Chapter 45: Anti-arrhytmic Agents

A nurse is monitoring the drug level of a client receiving quinidine. Which serum drug level would the nurse immediately report to the primary health care provider? a)6.2 mcg/mL b)2.5 mcg/mL c)3.8 mcg/mL d)4.1 mcg/mL

a)6.2 mcg/mL (page 784)

The nurse is preparing discharge teaching for a client prescribed chronic antiarrhythmic medication therapy. Which signs/symptoms should be reported to the health care provider immediately? (Select all that apply.) a)Chest pain b)Dyspnea c)Nausea d)Heart palpations e)Diarrhea

a)Chest pain b)Dyspnea d)Heart palpations (page 789-790)

Lidocaine (Xylocaine) is available in a variety of dosage forms. How should a nurse administer lidocaine to a client with a ventricular arrhythmia? a)Intravenously b)Intramuscularly c)Topically d)Orally

a)Intravenously (page 781)

The nurse is caring for a client admitted to the telemetry unit with atrial fibrillation on the electrocardiogram (ECG) monitor. The nurse should perform which assessment(s) for safe administration of the first dose of quinidine? Select all that apply. a)Obtain a history of allergies to medications and specific reactions. b)Assess if the client has systemic lupus erythematosus or myasthenia gravis. c)Check baseline renal and hepatic function before administering drug. d)After administration, assess for tinnitus, hearing loss, headache, and vertigo. e)Determine if the client has had grapefruit or grapefruit juice recently.

a)Obtain a history of allergies to medications and specific reactions b)Assess if the client has systemic lupus erythematosus or myasthenia gravis. c)Check baseline renal and hepatic function before administering drug. d)After administration, assess for tinnitus, hearing loss, headache, and vertigo. (page 788)

After a cardiac muscle contracts, what chemical reaction is needed to prepare the muscle cells for the next contraction? a)Potassium ions return to the intracellular space. b)Sodium ions return to the intracellular space. c)Potassium ions return to the extracellular space. d)Calcium ions return to the intracellular space.

a)Potassium ions return to the intracellular space (page 776)

A client diagnosed with a dysrhythmia has not responded appreciably to treatment with oral propranolol. When the medication is discontinued, what instruction should the nurse provide the client to maximize safety? a)Taper down the propranolol dose over a period of 2 weeks. b)Be prepared to substitute an intramuscular propranolol for several months. c)Gradually replace the propranolol with newly prescribed metoprolol. d)Monitor cardiac status at regularly after taking the final dose of propranolol.

a)Taper down the propranolol dose over a period of 2 weeks. (page 784)

The primary health care provider prescribes a class I sodium channel blocker to be given intravenously. Which drug would the nurse most likely administer? a)lidocaine b)disopyramide c)flecainide d)mexiletine

a)lidocaine (page 784)

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? a)Lidocaine b)Quinidine c)Flecainide d)Procainamide

b)Quinidine (page 783)

A client has a complex cardiac history that includes recurrent ventricular fibrillation. After the failure of more conservative treatments, the care team has introduced oral amiodarone. What assessments should be prioritized by the nurse who is providing care for this client? a)Orientation and cognition b)Respiratory assessment c)Neurological assessment d)Active and passive range of motion

b)Respiratory assessment (page 785)

The health care provider orders quinidine for a client who is receiving a common treatment for atrial fibrillation. The nurse would monitor this client for: a)increased quinidine effect. b)digoxin toxicity. c)bleeding. d)renal dysfunction.

b)digoxin toxicity (page 783)

An adult client with a long-standing dysrhythmia has been taking oral propranolol for the last several months, resulting in acceptable symptom control. What is a priority teaching point for the nurse to communicate to this client? a)the need to measure the radial pulse for 1 minute prior to each dose of propranolol b)the importance of not stopping the medication abruptly c)the need to avoid taking over-the-counter antacids d)the need to limit intake of high-potassium foods

b)the importance of not stopping the medication abruptly (page 790)

The primary health care provider prescribes sotalol (Betapace) 80 mg BID orally. The drug is available in 40 mg tablets. The nurse will administer how many tablets in 24 hours? a)1 b)3 c)4 d)6

c)4 (page 782)

What would the nurse teach the client to monitor for when beginning an antidysrhythmic drug regimen? a)Diarrhea b)Gastric upset c)Syncope d)Dry mouth

c)Syncope (page 776-777)

Propranolol is ordered for a client who has a cardiac arrhythmia. It will be important for the nurse to determine if the person has a history of: a)chronic heart failure secondary to a tachyarrhythmia. b)idiosyncratic reaction to cinchona derivatives. c)hypersensitivity to beta blockers. d)hypersensitivity to sulfonylureas.

c)hypersensitivity to beta blockers (page 784)

The nurse should advocate for a lower-than-normal dose if the client prescribed quinidine has a history of what medical diagnosis? a)type 1 or type 2 diabetes b)primary hypertension c)liver disease d)chronic obstructive pulmonary disease

c)liver disease (page 783)

A client diagnosed with heart disease is prescribed an antiarrhythmic drug. Further teaching is needed when the client makes which statement? a)"I will take my medication at the prescribed time." b)"I need to call my primary care provider before taking any herbal supplements." c)"I can check the drug label about taking the medicine with food." d)"I know I must take my medication every day for my heartbeat to be fixed."

d)"I know I must take my medication every day for my heartbeat to be fixed." (page 789-790)

A breast-feeding woman is prescribed a Class 3 antiarrhythmic. What information should the nurse provide to the client regarding the safety of the breast-feeding while taking this medication? a)The medication doesn't pass into the breast milk. b)The safety of this class of antiarrhythmic medications has not been established. c)The decision to continue breast-feeding should be based on the stress is creates for the woman d)Breast-feeding must be discontinued and other forms of feeding should be introduced.

d)Breast-feeding must be discontinued and other forms of feeding should be introduced. (page 785)

A client is admitted to the emergency department with a ventricular dysrhythmia associated with an acute myocardial infarction. What assessment should the nurse make prior to administering a bolus of lidocaine IV? a)Assess for lidocaine administration in the client's history. b)Determine the client's ability to swallow. c)Assess the client's nutritional history for allergies. d)Determine if the client has had a reaction to local anesthesia.

d)Determine if the client has had a reaction to local anesthesia. (page 783)

A nurse is the cardiac care unit is preparing to hang an intravenous dose of dofetilide (Tikosyn) for a client who has just been admitted. What is the most likely goal of this intervention? a)To treat sinus bradycardia accompanied by hypotension b)To resolve the client's uncompensated heart failure c)To treat the client's ventricular tachycardia d)To convert the client's atrial fibrillation to normal sinus rhythm

d)To convert the client's atrial fibrillation to normal sinus rhythm (page 777)