, or shortness of breath

Initiation of the heart's electrical impulses depends predominantly on what electrolyte movement? Select all that apply.

predominately on the movement of sodium and calcium ions into a myocardial cell and movement of potassium ions out of the cell