Week 8 Sherpath: Unclassified Antidysrhythmic Therapy

The nurse is preparing to administer a loading dose of digoxin to a patient in atrial fibrillation with a heart rate of 130 beats/minute. Which statement describes the rationale for the loading dose? A. Reduce the half-life of digoxin. B. Increase the duration of digoxin action. C. Increase the peak level of digoxin. D. Achieve therapeutic effect of digoxin more quickly.

D. Achieve therapeutic effect of digoxin more quickly. A loading dose allows the therapeutic level of digoxin to be achieved more quickly. This dose is called "digitalizing."

A patient remains in supraventricular tachycardia after administration of adenosine 6 mg. Which action would the nurse anticipate taking? A. Prepare to administer adenosine 12 mg in 5 minutes after the previous dose. B. Give adenosine 6 mg in 1 to 2 minutes after the previous dose. C. Start adenosine continuous infusion at 12 mg/minute. D. Administer adenosine 12 mg in 1 to 2 minutes after the previous dose.

D. Administer adenosine 12 mg in 1 to 2 minutes after the previous dose. If the patient is does not respond to the first dose of adenosine within 1 to 2 minutes, then the nurse would prepare to administer adenosine 12 mg.

A nurse is reviewing laboratory results on a patient who is taking oral digoxin. Which electrolyte imbalance would the nurse associate with digoxin toxicity? A. Hyponatremia B. Hypochloremia C. Hypophosphatemia D. Hypokalemia

D. Hypokalemia Hypokalemia enhances the risk of cardiotoxicity caused by digoxin.

Which statement by Mr. Torres indicates an understanding of the possible side effects of adenosine? A. "I will feel the need to urinate." B. "I might feel some chest pressure, but it will not last long." C. "I will need to be on medicines for atrial fibrillation." D. "I need to be shocked after the medicine is given to me."

"I might feel some chest pressure, but it will not last long." The patient might experience brief chest pressure with adenosine. Other symptoms the patient may feel include nausea, lightheadedness, head or neck pain, or shortness of breath because of the brief periods of asystole. Because the half-life is less than 10 seconds, these symptoms should resolve quickly.

The nurse monitors the electrical activities of the heart while administering intravenous digoxin because of which potential effects to the heart? Select all that apply. A. Shortening of QR intervals B. Depression of ST segments C. Shortening of PR intervals D. Increase in atrioventricular (AV) conductions E. Inversion of T waves F. Widening of QRS complexes

A, B and E Shortening of QR intervals Digoxin can shorten QR intervals due to accelerated repolarizations of the AV node. Depression of ST segments Digoxin can cause ST segment depressions. Inversion of T waves Digoxin can cause T-wave inversions.

Before administering digoxin, the nurse would conduct a thorough assessment, knowing that digoxin accumulates the highest in which areas of the body? Select all that apply. A. Kidney B. Brain C. Intestine D. Skin E. Heart F. Skeletal muscle

A, C , E and F Kidney Digoxin accumulates mostly in the heart, kidneys, intestine, liver, stomach, and skeletal muscle. Intestine Digoxin accumulates mostly in the heart, kidneys, intestine, liver, stomach, and skeletal muscle. Heart Digoxin accumulates mostly in the heart, kidneys, intestine, liver, stomach, and skeletal muscle. Skeletal muscle Digoxin accumulates mostly in the heart, kidneys, intestine, liver, stomach, and skeletal muscle.

Which therapeutic effect does digoxin have on the heart? Select all that apply. A. Positive inotropic B. Positive chronotropic C. Negative dromotropic D. Increases conductivity E. Negative chronotropic F. Positive dromotropic

A, C and E Positive inotropic Digoxin increases myocardial contractility, a positive inotropic effect, without increasing oxygen demand. Negative dromotropic Digoxin reduces the conductivity of the heart, which is a negative dromotropic effect. Negative chronotropic Digoxin decreases heart rate, which is a negative chronotropic effect.

Which products can increase the risk for digoxin toxicity? Select all that apply. A. Quinidine B. Sucralfate C. Dronedarone D. St. John's wort E. Ginseng F. Bran

A, C and E Quinidine Quinidine can increase digoxin to a toxic level. Digoxin dose may need to be reduced by 50%.. Dronedarone Dronedarone can increase the risk of digoxin toxicity. The dose of digoxin may need to be reduced. Ginseng Ginseng can increase the risk of digoxin toxicity. Avoid ginseng.

Before administering digoxin, which action will the nurse take? A. Assess the apical pulse. B. Take the temperature. C. Auscultate the bowel. D. Auscultate the lungs.

A. Assess the apical pulse. Before administering digoxin, the nurse would assess the apical pulse and blood pressure.

The nurse will anticipate administering a second dose of adenosine shortly after the first dose because the drug is effective for which time frame? A. Less than 10 seconds B. 30 seconds C. 1 minute D. 2 minutes

A. Less than 10 seconds The duration of adenosine is less than 10 seconds. Frequently a second dose of adenosine is required to convert the paroxysmal supraventricular tachycardia into sinus rhythm.

Which parameter would the nurse follow when administering adenosine to a patient to treat supraventricular tachycardia? A. Undiluted and rapidly over 1 to 2 seconds as close to the heart as possible B. Undiluted and slowly in the antecubital fossa C. Diluted and rapidly in 5 mL normal saline as close to the heart as possible D. Undiluted over 1 to 2 minutes at the furthest intravenous port from the patient

A. Undiluted and rapidly over 1 to 2 seconds as close to the heart as possible Adenosine should be administered undiluted as rapidly as possible over 1 to 2 seconds as close to the heart as possible, such as the antecubital fossa. It is then followed immediately with 20 mL of normal saline flush.

A nurse is preparing to administer adenosine through an established intravenous site with intravenous fluids infusing. Which intravenous fluids would the nurse accept as compatible with adenosine? Select all that apply. A. D10W B. 0.9% NaCl C. D5W D. Theophylline drip E. Ringer's lactate

B, C and E 0.9% NaCl 0.9% NaCl (normal saline) is compatible with adenosine. D5W D5W is compatible with adenosine. Ringer's lactate Ringer's lactate is compatible with adenosine.

Digoxin is prescribed to a patient who has been taking verapamil for hypertension. Which dosing change would the nurse anticipate seeing in the prescription? A. An increase in digoxin dose by 50% B. A reduction in digoxin dose by 50% C. A decrease in verapamil dose by 50% D. An increase in verapamil dose by 50%

B. A reduction in digoxin dose by 50% Verapamil decreases digoxin clearance, thereby increasing the effects of digoxin. The dose of digoxin should be decreased by 50%.

A nurse would anticipate that which dysrhythmia will likely develop when adenosine is administered? A. Paroxysmal supraventricular tachycardia (PSVT) B. Asystole C. Premature ventricular contractions (PVCs) D. Atrial fibrillation

B. Asystole The nurse would anticipate asystole when administering adenosine. Asystole is rarely sustained and is resolved quickly.

A patient who has been taking digoxin for several months is now complaining about changes to vision. Which action would the nurse take? A. Discontinue the digoxin. B. Further inquire about the vision changes. C. Hold the drug. D. Notify the health care provider.

B. Further inquire about the vision changes. Vision changes may be normal in this patient, but digoxin can alter vision, such as seeing green, yellow, or purple halos. Therefore the nurse should inquire about the vision changes.

Which channels along the cell's membrane do adenosine affect? A. Sodium B. Potassium C. Calcium D. Magnesium

B. Potassium Adenosine stimulates the adenosine-sensitive potassium channels in the sinoatrial node and internodal tracts.

A patient with a history of heart failure is taking both a diuretic and digoxin. Which substance would the nurse anticipate administering to this patient? A. Intravenous fluids B. Potassium supplement C. Dextrose D. Cortisol

B. Potassium supplement Diuretics can cause potassium loss, increasing the risk of digitalis toxicity. Potassium supplements may be needed.

A nurse is preparing to administer digoxin to a patient who is complaining of nausea. Which action is the nurse's priority? A. Administer an antiemetic. B. Administer potassium. C. Assess for bradycardia. D. Check the digoxin level.

C. Assess for bradycardia. The priority action by the nurse is to assess for bradycardia. Nausea can be related to digoxin toxicity, which can cause bradycardia. Bradycardia may be the first clinical sign of digoxin toxicity.

A patient is being treated with digoxin for atrial fibrillation. Which finding would concern the nurse? A. Decrease of heart rate to 78 beats/min B. A blood pressure of 130/74 mm Hg C. Development of second-degree block D. Evidence of occasional premature ventricular contractions (PVCs)

C. Development of second-degree block Digoxin prolongs the PR interval as a result of the slowed atrioventricular (AV) conduction. Development of second-degree block is a contraindication for digoxin.

A patient's rhythm is now asystole after receiving adenosine. Which action would the nurse take? A. Start cardiac compression. B. Defibrillate with 360 joules. C. Monitor the patient. D. Administer potassium.

C. Monitor the patient. Asystole is common for a few seconds after receiving adenosine. While the patient should still be closely monitored, no treatment is required as a result of the short half-life of the drug.

The nurse will prepare to administer adenosine to a patient with which dysrhythmia? A. Premature ventricular contractions B. Ventricular tachycardia C. Paroxysmal supraventricular tachycardia D. Ventricular fibrillation

C. Paroxysmal supraventricular tachycardia Adenosine is indicated for paroxysmal supraventricular tachycardia. It is not effective in atrial or ventricular dysrhythmias.