Karch: Ch. 45 - Antiarrhythmic Agents
A nurse is monitoring the drug level of a client receiving quinidine. Which serum drug level would the nurse immediately report to the primary health care provider? 6.2 mcg/mL 2.5 mcg/mL 3.8 mcg/mL 4.1 mcg/mL
6.2 mcg/mL
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? 0.25 to 0.75 mg/min 10 to 20 mg/min 1 to 4 mg/min 6 to 8 mg/min
1 to 4 mg/min
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 6 to 8 mg/min 10 to 20 mg/min 0.25 to 0.75 mg/min
1 to 4 mg/min
A patient receives lidocaine IV. The nurse would expect the drug to exert its effects for how long? 90 to 120 minutes 10 to 20 minutes 60 to 90 minutes 30 to 40 minutes
10 to 20 minutes
A client receives lidocaine by intramuscular injection. The nurse would expect the drug to begin to exert its therapeutic effects within which time frame? 30 to 40 minutes 10 to 20 minutes 20 to 30 minutes 5 to 10 minutes
5 to 10 minutes
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." "If the dysrhythmia causes bradycardia, you will be prescribed medication." "You can be assured your cardiologist will prescribe medication therapy if the dysthymia gets progressively worse." "Dysrhythmias that cause tachycardia are the only that can be treated with medications."
"The dysrhythmia you have isn't interfering with getting oxygen to your body tissues so there is no need to treat it."
Which patient would a nurse determine to be at the greatest risk for quinidine toxicity? A 30-year-old pregnant woman A 44-year-old man diagnosed with cardiac insufficiency A 50-year-old woman with myasthenia gravis A 55-year-old man diagnosed with complete heart block
A 44-year-old man diagnosed with cardiac insufficiency
When describing the action of antiarrhythmics, which effect would most likely be included? Alteration in conductivity Enhancement of automaticity Reduction in cardiac output Reduction of peripheral resistance
Alteration in conductivity
The nurse is teaching a male client who is receiving quinidine about foods to avoid. The client demonstrates the need for additional teaching when he identifies the need to avoid: Antacids Apple juice Citrus juices Milk
Apple juice
A client receiving warfarin is prescribed disopyramide. The nurse would monitor for signs and symptoms of what as most important? Bleeding Disopyramide toxicity Renal dysfunction Arrhythmia
Bleeding
Which statement would be true about the mechanism of action of class II antiarrhythmic agents? Block the stimulation of the adrenergic receptors Cause depression in phase 2 of repolarization Block the influx of sodium into the cells Stimulate the uptake of potassium in the tissues
Block the stimulation of the adrenergic receptors
When describing the action of class II antiarrhythmics, which would the nurse include? Membrane stabilization with depression of phase 0 action potential Interference with calcium ion movement across the membrane Blockage of potassium channels during phase 3 action potential Blockage of beta receptors in the heart and kidneys
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 Electrocardiogram Serum electrolyte levels Liver function studies
Blood glucose levels
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? The medication doesn't pass into the breast milk. The safety of this class of antiarrhythmic medications has not been established. The decision to continue breast-feeding should be based on the stress is creates for the woman Breast-feeding must be discontinued and other forms of feeding should be introduced.
Breast-feeding must be discontinued and other forms of feeding should be introduced.
The nurse would instruct a client receiving acebutolol about which adverse effect? Hypertension Increased libido Improved exercise tolerance Bronchospasm
Bronchospasm
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 Nausea Heart palpations Diarrhea
Chest pain Dyspnea Heart palpations
Which best describes the action of class II antiarrhythmics? Competitive block beta receptor sites in the heart and kidneys Block sodium channels in the cell membrane during an action potential Block potassium channels slowing the outward movement of potassium Block the movement of calcium ions across the cell membrane
Competitive block beta receptor sites in the heart and kidneys
A 6-year old client is prescribed lidocaine to treat a ventricular arrhythmia after cardiac surgery. Which nursing intervention is especially important for the safety of this client as long as the therapy is continued? (Select all that apply.) Continuous cardiac monitoring Assess for known allergies Monitor for signs of developmental regression Accurate assessment of weight Regular monitoring of serum lidocaine levels
Continuous cardiac monitoring Regular monitoring of serum lidocaine levels
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? Assess for lidocaine administration in the client's history. Assess the client's nutritional history for allergies. Determine if the client has had a reaction to local anesthesia. Determine the client's ability to swallow.
Determine if the client has had a reaction to local anesthesia.
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? Increased energy Improved functional status Dizziness Improved mentation
Dizziness
A client is prescribed propranolol (Inderal). Which condition in the client's history may affect the treatment regimen? Dizziness Elevated glucose Nausea Diarrhea
Elevated glucose
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.) Polyuria Hypotension Mental confusion Shortness of breath Leg pain
Hypotension Mental confusion Shortness of breath
There are four primary classes of antidysrhythmic drugs. What class consists primarily of potassium channel blockers? I II III IV
III
A client has been prescribed IV amiodarone for emergency treatment of a serious ventricular arrhythmia. The nurse monitors the client's ECG anticipating a noted change how long after the medication is delivered? Immediately 10 minutes 90 minutes 2-3 days
Immediately
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
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
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 anticoagulant effects Increased digoxin level Decreased red blood cell count Decreased white blood cell count
Increased digoxin level
A client is to receive esmolol. The nurse would expect to administer this agent by which route? Oral Intramuscular Intravenous Subcutaneous
Intravenous
A patient is prescribed esmolol for treatment of supraventricular tachycardia. The nurse would expect to administer this drug by which route? Intravenous Oral Subcutaneous Intramuscular
Intravenous
Lidocaine (Xylocaine) is available in a variety of dosage forms. How should a nurse administer lidocaine to a client with a ventricular arrhythmia? Intravenously Intramuscularly Topically Orally
Intravenously
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 inhibits the increase of the refractory period of the cells. It stimulates the sympathetic nervous system. It slows the conduction through the AV node. It produces skeletal muscle relaxation.
It slows the conduction through the AV node.
A client is prescribed disopyramide. The nurse would expect to administer this drug by which route? Subcutaneous Intravenous Oral Intramuscular
Oral
The health care provider has ordered quinidine for a 12-year-old child. The nurse expects to administer this medication in what form? SC Oral IM IV
Oral
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
What is the safest precaution to take when administering an antiarrhythmic drug intravenously (IV)? Choose the BEST response. Administer the drug through new IV line. Relocate the client's room next to the nurse's station. Place the client on a cardiac monitor. Count the apical pulse before administration.
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 condition can an anti-arrhythmic drug be safely administered? Aortic stenosis Premature ventricular contraction Third-degree heart block Severe congestive heart failure
Premature ventricular contraction
Which agent would be classified as a class Ia antiarrhythmic? Flecainide Procainamide Lidocaine Mexiletine
Procainamide
The teaching plan for a client taking amiodarone should include which instruction? Take this medication with grapefruit juice for optimal absorption. Use a reliable form of birth control while taking this medication. Urinary retention is common and no need for concern. Drowsiness is common but will not interfere with any of your usual activities.
Use a reliable form of birth control while taking this medication.
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. Verapamil Propranolol Ibutilide Amiodarone Acebutolol
Propranolol Acebutolol
What important information should be included in a client's education about potential adverse effects of propranolol? Propranolol may cause bronchial and laryngospasms. Propranolol may cause rebound hypertension. Propranolol may cause severe agitation. Propranolol may cause restless leg syndrome.
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? Optic neuropathy Pulmonary toxicity Hypotension Vomiting
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 Tendon reflexes Hydration Visual acuity
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? Procainamide Lidocaine Flecainide Quinidine
Quinine
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
Which factor would necessitate a reduction in the dosage of disopyramide? Immobility Hypertension Renal impairment Chronic diarrhea
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? Orientation and cognition Respiratory assessment Neurological assessment Active and passive range of motion
Respiratory assessment
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. Be prepared to substitute an intramuscular propranolol for several months. Gradually replace the propranolol with newly prescribed metoprolol. Monitor cardiac status at regularly after taking the final dose of propranolol.
Taper down the propranolol dose over a period of 2 weeks.
In some cases, low-dose amiodarone may be used to prevent recurrence of what cardiac disorder? atrial fibrillation angina pectoris ventricular hypertrophy mitral valve regurgitation
atrial fibrillation
A 75-year-old client presents to the physician with a cardiac dysrhythmia. The physician chooses to treat the dysrhythmia because of symptoms related to: diabetic neuropathy. cardiomyopathy. circulatory impairment. MÉniÈre's disease.
circulatory impairment.
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 treat sinus bradycardia accompanied by hypotension To resolve the client's uncompensated heart failure To treat the client's ventricular tachycardia To convert the client's atrial fibrillation to normal sinus rhythm
To convert the client's atrial fibrillation to normal sinus rhythm
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: lidocaine. amiodarone. acebutolol. verapamil.
acebutolol
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 Amiodarone Disopyramide Propafenone
acebutolol
Which class IV calcium channel blocker is exclusively administered to treat acute supraventricular tachycardia? bethanechol chloride chlorambucil diltiazem midazolam hydrochloride
diltiazem
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? peripheral pulses blood pressure level of consciousness oxygen saturation levels
blood pressure
When describing the drugs classified as class IV antiarrhythmics, the nurse would identify these as: calcium channel blockers. beta blockers. cardiac glycosides. vasodilators.
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? every 1-hour monitoring of potassium levels blood pressure monitoring every 10 minutes echocardiography continuous ECG monitoring
continuous ECG monitoring
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
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: increased quinidine effect. digoxin toxicity. bleeding. renal dysfunction.
digoxin toxicity.
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. chronic heart failure secondary to a tachyarrhythmia. idiosyncratic reaction to cinchona derivatives. hypersensitivity to sulfonylureas.
hypersensitivity to beta blockers.
A client is administered diltiazem IV, followed by propranolol IV. The nurse should assess for what potential side effect of this medication combination? anaphylaxis hypertensive crisis impaired myocardial contractility valve regurgitation
impaired myocardial contractility
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: blocking adrenergic receptors and producing antisympathetic effects. inhibiting the movement of calcium ions across the cardiac muscle cell membrane. decreasing sodium and potassium conduction. weakening diastolic depolarization and the action potential duration.
inhibiting the movement of calcium ions across the cardiac muscle cell membrane.
An adult client with a history of coronary artery disease is undergoing cardiac catheterization. What drug should the nurse most likely prepare for administration when the client suddenly begins exhibiting ventricular tachycardia? lidocaine magnesium sulfate (MgSO4) digoxin epinephrine
lidocaine
The primary health care provider prescribes a class I sodium channel blocker to be given intravenously. Which drug would the nurse most likely administer? flecainide disopyramide mexiletine lidocaine
lidocaine
The nurse should advocate for a lower-than-normal dose if the client prescribed quinidine has a history of what medical diagnosis? type 1 or type 2 diabetes primary hypertension liver disease chronic obstructive pulmonary disease
liver disease
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-onset chest pain mitral valve regurgitation acute renal failure new dysrhythmias
new dysrhythmias
The risk for which outcome is increased when a client experiences a drug-to-drug interaction while on amiodarone therapy? hypersensitivity to amiodarone new dysrhythmias hypertensive crisis seizure activity
new dysrhythmias
An adult client with a long-standing dysrhythmia has been taking oral propranolol for the last several months, resulting in acceptable symptom control. What is a priority teaching point for the nurse to communicate to this client? the need to measure the radial pulse for 1 minute prior to each dose of propranolol the importance of not stopping the medication abruptly the need to avoid taking over-the-counter antacids the need to limit intake of high-potassium foods
the importance of not stopping the medication abruptly