Chapter 30

A client with a dysrhythmia asks the nurse why they cannot take a prescription instead of have cardioversion for treatment? Which response should the nurse provide the client? 1) "Antidysrhythmic prescriptions have many side effects; cardioversion is considered safer." 2) "Special diets are necessary with antidysrhythmic prescriptions, and they are hard to follow." 3) "Antidysrhythmic prescriptions don't really work very well for most dysrhythmias." 4) "There is a high risk of seizures when you take antidysrhythmic prescriptions."

1) "Antidysrhythmic prescriptions have many side effects; cardioversion is considered safer." p. 419

The nurse is assessing a male client prescribed propranolol (Inderal) for adherence to the treatment plan. Which is an important question for the nurse to ask the client? 1) "Have you noticed any changes in your sexual functioning?" 2) "Has your appetite increased or decreased?" 3) "Have you noticed any changes in your bowel function?" 4) "Have you noticed any difficulty in your ability to concentrate?"

1) "Have you noticed any changes in your sexual functioning?" p. 425

Which statement made by a client receiving amiodarone should the nurse be most concerned about? 1) "I have a cough that is getting worse." 2) "I often feel tired throughout the day." 3) "I have lost 5 pounds over the last 3 weeks." 4) "I have a rash on my skin that will not go away."

1) "I have a cough that is getting worse." p. 426

Which information should the nurse include in the education for a client is prescribed an additional once-daily amiodarone to control persistent atrial fibrillation? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1) "I will avoid drinking grapefruit juice." 2) "I understand the effect of the prescription will last 4 to 8 weeks after I stop taking it." 3) "I will monitor my blood pressure and report any significant changes." 4) "I will avoid the use of St John's wort." 5) "I will follow a low sodium diet."

1) "I will avoid drinking grapefruit juice." 2) "I understand the effect of the prescription will last 4 to 8 weeks after I stop taking it." 3) "I will monitor my blood pressure and report any significant changes." 4) "I will avoid the use of St John's wort." p. 424, 426

The nurse has provided education for a client who will self-administer a twice-daily antidysrhythmic prescription. Which statements made by the client indicate further teaching is needed? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1) "If I get the flu, I should stop taking the medication until my fever goes down." 2) "I should take my doses as close to 12 hours apart as I can." 3) "If I forget a dose of the prescription I should take two pills for the next dose." 4) "If I can't take the prescription for a couple of days because I am sick, I should call the clinic for advice." 5) "I should get my prescription refilled before I am completely out of medicine."

1) "If I get the flu, I should stop taking the medication until my fever goes down." 3) "If I forget a dose of the prescription I should take two pills for the next dose." p. 424, 425

Which statements made by a client that has been receiving a prescription for an atrial dysrhythmia indicate the client requires further information? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1) "Since I can't drink coffee anymore, I have started drinking diet cola in the mornings." 2) "I have found that a glass of wine after work and one with dinner helps me to relax from my stressful job." 3) "We have celebrated several birthdays since I saw you last. I love chocolate birthday cake." 4) "I have really worked at stopping my smoking since I was last here." 5) "My friends and I have found several restaurants in our area that offer good, low-fat meals."

1) "Since I can't drink coffee anymore, I have started drinking diet cola in the mornings." 2) "I have found that a glass of wine after work and one with dinner helps me to relax from my stressful job." 3) "We have celebrated several birthdays since I saw you last. I love chocolate birthday cake." p. 424

A client prescribed verapamil (Calan) asks the nurse if it is okay to take herbal supplements with the prescription. Which response should the nurse provide the client? 1) "Some herbal supplements may interact with your prescription." 2) "Using herbal supplements may increase your blood pressure too much." 3) "Herbal supplements are okay as long as you take calcium salts with them." 4) "Most herbal supplements are okay, but you should avoid St. John's wort."

1) "Some herbal supplements may interact with your prescription." p. 428

A client tells the nurse they are nervous about taking prescribed verapamil (Calan). Which response should the nurse provide the client? 1) "This prescription is safe, and most patients do very well with it." 2) "This prescription increases your blood pressure, but we will be monitoring that." 3) "This prescription has many side effects, but you should be okay." 4) "This prescription is a potassium channel blocker and is considered safe."

1) "This prescription is safe, and most patients do very well with it." p. 428

A client states to the nurse, "I read that my antidysrhythmic drug can actually cause me to have irregular heartbeats. How can this be?" Which response should the nurse provide the client? 1) "Your medication blocks the flow of the electrolytes in your heart, and this can cause irregular beats." 2) "The literature is not always accurate, but if you have concerns I recommend discussing them with your healthcare provider." 3) "The aspirin that you take every day will help you avoid experiencing the irregular heartbeats." 4) "Your prescription is not the problem; it is when you mix it with over-the-counter (OTC) drugs that you develop irregular beats."

1) "Your medication blocks the flow of the electrolytes in your heart, and this can cause irregular beats." p. 421

The educator is reviewing the mechanism of action of intravenous glucagon as a treatment for an overdose of propranolol (Inderol) with the nursing staff. Which information should the educator include? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1) Improves AV node conduction 2) Dilates the coronary arteries 3) Increases the heart rate 4) Enhances myocardial contractility 5) Increases the fluid volume in the vascular system

1) Improves AV node conduction 3) Increases the heart rate 4) Enhances myocardial contractility p. 425

Which classification of drug is used to treat ventricular tachycardia? 1) Potassium channel blocker 2) Calcium channel blocker 3) Beta-adrenergic antagonist 4) Sodium channel blocker

1) Potassium channel blocker p. 421

Which assessment findings indicate a client receiving verapamil (Calan) is experiencing adverse effects? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1) The client tells the nurse they have frequent headaches. 2) The client has 3+ edema in the ankles and feet. 3) The client states, "Everything I eat tastes like metal." 4) The client states, "I got so dizzy yesterday that I had to lie down for a while." 5) The client's face is flushed.

1) The client tells the nurse they have frequent headaches. 2) The client has 3+ edema in the ankles and feet. 4) The client states, "I got so dizzy yesterday that I had to lie down for a while." p. 428

Which is the priority outcome for the client with type 1 diabetes mellitus prescribed propranolol (Inderal)? 1) The client will maintain blood glucose within normal limits. 2) The client will decrease the required number of calories/day. 3) The client will maintain adequate peripheral circulation. 4) The patient will perform activities of daily living.

1) The client will maintain blood glucose within normal limits p. 425

Which antidysrhythmic agent also dilates coronary arteries and is frequently used to treat angina? 1) Verapamil (Calan) 2) Amiodarone (Cordarone) 3) Procainamide (Pronestyl) 4) Lidocaine (Xylocaine)

1) Verapamil (Calan) p. 428

A client states to the nurse, "This educational video you gave me shows normal electrical conduction through the heart, but I still don't understand it. Can you explain it to me?" Which responses should the nurse include in the discussion? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1) "Conduction through the bundle of His is the slowest in the heart." 2) "Conduction begins in the sinoatrial (SA) node and travels to the atrioventricular (AV) node." 3) "Conduction continues through the bundle branches to the Purkinje fibers." 4) "Conduction travels from the atrioventricular (AV) node through the bundle of His." 5) "The sinoatrial (SA) node is located in the left atrium."

2) "Conduction begins in the sinoatrial (SA) node and travels to the atrioventricular (AV) node." 3) "Conduction continues through the bundle branches to the Purkinje fibers." 4) "Conduction travels from the atrioventricular (AV) node through the bundle of His." p. 417, 418

The client tells the nurse, "My healthcare provider says I have atrial fibrillation. Is this serious and how is it treated?" Which responses should the nurse provide the client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1) "This condition is best treated with what we call antidysrhythmic drugs." 2) "This is very common; your doctor will discuss the best treatment with you." 3) "Depending on your symptoms, your healthcare provider may use an electrical shock." 4) "This is quite serious; did your healthcare provider discuss a heart transplant?" 5) "It is very serious, even more serious than a ventricular dysrhythmia."

2) "This is very common; your doctor will discuss the best treatment with you." 3) "Depending on your symptoms, your healthcare provider may use an electrical shock." p. 417, 418

Which is the purpose of the AV node? 1) Pace the heart at 40-60 bpm. 2) Delay the impulse from the SA node. 3) Pace the heart at 60-100 bpm. 4) Enhance the impulse from the SA node.

2) Delay the impulse from the SA node. p. 418

Which laboratory value should the nurse notify the healthcare provider prior to administering amiodarone (Cordarone)? 1) Sodium 140 mEq/L 2) Potassium 3.1 mEq/L 3) Potassium 4.9 mEq/L 4) International normalized ratio (INR) of 12 seconds

2) Potassium 3.1 mEq/L p. 426

Which is a client with a heart rate of 170 bpm and a normal QRS duration most likely experiencing? 1) Tachydysrhythmia originating from the bundle branches. 2) Tachydysrhythmia originating from the atria. 3) Tachydysrhythmia originating from the ventricles. 4) Tachydysrhythmia originating from the Purkinje fibers.

2) Tachydysrhythmia originating from the atria. p. 420

The nurse is providing a client education about dysrhythmias. Which statement should the nurse include in the teaching? 1) "Dysrhythmias cause serious electrolyte imbalances; this results in heart block." 2) "Dysrhythmias are the result of longstanding, uncontrolled hypertension." 3) "Dysrhythmias interrupt the normal electrical pathways in the heart so it can't beat properly." 4) "Dysrhythmias alter the blood flow through the heart and cause it to stop beating."

3) "Dysrhythmias interrupt the normal electrical pathways in the heart so it can't beat properly." p. 417

The nurse has completed the education for a client prescribed propranolol (Inderal). Which statement by the client indicates an understanding of the information? 1) "I will take my pulse every day and call my healthcare provider if it is higher than 100." 2) "I will call my healthcare provider if my anxiety increases and I start worrying again." 3) "I will take my pulse every day and call my healthcare provider if it is less than 60." 4) "I will call my healthcare provider if I lose more than 3 pounds a week."

3) "I will take my pulse every day and call my healthcare provider if it is less than 60." p. 425

The nurse has provided education for a client prescribed procainamide hydrochloride (Pronestyl). Which statement made by the client indicates an understanding of the information? 1) "I will not take the prescription on an empty stomach." 2) "This prescription may make me feel confused." 3) "I will take this prescription even when I am feeling well." 4) "If my pulse is less than 60 I will not take my prescription."

3) "I will take this prescription even when I am feeling well." p. 423

Which information should the nurse include in the education for a client prescribed an antidysrhythmic? 1) "Elevate your extremities if you notice any swelling." 2) "Weigh yourself every other day." 3) "Take the first dose of your prescription before bed." 4) "Take your medication while you are lying down."

3) "Take the first dose of your prescription before bed." p. 424

The nurse has provided education about dysrhythmias for a group of clients. Which statement made by a client indicates an understanding of the information? 1) "The sodium, potassium, and magnesium levels must be okay for the heart to have an electrical impulse." 2) "Potassium is the most important electrolyte when it comes to the electrical impulse in the heart." 3) "The sodium, potassium, and calcium levels must be okay for the heart to have an electrical impulse." 4) "Enhancing potassium and sodium is how our prescriptions will work to prevent dysrhythmias."

3) "The sodium, potassium, and calcium levels must be okay for the heart to have an electrical impulse." p. 420

Depolarization occurs when which two electrolytes rush into the cell? 1) Sodium and potassium 2) Calcium and magnesium 3) Calcium and sodium 4) Chloride and potassium

3) Calcium and sodium p. 421

Which occurs initially in the cardiac conduction pathway? 1) The action potential moves over the bundle branches. 2) The action potential moves through the AV node. 3) The SA node generates an action potential. 4) The action potential travels across the bundle of His.

3) The SA node generates an action potential. p. 419, 420

Which current prescription should the nurse be concerned with for the client newly prescribed amiodarone (Cordarone)? 1) Oxycodone (OxyContin) 2) Omeprazole (Prilosec) 3) Warfarin (Coumadin) 4) Fluoxetine (Prozac)

3) Warfarin (Coumadin) p. 426

Which classification of drug is used for the treatment of paroxysmal supraventricular tachycardia (PSVT)? 1) Sodium channel blocker 2) Beta-adrenergic antagonist 3) Potassium channel blocker 4) Calcium channel blocker

4) Calcium channel blocker p. 421

Which adverse effect should the nurse monitor a client for that is prescribed an antidysrhythmic? 1) Depression, irritability, fatigue, and nausea 2) Anorexia, insomnia, confusion, and 2+ pitting peripheral edema 3) Low-grade fever, diaphoresis, weakness, and dry mucous membranes 4) Palpitations, chest pain, weakness, and fatigue

4) Palpitations, chest pain, weakness, and fatigue p. 421

Which adverse effect is shared among all antidysrhythmic drugs? 1) Edema 2) Impotence 3) Photosensitivity 4) Prodysrhythmic effects

4) Prodysrhythmic effects p. 421