Ch. 25 Pharm EAQ antidysrhythmics
A patient visiting the clinic has been taking amiodarone for several months. The nurse observes a bluish discoloration in the patient's skin. Which action by the nurse is most appropriate? Call for the crash cart. Apply a pulse oximeter. Call the health care provider. Apply a nonrebreather oxygen mask.
Apply a pulse oximeter. Assess first. Amiodarone can be absorbed in fat and manifest as a bluish discoloration. Before assuming the patient is cyanotic, the nurse would fully assess the patient by applying a pulse oximeter. If the patient's assessment findings are consistent with hypoxia, the next steps include oxygen application, notifying the health care provider, and possible crash cart retrieval. p. 392
A patient who is diagnosed with heart failure is prescribed digoxin and amiodarone. Which clinical manifestation would the nurse assess for if these medications are co-administered? Bradycardia Constipation Increased bleeding Nausea and vomiting
Bradycardia Amiodarone, when administered with digoxin, increases the risk for bradycardia. Constipation is a side effect of many cardiac medications and may not be specifically attributable to co-administration of digoxin and amiodarone. Amiodarone, when administered with warfarin, may increase the risk of bleeding. Nausea and vomiting are side effects of many cardiac medications, such as procainamide and flecainide; therefore, these side effects may not be attributed specifically to the co-administration of digoxin and amiodarone. p. 391
The nurse is assessing patients who are prescribed acebutolol. A patient with which condition would benefit from the administration of digoxin? Bradycardia Hypotension Bronchospasm Cardiac failure
Cardiac failure A patient who has cardiac failure due to acebutolol toxicity should be managed by digoxin because digoxin is a cardiac glycoside that improves the contractility of the heart. A patient who has bradycardia should be managed by administering 1 to 3 mg of atropine. Vasopressors should be administered to the patient who has hypotension. A patient who has bradycardia should be given 1 to 3 mg of atropine. A patient who has bronchospasm should be administered beta2-adrenergic or theophylline medications to alleviate the toxic effects of acebutolol. p. 395
Which class of drugs has a "cardioprotective" effect? Class Ia Class II Class III Class IV
Class II antidysrhythmics are also known as beta-blockers, which work by blocking sympathetic nervous system stimulation to the heart and the heart's conduction system. By doing so, beta-blockers prevent catecholamine-mediated actions on the heart. This is known as a cardioprotective effect. The resulting cardiovascular effects include a reduced heart rate, delayed atrioventricular node conduction, reduced myocardial contractility, and decreased myocardial automaticity. This effect is not found in class Ia, III, or IV drugs. p. 395
Which class of antidysrhythmic drugs is used for paroxysmal supraventricular tachycardia? Class Ic Class II Class III Class IV
Class IV Class IV drugs (calcium channel blockers) are indicated for the treatment of paroxysmal supraventricular tachycardia, as well as for rate control for atrial fibrillation and flutter. Class Ic drugs are used for ventricular tachycardia and supraventricular tachycardia dysrhythmias, atrial fibrillation and flutter, and Wolff-Parkinson-White syndrome. Class II drugs are given to treat both supraventricular and ventricular dysrhythmias. Class III drugs are used for life-threatening ventricular tachycardia or fibrillation and atrial fibrillation or flutter resistant to other drug therapy. p. 391
The nurse will monitor for which therapeutic effect while administering quinidine? -Shortened repolarization -Reduced blood pressure -Decreased heart rate -Reduced secretions
Decreased heart rate Quinidine, a Class IA antidysrhythmic drug, slows the conduction rate and prolongs repolarization, which decreases heart rate such as in atrial fibrillation with rapid ventricular response. Decreasing heart rate is a therapeutic effect. However, the nurse will need to monitor for heart rate less than 60 beats/minute, indicating bradycardia, which is a side effect of quinidine.
The nurse would monitor for which adverse effect after amiodarone is administered? Select all that apply. Dyspnea Hypertension Photosensitivity Hyperthyroidism Elevated liver enzymes
Dyspnea Photosensitivity Hyperthyroidism Elevated liver enzymes Amiodarone, a class III drug, may lead to pulmonary toxicity (as evidenced by dyspnea and alveolar damage), photosensitivity, thyroid disorders (hypo- or hyperthyroidism), abnormal liver function, and decrease in blood pressure and pulse rate. Amiodarone does not cause hypertension. p. 392
A nurse is caring for a patient who has been started on ibutilide. Which assessment is the priority for this patient? Lung sounds Electrocardiogram (ECG) Blood pressure measurement Blood urea nitrogen and creatinine
Electrocardiogram (ECG) Ibutilide is specifically indicated for treatment of atrial fibrillation and flutter. It is important for the nurse to obtain an ECG to see if the patient has converted to sinus rhythm. Pulmonary and renal side effects are not a concern. Hypotension is a potential side effect but is not a priority assessment in this case. p. 391
When preparing a teaching plan for a patient with a new prescription for amiodarone, which food or drink would the nurse advise the patient to avoid? Gluten Poultry Whole milk Grapefruit juice
Grapefruit juice Grapefruit juice can inhibit the metabolism of several antidysrhythmics such as amiodarone, disopyramide, and quinidine. It is not necessary for the nurse to advise the patient to avoid gluten, poultry, or whole milk because these foods do not interfere with the metabolism of amiodarone. p. 396
A patient taking atenolol and amiodarone by mouth reports not being able to complete his usual exercise routine. The patient attributes this complaint to the medication because the atenolol is a new medication. Which response by the nurse is appropriate? "Feeling tired is normal when you exercise a lot." "As we age, exercising is a challenge and fatigue is normal." "You should report your fatigue to your health care provider." "You should not be exercising at all while taking this medication."
"You should report your fatigue to your health care provider." When beta-blockers are used with an antidysrhythmic, any shortness of breath, weight gain, changes in baseline blood glucose levels, or excess fatigue must be reported to the prescriber immediately. The patient is complaining of excess fatigue in this case because exercise is an activity he "usually" completes without complaint, as inferred from the patient's statement. Feeling tired while exercising is not normal. Exercise should be encouraged. p. 401
Which time frame after administration of flecainide would the nurse expect the onset of action to occur? -15 minutes -3 hours -12 to 27 hours -1-2 days
3 hours Flecainide's onset is 3 hours.
An intravenous bolus dose of diltiazem 0.25 mg/kg over 2 minutes is prescribed for a patient in the cardiac intensive care unit. Diltiazem is available in a 25-mg vial 5 mg/mL. The patient weighs 168 pounds. How many milliliters will the nurse administer? Round the final answer to the nearest tenth. ________mL
3.8mL 168 / 2.2 = 76.36 kg76.36 × 0.25 mg = 19.09 mg19.09 mg/5 mg × mL = 3.8 mL p. 393
The nurse would be least concerned about toxic effects of medication in which patient? 40-year-old treated with lidocaine 34-year-old treated with amiodarone 54-year-old treated with adenosine 68-year-old treated with procainamide
54-year-old treated with adenosine Adenosine has a half-life of only 10 seconds; therefore, toxic effects are least likely with this drug and are self-limiting. The half-life of lidocaine is only 8 minutes, but the risk of toxic effects on the central nervous system can be significant. Amiodarone may take several days to weeks to be completely excreted. An older adult is at higher risk for toxic effects of medications metabolized by the liver and kidneys. Procainamide's half-life is 3 to 4 hours, so effects could last for up to 16 hours. p. 398
The nurse is caring for a patient who is taking amiodarone. The patient has also been on a treatment regimen that includes digoxin. Based on this information, the nurse knows to monitor the patient closely for evidence of which adverse effect? AV block Tachycardia Prolonged QT interval Decreased digoxin levels
AV block The interaction of amiodarone and digoxin can result in AV block or bradycardia (not tachycardia). Prolonged QT interval is an effect of amiodarone and other drugs, such as antifungals and quinidine, not digoxin. Amiodarone and digoxin can lead to an increase in digoxin levels by 50%. p. 392
In order to produce asystole that quickly converts into a sinus rhythm, the nurse administers which drug? Atenolol Diltiazem Adenosine Procainamide
Adenosine Adenosine is an unclassified antidysrhythmic that slows electrical conduction time through the AV node. It commonly causes asystole for a period of seconds before ideally converting to normal sinus rhythm. Repeat doses may be necessary to achieve desired results. Atenolol is a class II antidysrhythmic, or beta-blocker. Diltiazem is a class IV antidysrhythmic, or calcium channel blocker. Procainamide is a class Ia antidysrhythmic drug. None of these drugs cause a short period of asystole. p. 398
Which common adverse effect is found with the use of beta-blockers? Altered blood glucose levels Prodysrhythmic effect Pulmonary toxicity Torsades de pointes
Altered blood glucose levels The most commonly reported adverse effects with using beta-blockers, or class II antidysrhythmic drugs, include altered blood glucose levels, bradycardia, hypotension, dizziness, fatigue, atrioventricular block, heart failure, wheezing, dry mouth, and impotence. Many antidysrhythmics are themselves capable of producing new dysrhythmias such as the prodysrhythmic effect found with the use of propafenone, a class Ic antidysrhythmic drug. Pulmonary toxicity is an adverse effect found with the use of amiodarone, a class III antidysrhythmic drug, whereas torsades de pointes is a side effect of dofetilide, another class III antidysrhythmic drug. p. 392
The nurse recognizes which drug as a class III antidysrhythmic? Atenolol Lidocaine Verapamil Amiodarone
Amiodarone Class III drugs, such as amiodarone, prolong repolarization in phase 3. Atenolol is a class II beta-blocker that depresses phase 4 of depolarization. Lidocaine is a class I membrane-stabilizing antidysrhythmic. Verapamil is a class IV calcium channel blocker that depresses phase 4 depolarization. p. 393
Which condition necessitates a dosage reduction of 50% for lidocaine? Epilepsy Liver cirrhosis Tuberculosis Lung disease
Liver cirrhosis Because of lidocaine's extensive hepatic metabolism, a dosage reduction for this drug of 50% is recommended for patients with liver failure or cirrhosis. Dosage reductions may also be necessary in patients with renal impairment. Epilepsy, tuberculosis, and lung disease do not necessitate a 50% dosage reduction of lidocaine for treatment, as they do not involve the liver. p. 394
Which medication would make a patient prone to dry mouth and wheezing? Ibutilide Quinidine Metoprolol Amiodarone
Metoprolol Metoprolol is a beta-blocker and might cause dry mouth and wheezing as a side effect; therefore, the nurse would teach the patient about methods to manage dry mouth and wheezing. A patient who is taking ibutilide might experience nonsustained ventricular tachycardia but not dry mouth. A patient who is taking quinidine might experience hypotension and a prolonged QT interval and not dry mouth or wheezing. A patient who is taking amiodarone might experience pulmonary toxicity. p. 392
Which symptom, if reported by a patient recently started on quinidine, would the nurse find most concerning? -Headache -Diarrhea -Dizziness -Shortness of breath
Shortness of breath Following initiation of quinidine therapy may be a symptom of a pulmonary embolus. A clot, dislodged from the atria once sinus rhythm is reestablished, can travel to the pulmonary system and can be fatal. This symptom would be the most concerning to the nurse.
The nurse can safely administer verapamil to a patient with which vital signs? Apical pulse of 58 beats/min Radial pulse of 110 beats/min Cardiac monitor rate of 60 beats/min Systolic blood pressure of 110 mmHg
Systolic blood pressure of 110 mmHg Verapamil may be administered to manage abnormal rhythms and is to be given only after checking and documenting pulse rates and blood pressure. Contact the prescriber and withhold the drug (if supported by facility policy and the prescriber's guidelines) if the pulse rate is 60 beats/min or lower or 100 beats/min or higher and/or the systolic blood pressure is 90 mm Hg or lower. p. 398
The nurse is caring for a patient who has been experiencing ventricular dysrhythmias without atrial involvement. The nurse anticipates that the patient will be placed on which class of drug? Class II drug Class Ia drug Class Ib drug Class Ic drug
The class Ib drug lidocaine is given for ventricular dysrhythmias only. Class Ia, Ic, and II drugs are used to treat dysrhythmias with atrial, supraventricular, and ventricular involvement. p. 390
The nurse has administered quinidine parenterally and would carefully monitor the patient for which adverse effect? Select all that apply. Tinnitus Diarrhea Hypertension Blurred vision Increased appetite
Tinnitus Diarrhea Blurred vision Adverse effects for class I antidysrhythmic drugs include tinnitus, diarrhea, blurred vision, hypotension (not hypertension), anorexia, rash, electrocardiogram changes, bitter taste, gingival hyperplasia, decreased (not increased) appetite, decreased blood pressure, and pulse rate. p. 394
The nurse is caring for a patient who is prescribed amiodarone. Which assessment would the nurse perform to identify adverse effects of this medication? Select all that apply. One, some, or all responses may be correct. Visual changes Bilirubin levels Respiratory rate Echocardiogram Complete blood count
Visual changes Bilirubin levels Respiratory rate Echocardiogram A patient who is taking amiodarone may develop visual changes, pulmonary toxicity, jaundice, bradycardia, QT prolongation, and torsades de pointes, so the nurse would monitor the patient's vision, bilirubin levels, respiratory rate, and echocardiogram results to reduce the incidence of adverse drug reactions in the patient. Complete blood count would be monitored in patients who are on procainamide to identify potential agranulocytosis. p. 392
The nurse is caring for a patient who is prescribed amiodarone. Which assessments should the nurse perform to identify adverse effects of this medication? Select all that apply. Visual changes Bilirubin levels Respiratory rate Echocardiogram Complete blood count
Visual changes Bilirubin levels Respiratory rate Echocardiogram A patient who is taking amiodarone may develop visual changes, pulmonary toxicity, jaundice, bradycardia, QT prolongation, and torsades de pointes, so the nurse would monitor the patient's vision, bilirubin levels, respiratory rate, and echocardiogram results to reduce the incidence of adverse drug reactions in the patient. Complete blood count would be monitored in patients who are on procainamide to identify potential agranulocytosis. p. 392
Verapamil 0.3 mg/kg × one dose is prescribed for a 5-year-old child. Verapamil is available for injection in vials of 2.5 mg/mL. The child weighs 52 pounds. How many milliliters should the nurse administer? Round final answer to the nearest tenth. _______mL
52/2.2 = 23.64 kg0.3 × 23.64 = 7.09 mg7.09 mg × 1 mL = 2.8 mL2.5 mg p. 393
The patient with which medical condition will most likely benefit from lidocaine administered intravenously? -Acute ventricular tachycardia -Deep laceration to the leg -Atrial fibrillation -Dental caries
Acute ventricular tachycardia Lidocaine administered intravenously is indicated for patients with ventricular dysrhythmias, such as acute ventricular tachycardia.
The cardiac monitor alarm alerts the nurse that a patient is experiencing paroxysmal supraventricular tachycardia (PSVT) with a heart rate of 180 beats/min. Which fast-acting medication would the nurse expect to administer? Lidocaine Adenosine Epinephrine Amiodarone
Adenosine Adenosine is an unclassified antidysrhythmic drug. It slows the electrical conduction time through the AV node and is indicated for the conversion of PSVT to sinus rhythm. Lidocaine, epinephrine, and amiodarone are not the preferred drugs for PSVT. p. 398
A patient with blood pressure of 124/74 mm Hg has been prescribed metoprolol after a recent myocardial infarction. Which best answers if the patient asks why metoprolol has been prescribed? For many reasons, not just to control blood pressure To help relax the blood vessels in the cardiovascular system After a heart attack, to help keep blood pressure under control After a heart attack, to help decrease the chance for sudden cardiac death
After a heart attack, to help decrease the chance for sudden cardiac death Metoprolol is a cardioselective beta-blocker commonly given after a myocardial infarction to reduce the risk of sudden death. Metoprolol relaxes the blood vessels and is used to treat other conditions such as hypertension and angina, but these responses are not specifically applicable to the patient's current condition. p. 395
The nurse is administering a class IV antidysrhythmic drug to a patient. How would the nurse evaluate for the therapeutic effectiveness of the medication? Select all that apply. Assess pain Monitor cardiac output Check blood pressure Count ventricular rate Listen to breath sounds Check for pupil constriction
Assess pain Monitor cardiac output Check blood pressure Count ventricular rate Class IV antidysrhythmic drugs are calcium channel blockers. Chest pain assessment, cardiac monitoring, blood pressure, and ventricular rate are all assessments that can be performed to evaluate the effectiveness of calcium channel blockers. These drugs are also prescribed to treat hypertension and angina. Verapamil and diltiazem are most commonly used for treating dysrhythmias, specifically those that arise above the ventricles, and for controlling the ventricular response to atrial fibrillation and flutter by slowing conduction of the AV node, which prevents the ventricles from beating as fast as the atria. Breath sounds and pupil responses are not expected to be affected by calcium channel blockers. p. 390
A patient has received three times the prescribed dose of propafenone in error. The charge nurse is called into the room and observes that the patient is unresponsive with no pulse. Which is the nurse's priority action? Notify the health care provider. Place the patient on cardiac monitoring. Start an IV line with a large-bore catheter. Begin cardiopulmonary resuscitation (CPR) efforts.
Begin cardiopulmonary resuscitation (CPR) efforts. The main effects of the antidysrhythmics involve the heart, circulation, and central nervous system. Specific antidotes (reversal agents) are not available, and the management of an overdose involves maintaining adequate circulation and respiration using general support measures (such as CPR) and providing any required symptomatic treatment. Early chest compressions and defibrillation, as indicated, are recommended ASAP by the American Heart Association's 2015 guidelines. CPR beginning with chest compressions should be initiated right away, followed by notifying the health care provider. When help arrives, the patient can then be placed on a cardiac monitor and an IV line can be started. p. 389
Before administering quinidine, the nurse would assess the patients for which contraindication? -Atrial fibrillation -Complete heart block -Atrial Flutter -Ventricular tachycardia
Complete heart block Complete heart block is a contraindication for administration of quinidine.
Which food or beverage is appropriate to include when developing a dietary teaching plan for a patient started on antidysrhythmic medication without a history of heart failure? Select all that apply. Chocolate More citrus fruits Decaffeinated coffee Eight glasses of water daily Extra servings of dairy products
Decaffeinated coffee Eight glasses of water daily When developing dietary teaching, recommend a well-balanced diet without an excess of alkaline ash foods (e.g., citrus fruits, vegetables, milk). The patient should be educated to limit or avoid caffeine intake. Decaffeinated coffee is a reasonable alternative to regular coffee. Encourage an increase in fluid intake of up to eight glasses of water a day, unless contraindicated. Chocolate, tea, some soft drinks, and energy drinks contain caffeine and should be avoided.STUDY TIP: Develop a realistic plan of study. Do not set rigid, unrealistic goals. pp. 401-402
Which medication reduces activity in the sinoatrial (SA) node? Esmolol Diltiazem Lidocaine Dofetilide
Esmolol Esmolol reduces activity in the SA node. Diltiazem prolongs the atrioventricular nodal-effective refractory period. Lidocaine has minimal effect on the SA node and automaticity. Dofetilide prolongs the effective refractory period.
Which antipsychotic drug prolongs the QT interval? Haldoperidol Droperidol Sotalol Terbutaline
Haldoperidol Antipsychotic drugs that prolong the QT interval include haldoperidol, pimozide, thioridazine, chlorpromazine, risperidone, clozapine, and quetiapine. Droperidol is an antinauseant that prolongs the QT interval. Sotalol, an antidysrhythmic, and terbutaline, a bronchodilator, both prolong the QT interval. p. 393
Which method of administration of diltiazem by the nurse is correct? Intravenous (IV) tubing in a delivery pump Drawing up the medication in a heparin flush Pushing IV over 30 seconds. Hanging the medication secondary to a free-hanging dextrose solution.
Intravenous (IV) tubing in a delivery pump It is recommended that an infusion pump be used for IV dosing of any of the classes of antidysrhythmics, with proper solution and dilution. A diltiazem drip should be hung as a primary IV drip. IV incompatibilities should be checked before administration, including heparin. Diltiazem should not be injected quickly. Dextrose is incompatible with many medications. p. 393
Which medication acts by blocking sodium channels, accelerating repolarization, and decreasing the duration of the action potential? Lidocaine Verapamil Propafenone Dronedarone
Lidocaine Lidocaine acts by blocking the sodium channels, accelerating repolarization, and decreasing the action potential duration. Verapamil is a calcium channel blocker, which works by inhibiting the calcium channels, resulting in a shortening of the action potential. Verapamil delays repolarization. Propafenone also acts by blocking sodium channels but has little effect on repolarization or action potential duration. Dronedarone increases the action potential duration by prolonging repolarization in phase 3. p. 389
The nurse knows that which structure in the heart is referred to as the pacemaker? SA node AV node Bundle of His Purkinje fibers
SA node The SA node is the pacemaker because it can spontaneously depolarize faster and more easily than the other areas. After the pacemaker (SA node) triggers an electrical impulse, the electrical pulse travels through the AV node to the bundle of His and Purkinje fibers.Test- p. 386
Which medication increases the duration of the action potential by prolonging repolarization in phase 3? Sotalol Verapamil Flecainide Adenosine
Sotalol increases the action potential duration by prolonging repolarization in phase 3. It also has beta-blocking properties. Verapamil acts by blocking the calcium channels. Flecainide blocks the sodium channel but does not have a pronounced effect on the duration of the action potential or repolarization. Adenosine acts by several mechanisms and does not fall under one particular category. p. 392
The patient demonstrates understanding of the nurse's teaching about quinidine when the patient makes which statement? "I should always take this medicine on an empty stomach." "I should call my doctor immediately if my ears are ringing." "There are different salt forms that I can take interchangeably." "Lightheadedness is expected. I should just change positions slowly."
"I should call my doctor immediately if my ears are ringing." During treatment with quinidine (or with any of the antidysrhythmics), immediately report any patient complaint of tinnitus, lightheadedness, angina, hypotension, loss of appetite, or diarrhea to the prescriber. Advise patients that oral dosage forms of antidysrhythmics are generally better tolerated if taken with food and fluids to help minimize gastrointestinal upset, unless otherwise prescribed. Quinidine comes in different salt forms, and these are not interchangeable. p. 394
The health care provider has prescribed amiodarone for a patient with ventricular dysrhythmias. The nurse verifies the patient's medical history; the nurse would notify the health care provider if the patient makes which statement? "I get faint when I see needles." "I wear eyeglasses to read print up close." "I take a blood thinner so I don't get clots." "I break out in a rash when I take antibiotics."
"I take a blood thinner so I don't get clots." Amiodarone has two very significant drug interactions, namely with digoxin and warfarin. Patients often refer to anticoagulants as "blood thinners." The nurse would verify which medication the patient is taking, then notify the health care provider. When amiodarone is prescribed in patients taking warfarin, it is recommended to reduce the dose of warfarin by 50% at the start of warfarin therapy. The nurse can provide emotional reassurance and compassionately administer the amiodarone to help reduce the patient's fears. The patient may get faint at the sight of needles; however, the priority of care is to eliminate dysrhythmias. Amiodarone's adverse effects include visual halos, photophobia, and dry eyes, but wearing eyeglasses is not a contraindication. Amiodarone is an antidysrhythmic, and there should be no cross-sensitivities with antibiotics. p. 392
A patient that has been started on oral quinidine calls the clinic reporting that he has had a lot of "ringing" in his ears. Which response by the nurse is appropriate? "Earplugs are helpful at night." "Decrease your dose by half." "Stop the medication immediately." "I'll talk to the prescriber right away."
"I'll talk to the prescriber right away." Quinidine can cause cinchonism; symptoms of mild cinchonism include tinnitus, loss of hearing, slight blurring of vision, and gastrointestinal upset. The nurse would report signs of tinnitus to the prescriber right away. Recommending earplugs is not the most effective treatment for this patient. The symptoms should be reported to the prescriber. The nurse would not suggest dose adjustments without consulting the prescriber. An abrupt discontinuation of these drugs may lead to severe or life-threatening complications. p. 394
A patient with a history of gastroesophageal reflux asks the nurse if it is okay to take over-the-counter medication for heartburn with the newly prescribed antidysrhythmic drug. Which response by the nurse is correct? "An over-the-counter antacid is fine to take with your antidysrhythmic." "It's best to take the antidysrhythmic on an empty stomach if heartburn occurs." "Take an antacid, if needed, 2 hours before or 2 hours after the antidysrhythmic." "You can take an antacid along with the antidysrhythmic 30 minutes before eating."
"Take an antacid, if needed, 2 hours before or 2 hours after the antidysrhythmic." If an antacid is needed, it must be taken either 2 hours before or 2 hours after the drug to avoid interference with drug absorption. An antacid is fine to take; however, the more specific instructions of when to take the antacid should be provided to the patient. Antidysrhythmics can be taken with food if gastrointestinal upset occurs. p. 401
The health care provider discontinues a patient's quinidine and prescribes procainamide. The patient asks the nurse about the possible side effects of this medication. Which response by the nurse is correct? "Take this medication with food to relieve an upset stomach." "Use over-the-counter steroid cream if a red, swollen rash occurs." "Taking an antacid with this medication will relieve digestive problems." "Diphenhydramine can be taken with the medication if you develop a rash or breathing problems."
"Take this medication with food to relieve an upset stomach." All antidysrhythmics can be taken with food to relieve an upset stomach. The patient should be instructed to notify the prescriber, rather than using a steroid cream, if any type of rash or breathing problems develop. These may be signs of hypersensitivity or a systemic lupus erythematous-like syndrome that can develop in about 30% of patients taking procainamide long term. Antacids should be taken 2 hours before or 2 hours after taking antidysrhythmic drugs to avoid interfering with drug absorption. If the patients develops a rash, it should be reported to the prescriber versus recommending taking diphenhydramine. p. 393
A patient telephones the clinic and asks the nurse if he should still take today's "heart pills" since he noticed a waxy shell that looked like a pill capsule in his bowel movement yesterday. Which response by the nurse is correct? "Wait 24 hours to make sure all of yesterday's dose is out of your system." "The wax is part of the capsule shell, but the drug is still getting absorbed." "I need to discuss this situation with the prescriber, and I will call you back." "After today's bowel movement, take the medication if there is no waxy shell."
"The wax is part of the capsule shell, but the drug is still getting absorbed." Some dosage forms are delivered in a sustained-released tablet or capsule that may be composed of a wax matrix, and this matrix may be visible in the patient's stool. This extended-release dosage form provides for a slow release of the medicine, and the wax substance may then be passed out of the body through the stool. The nurse would advise patients that the passing of the matrix through the stool occurs after the drug has been absorbed, and although the matrix is often visible to the naked eye, it is of no major concern. The patient does not need to wait 24 hours or for the next bowel movement to take the next dose. The waxy shell is an expected finding, and the prescriber does not need to be notified. p. 401
A nurse is caring for a patient who is prescribed procainamide. Which nursing action is appropriate when providing care to the patient? Monitoring for tachycardia Measuring blood pressure regularly Assessing for signs of thrombophlebitis Asking the patient about any changes in vision
A patient who is prescribed procainamide may develop hypotension; therefore, the nurse would measure the patient's blood pressure regularly to assess for this complication. Tachycardia is an adverse effect of propafenone. Thrombophlebitis is an adverse effect of phenytoin. A patient who is on flecainide might experience visual disturbances. p. 393
A nurse is providing care to several patients on a medical-surgical unit. The nurse understands that the patient taking which medication would benefit from thyroid studies? Sotalol Atenolol Diltiazem Amiodarone
Amiodarone Amiodarone has iodine in its chemical structure, which may affect the thyroid gland; therefore, this patient would benefit from regular thyroid function tests to monitor for toxicity. The patient who is taking sotalol might experience bradycardia and chest pain, so regular monitoring of cardiac function would be required. The patient who is taking atenolol may have bradycardia, hypotension, and atrioventricular block; therefore, assessment of cardiac function would be important. Diltiazem medication may cause constipation, bradycardia, heart block, and hypotension; this patient might need regular assessment of bowel movements and cardiac function. p. 396
Which drug has an immediate onset of action and peak plasma concentration and is used when verapamil has been ineffective or is contraindicated? Sotalol Dofetilide Diltiazem Adenosine
Adenosine Adenosine, an unclassified antidysrhythmic drug that slows the electrical conduction time through the atrioventricular node, has an immediate onset of action and reaches peak plasma concentration almost immediately. It is indicated for the conversion of paroxysmal supraventricular tachycardia (PSVT) to sinus rhythm and is particularly useful when the PSVT has failed to respond to verapamil or when the patient has coexisting conditions such as heart failure, hypotension, or left-ventricular dysfunction that limit the use of verapamil. Sotalol, a class III antidysrhythmic drug, is a selective beta-blocker with an onset of action of 1-2 hours and a time to peak plasma concentration of 2.5-4 hours. Dofetilide is a class III antidysrhythmic drug used to treat life-threatening ventricular tachycardia or fibrillation and atrial fibrillation or flutter resistant to other drug therapy and has an onset of action of 1 hour and time to peak plasma concentration of 2-3 hours. Diltiazem, a class IV antidysrhythmic drug primarily indicated for the temporary control of a rapid ventricular response in patients with atrial fibrillation or atrial flutter and PSVT, has an onset of action of 0.5-1 hour and a time to peak plasma concentration of 2-3 hours. p. 398
Before administering amiodarone, which assessment is most important for the nurse to complete? Temperature Skin integrity Allergy history Respiratory rate
Allergy history Use of amiodarone is contraindicated in patients who have a known hypersensitivity to the drug. Elevated temperature, altered skin integrity, and decreased or increased respiratory rate are not contraindications. The other absolute contraindications include severe sinus bradycardia or second- or third-degree heart block. p. 396
A nurse is caring for a patient who is taking lidocaine. For which adverse effect would the nurse monitor in the patient? Anorexia Bradycardia Bronchospasm Prodysrhythmic effect
Bradycardia Bradycardia is an adverse effect of lidocaine, for which the nurse would monitor in the patient. Anorexia is an adverse effect of quinidine but is not associated with lidocaine. Bronchospasm is a potential side effect of beta-blockers. Prodysrhythmic effects are observed in patients who are taking propafenone. p. 394
Which class of drugs in the Vaughan Williams classification system is emerging as among the most widely used antidysrhythmics? Class I Class II Class III Class IV
Class III The Vaughan Williams classification, based on the electrophysiologic effect of particular drugs on the action potential, identifies four major classes of antidysrhythmics: I (including Ia, Ib, and Ic), II, III, and IV. Class III drugs have emerged as among the most widely used antidysrhythmics at this time. There is currently a gradual trend away from the use of class Ia drugs. The formerly available class Ic drug encainide was removed from the market after research indicated a high risk for fatal cardiac dysrhythmias. The role of class II drugs (beta-blockers) continues to grow in the field of cardiology, including in the management of dysrhythmias. The class IV drugs (calcium channel blockers) have limited usefulness in treating tachydysrhythmias (dysrhythmias involving tachycardia), unlike most of the other classes.
The nurse is caring for a patient who has been experiencing atrial fibrillation that has been resistant to drug therapy. The nurse anticipates that the patient will now be placed on which class of drug? Class II drug Class Ic drug Class III drug Class IV drug
Class III The class III drugs are given for atrial fibrillation that is resistant to other drug therapy. Class Ic, II, and IV drugs are used to treat dysrhythmias with atrial, supraventricular, and ventricular involvement, although class III is specific to the treatment of atrial fibrillation that has been resistant to these other classes. p. 391
Verapamil has been administered to a patient parenterally. The nurse would closely monitor for which adverse effect of this drug? Select all that apply. Dizziness Decreased blood pressure Complaints of constipation Equivocal atrial and ventricular rates Heart block evident on cardiac monitor
Dizziness Decreased blood pressure Complaints of constipation Heart block evident on cardiac monitor Verapamil is a class IV antidysrhythmic drug, or calcium channel blocker. These drugs are associated with dizziness, hypotension, constipation, heart block, and dyspnea. Verapamil can temporarily control a rapid ventricular response to frequent atrial stimulations. When effective, verapamil assists in matching the atrial and ventricular rates. p. 392
The patient who is receiving antidysrhythmic drugs exhibits increased cardiac output, increased activity tolerance, a blood pressure of 130/75, and a pulse of 86 and has voided 400 mL of urine during the past 8-hour shift. Which action by the nurse is appropriate? Notify the health care provider. Increase the continuous intravenous fluid rate. Document the findings in the patient's medical record. Place the patient in the Trendelenburg position to improve venous return.
Document the findings in the patient's medical record. In general, therapeutic effects for antidysrhythmic drugs include improved cardiac output, decreased chest discomfort, decreased fatigue, improved skin color and urinary output, and conversions of heart irregularities to normal rhythm. The findings are reassuring. The health care provider does not need to be notified, and the patient does not require repositioning. The dose requires no adjustment, as the patient has demonstrated therapeutic effectiveness of the drug. p. 400
When administering adenosine, which action by the nurse is correct? Give the medication in an intravenous (IV) push over 12 to 15 seconds. Ensure patency and placement of a larger-bore IV catheter. Remind the patient not to chew or crush sustained-release tablets. Check IV compatibility before mixing in lactated Ringer solution.
Ensure patency and placement of a larger-bore IV catheter. Adenosine must be given IV push very quickly, so IV patency and placement must be verified before administration. The half-life of adenosine is less than 10 seconds; administering the drug over 12 to 15 seconds is too slow for the medication to reach the heart and take effect. The drug is available only in parenteral form, not in tablets. Adenosine is not mixed with IV solution and is hung. It is given undiluted via IV push very rapidly, immediately followed by a saline flush. p. 398
A patient has been prescribed amiodarone. Which topic would the nurse include when teaching the patient about this medication? Select all that apply. Gastrointestinal (GI) upset Sunscreen use High-fiber diet Decreased fluid intake Photophobia and wearing sunglasses
Gastrointestinal (GI) upset Sunscreen use High-fiber diet Photophobia and wearing sunglasses Amiodarone may lead to GI upset, which may be prevented or decreased by taking the drug with food or a snack. Photosensitivity (sunburn and other exaggerated skin reactions to the sunlight) and photophobia (light sensitivity) are other concerns with this drug. With photosensitivity, protective clothing/hat and sunscreen are needed. Emphasize protection of the eyes by wearing sunglasses and/or tinted contact lenses for patients taking this medication. Recommend consumption of a high-fiber diet and increased fluids to minimize constipation, which is a common side effect of antidysrhythmic drugs. p. 391
The patient has received a dose of esmolol. The nurse would carefully monitor for which adverse effect? Select all that apply. Tachycardia Hypotension Bronchospasm Decreased cardiac output Capillary blood glucose 145 mg/dL
Hypotension Bronchospasm Decreased cardiac output Capillary blood glucose 145 mg/dL Beta-blockers can be prescribed to treat blood pressure and angina. Class II beta-blockers such as esmolol may cause hypotension, bronchospasm, bradycardia (not tachycardia), AV block, and heart failure (decreased cardiac output), and changes in blood glucose levels. p. 392
Which is the most appropriate outcome criterion for a patient who has been prescribed an antidysrhythmic medication? Increased cardiac output Weight gain of 5 lb in 1 week Systolic blood pressure 90 mmHg Palpated radial and pedal pulses
Increased cardiac output The most appropriate outcome criteria when taking antidysrhythmic medications are that the patient's symptoms of dysrhythmia and subsequent cardiac output are decreased and/or alleviated. Weight gain of 5 pounds or more in 1 week is of concern, and the prescriber should be notified. Heart failure may be developing or worsening if the patient already has known heart failure. The systolic blood pressure should be greater than 90 mm Hg. The patient's peripheral pulses should be equal, strong, and regular bilaterally with warm, pink extremities. p. 399
A 100-mg IV bolus of lidocaine is prescribed for a patient experiencing ventricular dysrhythmias. Which available lidocaine medication would the nurse use to prepare this bolus? Lidocaine vial of clear solution Lidocaine 1% vial of light yellow solution Lidocaine with epinephrine vial of clear solution Lidocaine premixed in 50 mL of normal saline prepared within the past 48 hours
Lidocaine vial of clear solution Lidocaine vials should contain clear solution labeled as cardiac or not for cardiac use. The plain solution is used for cardiac conditions. Lidocaine with epinephrine must never be used intravenously and is only to be used as a topical anesthetic. Parenteral solutions of these drugs are usually stable for only 24 hours. p. 393
Which medication prolongs the effective refractory period? Atenolol Lidocaine Propafenone Procainamide
Procainamide Procainamide prolongs the effective refractory period. Atenolol blocks beta-adrenergic cardiac stimulation. Lidocaine decreases myocardial excitability in the ventricles. Propafenone produces a dose-related depression of cardiac conduction, especially in the bundle of His/Purkinje system. p. 390
The nurse is caring for four patients who are on antidysrhythmic medications. The patient taking which medication would the nurse recognize as being at risk for developing a systemic lupus erythematosus (SLE)-like syndrome? Quinidine Flecainide Amiodarone Procainamide
Procainamide The patient who is taking procainamide might develop SLE-like syndrome because of its anticholinergic effect. The patient who is taking quinidine might develop hypotension, QT prolongation, and anorexia. The patient who is taking flecainide might experience dizziness and visual disturbances. The patient who is taking amiodarone might experience bradycardia, hypotension, and visual disturbances. p. 393
After administering diltiazem to a patient experiencing paroxysmal supraventricular tachycardia (PSVT), the nurse monitors the patient for which side effect? Prominent U wave Prolonged P-R interval Prolonged Q-T interval Prolonged QRS interval
Prolonged Q-T interval Diltiazem is a class IV antidysrhythmic calcium channel blocker commonly used for treating dysrhythmias, specifically those that arise above the ventricles (PSVT) and for controlling the ventricular response to atrial fibrillation and flutter by slowing conduction and prolonging refractoriness of the AV node. The drug has little effect on the ventricular tissues. The use of diltiazem can result in a prolonged Q-T interval. A prominent U wave or prolonged P-R interval or QRS interval are not specifically associated with the use of diltiazem. pp. 397-398
The nurse is caring for a patient who is being treated with amiodarone. The nurse notes that the patient is experiencing a hacking cough. Which action by the nurse is best? Document the findings in the patient's chart. Notify the health care provider regarding this symptom. Administer medication to help the patient rest. Administer the cough syrup that has been prescribed.
Notify the health care provider regarding this symptom. The most serious adverse effect of this drug is pulmonary toxicity, which involves a clinical syndrome of progressive dyspnea and cough accompanied by damage to the alveoli. A hacking cough should be reported to the health care provider, not just documented as if it is an expected finding. The hacking cough could be a sign of a serious problem and should be addressed before administering any medication to help the patient rest. Cough syrup may mask an underlying problem if the cough is indicative of pulmonary toxicity. p. 396
A nurse is caring for a patient who is prescribed quinidine. For which adverse effect would the nurse assess in the patient? Dyspnea Tachycardia Agranulocytosis Prolonged QT interval
Prolonged QT interval A patient who is prescribed quinidine may experience prolonged QT intervals. Dyspnea can be caused by flecainide. A patient who is taking propafenone might experience tachycardia. Procainamide can cause agranulocytosis in patients. p. 393
Which is the priority assessment to complete before the nurse administers an antidysrhythmic medication? Pulse rate Temperature Respiratory rate Lung auscultation
Pulse rate When antidysrhythmic drugs are administered, the nurse would monitor vital signs, especially pulse rate and blood pressure. Pulse rate should be assessed prior to administration of an antidysrhythmic medication and periodically thereafter. Temperature, respiratory rate, and lung auscultation may be performed but they are not directly correlated to the administration of an antidysrhythmic medication. p. 398
Which medication blocks sodium channels, delays repolarization, and increases the duration of the action potential? Quinidine Lidocaine Flecainide Amiodarone
Quinidine Quinidine blocks sodium channels, delaying repolarization and increasing the duration of the action potential. Lidocaine increases and also blocks sodium channels and accelerates repolarization. It also decreases the duration of the action potential. Flecainide has a more pronounced effect on the blockage of sodium channels; however, it will have little effect on repolarization or the duration of the action potential. Amiodarone increases the duration of the action potential by prolonging repolarization in phase 3. p. 389
The nurse is caring for a patient who is currently being treated with digoxin. The health care provider plans to begin treatment with amiodarone. The nurse anticipates that the interaction of the two drugs will require which dosage adjustment? The dose of digoxin will be reduced by 50%. The dose of digoxin will be increased by 50%. The dose of amiodarone will be reduced by 50%. The dose of amiodarone will be increased by 50%.
The dose of digoxin will be reduced by 50%. When amiodarone is started in patients who are already taking an antidysrhythmic drug, the dose of digoxin should be reduced by 50% to compensate for the interaction of the two medications. The digoxin level increases, not decreases, with amiodarone administration; therefore, the dose should be reduced, not increased. Digoxin levels can be monitored; therefore, dose adjustments are made to digoxin, not amiodarone. p. 392
The nurse is caring for a patient who is being treated with amiodarone. After the patient is on the medication for 6 weeks, labwork drawn on the patient shows evidence of hypothyroidism developing. How would the nurse interpret this information? This is indicative of a toxic dosage of the medication. This is a possible adverse reaction to the medication. This is indicative of an inadequate dosage of the medication. The patient is developing an anaphylactic reaction to the medication.
This is a possible adverse reaction to the medication. Hypothyroidism or hyperthyroidism may develop as a result of taking the medication because of its lipophilic nature and the use of iodine in its chemical structure. Hypothyroidism is a potential adverse effect and is not indicative of toxicity or inadequate dosage. Signs of anaphylaxis usually appear quickly, not slowly over 6 weeks, and can manifest as wheezing, shortness of breath, and extreme difficulty breathing. p. 396
Which food selection would be an appropriate choice for a patient undergoing treatment with an antidysrhythmic drug? Whole-grain cereal with milk Bacon and eggs Turkey and cheese sandwich Cheeseburger with French fries
Turkey and cheese sandwich The patient who is being treated with these medications should maintain a well-balanced diet and avoid consuming an excessive amount of alkaline ash foods such as citrus fruits, vegetables, and milk (such as cereal with milk). A turkey and cheese sandwich is balanced and limited in alkaline ash foods. Bacon and eggs and a cheeseburger with French fries are both high in saturated fat and should be avoided. p. 401
