NUR 316- PREP U Chap 45
Quinidine is prescribed to a patient with cardiac arrhythmia. When documenting the patient's drug history, the nurse inquires about the concomitant use of any other drug. Which drug when given concomitantly may cause an increase in serum Quinidine levels? Cimetidine Barbiturates Hydantoins Nifedipine
Cimetidine Explanation: Cimetidine, when given concurrently with quinidine, may cause an increase in serum quinidine levels. Barbiturates, hydantoins, and nifedipine cause a decrease in serum quinidine levels.
Flecainide, propafenone, and moricizine are unique in that they have no effect on the repolarization phase but do have what effect? They increase conduction in the ventricles. They decrease conduction in the atria. They increase conduction in the atria. They decrease conduction in the ventricles.
They decrease conduction in the ventricles. Explanation: Flecainide, propafenone, and moricizine are class IC drugs that have no effect on the repolarization phase but greatly decrease conduction in the ventricles.
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? 0.25-0.75 mg/min 10-20 mg/min 1-4 mg/min 6-8 mg/min
1-4 mg/min Explanation: A continuous infusion of lidocaine IV after a bolus is 1-4 mg/minute. The administration of 0.25-0.75 mg/minute would be too small of a dosage. The administration of 10-20 or 6-8 mg/minute would be too large.
A patient receives lidocaine IV. The nurse would expect the drug to exert its effects for how long? 10 to 20 minutes 30 to 40 minutes 60 to 90 minutes 90 to 120 minutes
10 to 20 minutes Explanation: Lidocaine when given IV has a duration of action of 10 to 20 minutes.
A 65-year-old male patient is admitted to the hospital with sinus bradycardia. What is the underlying pathology of sinus bradycardia? A decrease in automaticity A change in the conduction through the AV node A decrease in electrical impulse generation in the SA node An increase in the electrical impulse in the bundle of His
A decrease in automaticity Explanation: When a disorder of impulse formation is present, the rate of SA nodal discharges is altered, allowing changes in the automaticity (ability to generate an impulse spontaneously) of the heart. Decreased automaticity results in sinus bradycardia; increased automaticity results in sinus tachycardia.
A nurse is preparing an in-service presentation about arrhythmias. As part of the presentation, the nurse is planning to include factors that contribute to arrhythmias. Which would the nurse include? (Select all that apply.) Accumulation of waste products Electrolyte imbalances Structural damage to conduction pathways Drug effects Increased oxygen delivery to cells Alkalosis
Accumulation of waste products Electrolyte imbalances Structural damage to conduction pathways Drug effects Explanation: Electrolyte disturbances, decreases in the oxygen delivered to the cells, structural damage in the conduction pathway, drug effects, acidosis, or the accumulation of waste products can trigger arrhythmias.
Which medications are Class II antiarrhythmics? (Select all that apply.) Acebutolol (Sectral) Propranolol (Inderal) Amiodarone (Cordarone) Ibutilide (Corvert) Verapamil (Calan)
Acebutolol (Sectral) Propranolol (Inderal) Explanation: Acebutolol and propranolol are class II antiarrhythmics.
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 Digoxin Verapamil Quinidine
Adenosine Explanation: The drug of choice for treating supraventricular tachycardia when vagal maneuvers have been ineffective is adenosine because it has a short duration of action and is associated with few adverse effects.
An antiarrhythmic drug is prescribed for a client whose apical pulse rate is 100. What is the nurse's best action? Hold the medication. Administer the medication with water. Notify the primary care provider. Perform an electrocardiogram (ECG).
Administer the medication with water. Explanation: When administering an antiarrhythmic drug, withhold the drug and notify the primary care provider when the pulse rate is below 60 beats/minute or above 120 beats/minute. The normal heart rate range for an adult is 60-100 beats per minute.
The nurse is 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? Ventricular tachycardia All acute ventricular arrhythmias Atrial fibrillation All acute atrial arrhythmias
All acute ventricular arrhythmias Explanation: Lidocaine and other Class 1B antiarrhythmic drugs are used to treat all acute ventricular arrhythmias.
When describing the action of antiarrhythmics, which effect would most likely be included? Reduction of peripheral resistance Enhancement of automaticity Alteration in conductivity Reduction in cardiac output
Alteration in conductivity Explanation: Antiarrhythmic agents alter the conductivity or suppress automaticity of the heart.
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 Flecainide Verapamil
Amiodarone Dofetilide Sotalol Ibutilide Explanation: Amiodarone is a class III antiarrhythmic. Dofetilide is a class III antiarrhythmic. Sotalol is a class III antiarrhythmic. Ibutilide is a class III antiarrhythmic. Flecainide is a class Ic antiarrhythmic. Verapamil is a class IV antiarrhythmic.
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: Citrus juices Antacids Milk Apple juice
Apple juice Explanation: Quinidine requires a slightly acidic urine for excretion. Clients receiving quinidine should avoid foods that alkalinize the urine, such as citrus juices, antacids, milk products, and vegetables.
A patient receives propranolol orally at 9:00 AM. The nurse would expect the drug to begin its action at which time? Between 10:00 to 10:30 AM Between 9:20 to 9:30 AM Between 11:30 AM to 12:00 PM Between 12:30 to 1:00 PM
Between 9:20 to 9:30 AM Explanation: Propranolol when given orally has an onset of action of 20 to 30 minutes. It reaches peak action at 60 to 90 minutes.
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 Explanation: 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.
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 Explanation: The combination of insulin used for type 1 diabetes and acebutolol increases the patient's risk for hypoglycemia necessitating close monitoring of the patient's blood glucose levels
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 Explanation: The combination of insulin used for type 1 diabetes and acebutolol increases the patient's risk for hypoglycemia necessitating close monitoring of the patient's blood glucose levels.
The nurse would instruct a client receiving acebutolol about which adverse effect? Hypertension Increased libido Improved exercise tolerance Bronchospasm
Bronchospasm Explanation: Bronchospasm is a possible adverse effect of acebutolol, a class II antiarrhythmic. Other effects include hypotension, decreased libido, and decreased exercise tolerance.
Lidocaine is the prototype of class IB antidysrhythmics used for treating serious ventricular dysrhythmias associated with what conditions? (Select all that apply.) Cardiac catheterization Cardiac surgery Digitalis-induced ventricular dysrhythmias Atrial dysrhythmia caused by diuretics Cardiac arrest
Cardiac catheterization Cardiac surgery Digitalis-induced ventricular dysrhythmias Explanation: Lidocaine is the prototype of class IB antidysrhythmics used for treating serious ventricular dysrhythmias associated with acute myocardial infarction, cardiac catheterization, or cardiac surgery and digitalis-induced ventricular dysrhythmias. It is not intended for use with clients experiencing cardiac arrest.
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? Assess for lidocaine administration in the patient's history Determine the patient's ability to swallow Assess the patient's nutritional history for allergies Determine if the patient has had a reaction to local anesthesia
Determine if the patient has had a reaction to local anesthesia Explanation: Lidocaine is contraindicated in patients allergic to local anesthetic agents. It is important to determine if the patient has been administered lidocaine in the past, but it is imperative to ascertain any untoward effects. The medication will be administered intravenously, so it is not necessary to assess the patient's ability to swallow. However, swallowing can be impaired after administration and should be assessed. It is not necessary to do a nutritional assessment at this time.
A patient is diagnosed with acute supraventricular tachycardia. Which class IV calcium channel blocker is administered intravenously to treat acute supraventricular tachycardia? Bethanechol chloride (Urecholine) Chlorambucil (Leukeran) Diltiazem (Cardizem) Midazolam hydrochloride
Diltiazem (Cardizem) Explanation: Diltiazem is administered intravenously to treat acute supraventricular tachycardia. Bethanechol is used to treat neurogenic bladder. Chlorambucil (Leukeran) is an antineoplastic agent used to treat chronic lymphocytic leukemia. Midazolam hydrochloride is administered to reduce anxiety.
Which arrhythmia would the nurse identify as being related to an alteration in conduction through the heart muscle? Premature atrial contraction Atrial flutter Ventricular fibrillation Heart block
Heart block Explanation: Heart block is an arrhythmia related to an alteration in conduction through the muscle. Premature atrial contraction, atrial flutter, and ventricular fibrillation are arrhythmias due to stimulation from an ectopic focus.
A client is prescribed propranolol (Inderal). Which condition in the client's history may affect the treatment regimen? Nausea Diarrhea Dizziness Elevated glucose
Elevated glucose Explanation: The client with diabetes may experience elevated glucose levels while taking propranolol, and the insulin or oral hypoglycemic drug dosages may need to be adjusted. Nausea, diarrhea, and dizziness are all adverse reactions to propranolol.
Mr. Franks, a 68-year-old male, is treated with lidocaine for frequent premature ventricular contractions after a myocardial infarction. The nurse needs to assess Mr. Franks frequently for adverse reactions that are dose related. What is the most common mild adverse effect of lidocaine therapy? Mood changes Double vision Hallucinations Fatigue
Fatigue Explanation: Adverse effects of lidocaine are seen particularly in the CV system and CNS. CV effects are related to serum levels; the most severe is cardiac depression coinciding with toxic levels of lidocaine. The most common CV effects are cardiac arrhythmias and hypotension. Other effects include bradycardia and CV collapse, which may lead to cardiac arrest. CNS adverse effects also are related to blood concentrations of lidocaine. The most common CNS effects are dizziness, lightheadedness, fatigue, and drowsiness. These common, mild effects are seen with low blood levels of lidocaine and resolve rapidly. As blood levels of lidocaine rise, nervousness, confusion, mood changes, hallucinations, euphoria, tinnitus, blurred or double vision, and a sensation of heat, cold, or numbness may occur.
Which of the following antiarrhythmics would have little effect on the duration of the action potential? Flecainide Procainamide Lidocaine Propranolol
Flecainide Explanation: Flecainide is a Class Ic drug that markedly depresses phase 0, with a resultant extreme slowing of conduction, but has little effect on the duration of the action potential. Procainamide is a Class Ia drug that depresses phase 0 of the action potential and prolongs the duration of the action potential. Lidocaine is a Class Ib drug that depresses phase 0 somewhat and actually shortens the duration of the action potential. Propranolol is a Class II drug that causes a depression of phase 4 of the action potential.
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 Explanation: Clients who are experiencing a dysrhythmia often experience oliguria, hypotension, mental confusion or syncope, or shortness of breath. Leg pain is not a symptom of dysrhythmia.
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 Explanation: Symptoms presenting suggest a cardiac condition. A diseased heart may not be able to maintain an adequate cardiac output with heart rates below 60 bpm above 120 bpm
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 Explanation: The nurse would assess this client for digoxin toxicity because quinidine and digoxin interact, leading to an 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 Explanation: Esmolol, a class II agent, is administered intravenously.
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. It is the drug of choice for clients who experience myocardial infarction. It is the drug of choice for clients with pulmonary edema. It is the drug of choice for the treatment of pneumonia
It is effective in reducing mortality after myocardial infarction. Explanation: Class II beta-adrenergic blockers are being used more extensively because of their effectiveness in reducing mortality after myocardial infarction and in clients with heart failure.
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 speeds conduction. It prolongs the refractory period. It shortens the refractory period. It increases contractility.
It reduces automaticity. It prolongs the refractory period. Explanation: Quinidine, the prototype of class IA antidysrhythmics, reduces automaticity, slows conduction, and prolongs the refractory period. It doesn't increase contractility of the heart muscle.
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 produces skeletal muscle relaxation. 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 slows the conduction through the AV node. Explanation: The major effect of amiodarone is that it slows the conduction through the AV node and prolongs the refractory period. It produces smooth muscle, not skeletal muscle, relaxation. It prolongs the refractory period; it does not inhibit the increase of the refractory period. It blocks the effects of the sympathetic nervous system instead of stimulating it.
Ms. Hall is started on quinidine therapy. What type of arrhythmia would the nurse be using quinidine to treat? Premature ventricular contractions Tachycardia Bradycardia Junctional arrhythmia
Junctional arrhythmia Explanation: Quinidine is used primarily to treat atrial arrhythmias, including premature atrial, AV junctional, paroxysmal atrial (supraventricular) tachycardia, paroxysmal AV junctional rhythm, atrial flutter, and paroxysmal and chronic AFib.
The nurse is administering lidocaine to a client and anticipates a reduced dosage if the client also has which conditions? (Select all that apply.) Liver disorders Alzheimer's disease Right-sided heart failure Ventricular dysrhythmia Rheumatoid arthritis
Liver disorders Right-sided heart failure Explanation: Lidocaine dosages are reduced when a client also has a liver disorder or right-sided heart failure. It would not be reduced when the client has Alzheimer's disease, ventricular dysrhythmia, or rheumatoid arthritis.
When educating a group of nursing students on the classification of various antiarrhythmic drugs, the nurse cites propafenone (Rythmol) as an example of class IC drugs. Which are the general modes of action of drugs in this class? (Select all that apply.) Depressing depolarization (phase 4) Marked depression of phase 0 Slight effect on repolarization Shortening of the action potential duration Profound slowing of conduction
Marked depression of phase 0 Slight effect on repolarization Profound slowing of conduction Explanation: The general mode of action of class IC antiarrhythmic drugs includes marked depression of phase 0, slight effect on repolarization, and profound slowing of conduction. Class IB drugs like lidocaine act by slight depression of phase 0 and shortening of the action potential duration. Calcium channel blockers like verapamil act by depressing the depolarization phase 4.
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 facial erythema Monitor the patient's level of consciousness Monitor normal serum calcium levels Monitor the patient for signs and symptoms of GI upset
Monitor the patient for signs and symptoms of GI upset Explanation: The most common adverse effects of quinidine involve the GI system and include nausea, vomiting, abdominal pain, diarrhea, and anorexia. Calcium levels do not affect the action of the drug. Erythema and changes in LOC are not associated with quinidine.
The nurse is administering intravenous amiodarone to a patient in the emergency department. Which task would the nurse need to prioritize? Checking the patient's urine output Monitoring the patient's blood pressure Giving drinks to the client Explaining the treatment to the patient's family
Monitoring the patient's blood pressure Explanation: Amiodarone has vasodilating effects and decreases systemic vascular resistance. Monitoring the patient's blood pressure for signs of hypotension should be a priority.
All antiarrhythmic medications can cause which of the following? (Select all that apply) New arrhythmias Worsen existing arrhythmias Increased blood pressure Increased blood glucose Increased body temperature
New arrhythmias Worsen existing arrhythmias Increased blood pressure Explanation: All antiarrhythmics can cause new arrhythmias or worsen existing arrhythmias.
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 Explanation: The patient can be safely administered an anti-arrhythmic drug if the patient has premature ventricular contractions. Aortic stenosis, third-degree heart block, and severe congestive heart failure are contraindications for the use of anti-arrhythmic drugs.
A client is prescribed disopyramide. The nurse would expect to administer this drug by which route? Oral Intramuscular Subcutaneous Intravenous
Oral Explanation: Disopyramide is administered orally.
The physician has ordered quinidine for a 12-year-old child. The nurse expects to administer this medication in what form? Oral IM SC IV
Oral Explanation: If quinidine is ordered for a child, it may only be administered orally. It is not intended for IV use. It is not available as IM or SC.
Ms. Smith is started on antiarrhythmic therapy to treat atrial fibrillation. The nurse caring for Ms. Smith knows which occurrence is a potential side effect of this medication? Malignant hyperthermia Shortness of breath Other arrhythmias Angina
Other arrhythmias Explanation: One problem with all antiarrhythmics is their ability to modify the rhythm of the heart; they can cause a new arrhythmia or exacerbate the arrhythmia that they are treating. This adverse effect is termed proarrhythmia.
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 Explanation: The nurse should inform the patient that peripheral edema could be an adverse effect to verapamil therapy. Diarrhea, hyperactivity, and hypertension are not adverse effects associated with verapamil therapy. Other adverse effects associated with verapamil are constipation, mental depression, and hypotension.
Which phase of the cardiac muscle action potential is affected by class I antiarrhythmics? Phase 0 Phase 1 Phase 2 Phase 3
Phase 0 Explanation: Class I antiarrhythmics stabilize the cell membrane by binding to sodium channels, depressing phase 0 of the action potential.
When describing the action of dofetilide, the nurse understands that the drug affects which phase of the action potential? Phase 0 Phase 1 Phase 2 Phase 3
Phase 3 Explanation: Dofetilide is a class III antiarrhythmic that blocks potassium channels and slows the outward movement of potassium during phase 3 of the action potential.
What is the safest precaution to take when administering an antiarrhythmic drug intravenously (IV)? Relocate the client's room next to the nurse's station. Place the client on a cardiac monitor. Count the apical pulse before administration. Administer the drug through new IV line.
Place the client on a cardiac monitor. Explanation: Cardiac monitoring is recommended when drugs are given intravenously and allows for observation of ECG activity, since severe bradycardia and hypotension can occur. Relocating the client does not assess the client's heart activity. Counting the apical pulse before administration is appropriate, but cardiac monitoring allows for continued assessment throughout administration and beyond. Administering the drug through new IV line may be appropriate, but this action does not provide continued cardiac assessment.
A client is receiving adenosine for treatment of supraventricular tachycardia. The nurse understands that this drug results in: Increased conduction through the atrioventricular node Prolonged refractory period Increased automaticity in the atrioventricular node Slowed release of calcium leaving the cell
Prolonged refractory period Explanation: Adenosine slows conduction through the atrioventricular node, prolongs the refractory period, and decreases automaticity through the atrioventricular node. Digoxin used as an antiarrhythmic slows calcium from leaving the cell, prolonging the action potential and slowing conduction and heart rate.
Which agent would a nurse identify as a class Ic antiarrhythmic? Propafenone Quinidine Mexilitene Disopyramide
Propafenone Explanation: Propafenone is a class Ic antiarrhythmic. Quinidine is a class Ia antiarrhythmic. Mexilitene is a class Ib antiarrhythmic. Disopyramide is a class Ia antiarrhythmic.
A patient with a cardiac arrhythmia is admitted to a health care facility. The patient is also experiencing myocardial infarction. Which drug is the health care provider most likely to prescribe for the patient? Acebutolol Amiodarone Propranolol Procainamide
Propranolol Explanation: The health care provider is most likely to prescribe propranolol to the patient. Propranolol is used for the treatment of cardiac arrhythmias, angina pectoris, hypertension, essential tremor, myocardial infarction, migraine headache, and pheochromocytoma. Acebutolol treats ventricular arrhythmias and hypertension. Amiodarone and procainamide are used in the treatment of life threatening ventricular arrhythmias but not myocardial infarction.
Which antidysrhythmic drug is also used to treat a myocardial infarction? Acebutolol (Sectral) Sotalol (Betapace) Propranolol (Inderal) Quinidine
Propranolol (Inderal) Explanation: Propranolol has reduced the risk of death and repeated myocardial infarction in those surviving the acute phase of a myocardial infarction.
Which is true in regards to the drug propranolol (Inderal)? (Select all that apply.) Propranolol is a class III anti-arrhythmic. Propranolol acts by blocking beta-adrenergic receptors of the heart and kidney. Propranolol reduces the release of renin. Propranolol increased excitability of the heart. Propranolol has membrane stabilizing effects.
Propranolol acts by blocking beta-adrenergic receptors of the heart and kidney. Propranolol reduces the release of renin. Propranolol has membrane stabilizing effects. Explanation: Propranolol (Inderal) is a class II anti-arrhythmic that acts by blocking beta-adrenergic receptors of the heart and kidney, reducing the influence of the sympathetic nervous system on theses areas, decreasing the excitability of the heart and the release of renin. Propranolol also has membrane stabilizing effects.
A 68-year-old male patient 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 patient education about potential adverse effects? Propranolol may cause sexual dysfunction. Propranolol may cause rebound hypertension. Propranolol may cause agitation. Propranolol may cause muscle twitching.
Propranolol may cause sexual dysfunction. Explanation: Potential adverse effects of propranolol may include sexual dysfunction.
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 Explanation: Pulmonary toxicity is a potentially fatal adverse effect of amiodarone. Other potentially fatal effects associated with the drug are liver disease and exacerbation of the underlying arrhythmia. Vomiting, hypotension, and optical neuropathy are all potential adverse effects of the drug. Vomiting and optical neuropathy, however, are not life-threatening, and hypotension can typically be controlled by reducing the infusion rate of amiodarone.
What is a life-threatening risk associated with the use of amiodarone? Decreased myocardial contractility Mitral atresia Ventricular irritability Pulmonary toxicity
Pulmonary toxicity Explanation: The FDA has issued a black box warning for amiodarone recommending that it be used only in clients with life-threatening dysrhythmias due to the risk of developing potentially fatal 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 Explanation: During anti-arrhythmic drug therapy, the nurse should closely monitor the patient's pulse rate. A change in the pulse rate and rhythm will help assess a response to drug therapy, the development of signs of CHF, the development of a new cardiac arrhythmia, or worsening of the arrhythmia being treated. It is not necessary to monitor the tendon reflexes, hydration or visual acuity when administering an anti-arrhythmic drug to the patient
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? Lidocaine Quinidine Flecainide Procainamide
Quinidine Explanation: The nurse should consider the drug Quinidine as the cause for these adverse effects. Quinidine toxicity is called cinchonism. Some of its symptoms include ringing in the ears (tinnitus), hearing loss, headache, nausea, vomiting, abdominal pain, dizziness, vertigo, and light-headedness. Lidocaine, flecainide, and procainamide do not cause tinnitus or hearing loss as adverse effects.
A patient 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 Explanation: Disopyramide is excreted in the kidneys and the liver in almost equal proportions. The dose must be reduced in renal insufficiency based on creatinine clearance. The dose does not need to be reduced in immobility, hypertension, or chronic diarrhea.
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? Orientation and cognition Respiratory assessment Neurological assessment Active and passive range of motion
Respiratory assessment Explanation: Amiodarone has several adverse effects that are potentially fatal. Pulmonary toxicity is the most important of these serious adverse effects. Consequently, the nurse should prioritize respiratory assessments over musculoskeletal or neurological assessments.
What should be included in the nurse's ongoing assessment of a client receiving flecainide (Tambocor)? (Select all that apply.) Response to therapy Signs of heart failure Development of new cardiac arrhythmias Worsening of arrhythmia being treated Monitoring of serum flecainide levels
Response to therapy Signs of heart failure Development of new cardiac arrhythmias Worsening of arrhythmia being treated Monitoring of serum flecainide levels Explanation: The nurse should closely monitor the client for a response to drug therapy, signs of heart failure, the development of new arrhythmias, the worsening of arrhythmia being treated, and serum flecainide levels.
Which would be a contraindication for the use of a class II antiarrhythmic? Sinus bradycardia Diabetes Thyroid dysfunction Hepatic dysfunction
Sinus bradycardia Explanation: 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? (Select all that apply.) Skin color Blood glucose Input and output Orientation Level of consciousness
Skin color Orientation Level of consciousness Explanation: The pre-administration assessment of the client's general condition should include observations such as skin color, orientation, level of consciousness, and the client's general status.
The nurse administering a Class I antiarrhythmic drug understands that the action of this drug is to: Stabilize or anesthetize the membranes of cardiac cells Indirectly block calcium channels Prolong repolarization Depress depolarization and lengthen repolarization
Stabilize or anesthetize the membranes of cardiac cells Explanation: Class I antiarrhythmics (sodium channel blockers) stabilize or anesthetize the membranes of cardiac cells. Class II antiarrhythmics (beta-adrenergic blockers) indirectly block calcium channels. Class III antiarrhythmics (potassium channel blockers) prolong repolarization. Class IV antiarrhythmics (calcium channel blockers) depress depolarization and lengthen repolarization.
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 electrolyte disturbances The patient has renal or hepatic disease The patient has cardiogenic shock
The patient has hypotension The patient has aortic stenosis The patient has cardiogenic shock Explanation: The nurse knows that antiarrhythmic drugs are contraindicated in patients with hypotension, aortic stenosis, and cardiogenic disturbances. Arrhythmic drugs are used cautiously and not contraindicated in patients with electrolyte disturbances and renal or hepatic disease.
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 treat sinus bradycardia accompanied by hypotension To resolve the patient's uncompensated heart failure To treat the patient's ventricular tachycardia To convert the patient's atrial fibrillation to normal sinus rhythm
To convert the patient's atrial fibrillation to normal sinus rhythm Explanation: Dofetilide is used to convert patients in atrial fibrillation to normal sinus rhythm and maintain them in sinus rhythm. This drug is not used in the treatment of bradycardia, heart failure, or ventricular arrhythmias.
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. Explanation: 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.
A cardiovascular assessment before administration of an antiarrhythmic medication includes which of the following? Select all that apply. Vital signs Electroencephologram Client's general status Subjective symptoms Apical pulse
Vital signs Client's general status Subjective symptoms Apical pulse Explanation: Before starting therapy with an antiarrhythmic medication, a cardiovascular assessment is done. Vital signs, general status, symptoms, and counting an apical pulse are all parts of a cardiovascular assessment. An electroencephologram (EEG) is done to assess a client's brain activity. An electrocardiogram (ECG) is included in a cardiovascular assessment.
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: take the medication with meals. avoid grapefruit and grapefruit juice. take an aspirin every day. avoid fresh fruit.
avoid grapefruit and grapefruit juice. Explanation: The patient should be instructed to avoid grapefruit and grapefruit juice because they may increase the verapamil level. The patient should also abstain from using alcohol and aspirin while taking this medication. Encouraging the patient to increase her fluid intake and include fresh fruit and fiber in her diet can help prevent constipation. Taking the medication with meals would not enhance its effect.
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: circulatory impairment. diabetic neuropathy. MÉniÈre's disease. cardiomyopathy.
circulatory impairment. Explanation: Cardiac dysrhythmias are common in older adults, but in general only those causing symptoms of circulatory impairment should be treated with antidysrhythmic drugs.
The health care provider orders quinidine for a client who is receiving digoxin. The nurse would monitor this client for: increased quinidine effect. digoxin toxicity. bleeding. renal dysfunction.
digoxin toxicity. Explanation: Quinidine interacts with digoxin, possibly leading to increased digoxin levels and digoxin toxicity. The effects of digoxin, not quinidine, are increased. Bleeding may occur if class I antiarrhythmics are given with oral anticoagulants such as warfarin. Renal dysfunction is unrelated to the use of both drugs.
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 chronic heart failure secondary to a tachyarrhythmia. idiosyncratic reaction to cinchona derivatives. hypersensitivity to beta blockers. hypersensitivity to sulfonylureas.
hypersensitivity to beta blockers. Explanation: Propranolol would be contraindicated in a patient with hypersensitivity to beta blockers since it blocks the beta-adrenergic receptor sites. For the same reason, it would not be contraindicated in chronic heart failure secondary to a tachyarrhythmia, treatable with beta blockers. It would also not be contraindicated in a patient with an idiosyncratic reaction to cinchona derivatives or in a patient with hypersensitivity to sulfonylureas because it is not a cinchona derivative and does not contain sulfonylurea.
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. Explanation: Verapamil acts by inhibiting the movement of calcium ions across the cardiac and arterial muscle cell membrane. It works preferentially in "slow response" myocardial tissue, such as the SA and AV nodes. Beta blockers inhibit adrenergic receptors and Class IB antiarrhythmics are among the drugs that decrease sodium and potassium conduction. Lidocaine weakens phase 4 diastolic depolarization and decreases the action potential duration and the effective refractory period of Purkinje fibers and ventricular muscle.
A patient has questions about the new medication prescribed for cardiac rhythm after having cardioversion performed. The nurse explains how the sodium channel blocker decreases the likelihood of dysrhythmias by: prolonging the refractory period. shortening conduction velocity. increasing automaticity of sodium-dependent cardiac tissue. increasing formation and conduction of electrical impulses.
prolonging the refractory period. Explanation: Sodium channel blockers slow conduction velocity, prolonging refractoriness and decreasing automaticity of sodium-dependent tissue.
