Exam 2 - Unit 9 *Optional*

A nurse assesses a client with tachycardia. Which clinical manifestation requires immediate intervention by the nurse? a. Mid-sternal chest pain b. Increased urine output c. Mild orthostatic hypotension d. P wave touching the T wave

ANS: A Chest pain, possibly angina, indicates that tachycardia may be increasing the client's myocardial workload and oxygen demand to such an extent that normal oxygen delivery cannot keep pace. This results in myocardial hypoxia and pain. Increased urinary output and mild orthostatic hypotension are not life-threatening conditions and therefore do not require immediate intervention. The P wave touching the T wave indicates significant tachycardia and should be assessed to determine the underlying rhythm and cause; this is an important assessment but is not as critical as chest pain, which indicates cardiac cell death.

A nurse teaches a client who experiences occasional premature atrial contractions (PACs) accompanied by palpitations that resolve spontaneously without treatment. Which statement should the nurse include in this client's teaching? a. "Minimize or abstain from caffeine." b. "Lie on your side until the attack subsides." c. "Use your oxygen when you experience PACs." d. "Take amiodarone (Cordarone) daily to prevent PACs."

ANS: A PACs usually have no hemodynamic consequences. For a client experiencing infrequent PACs, the nurse should explore possible lifestyle causes, such as excessive caffeine intake and stress. Lying on the side will not prevent or resolve PACs. Oxygen is not necessary. Although medications may be needed to control symptomatic dysrhythmias, for infrequent PACs, the client first should try lifestyle changes to control them.

A nurse prepares to discharge a client with cardiac dysrhythmia who is prescribed home health care services. Which priority information should be communicated to the home health nurse upon discharge? a. Medication reconciliation b. Immunization history c. Religious beliefs d. Nutrition preferences

ANS: A The home health nurse needs to know current medications the client is taking to ensure assessment, evaluation, and further education related to these medications. The other information will not assist the nurse to develop a plan of care for the client.

A nurse supervises an unlicensed assistive personnel (UAP) applying electrocardiographic monitoring. Which statement should the nurse provide to the UAP related to this procedure? a. "Clean the skin and clip hairs if needed." b. "Add gel to the electrodes prior to applying them." c. "Place the electrodes on the posterior chest." d. "Turn off oxygen prior to monitoring the client."

ANS: A To ensure the best signal transmission, the skin should be clean and hairs clipped. Electrodes should be placed on the anterior chest, and no additional gel is needed. Oxygen has no impact on electrocardiographic monitoring.

A nurse cares for a client who is on a cardiac monitor. The monitor displayed the rhythm shown below: Which action should the nurse take first? a. Assess airway, breathing, and level of consciousness. b. Administer an amiodarone bolus followed by a drip. c. Cardiovert the client with a biphasic defibrillator. d. Begin cardiopulmonary resuscitation (CPR).

ANS: A Ventricular tachycardia occurs with repetitive firing of an irritable ventricular ectopic focus, usually at a rate of 140 to 180 beats/min or more. Ventricular tachycardia is a lethal dysrhythmia. The nurse should first assess if the client is alert and breathing. Then the nurse should call a Code Blue and begin CPR. If this client is pulseless, the treatment of choice is defibrillation. Amiodarone is the antidysrhythmic of choice, but it is not the first action.

A nurse is teaching a client with premature ectopic beats. Which education should the nurse include in this client's teaching? (Select all that apply.) a. Smoking cessation b. Stress reduction and management c. Avoiding vagal stimulation d. Adverse effects of medications e. Foods high in potassium

ANS: A, B, D A client who has premature beats or ectopic rhythms should be taught to stop smoking, manage stress, take medications as prescribed, and report adverse effects of medications. Clients with premature beats are not at risk for vasovagal attacks or potassium imbalances.

A nurse teaches a client with a new permanent pacemaker. Which instructions should the nurse include in this client's teaching? (Select all that apply.) a. "Until your incision is healed, do not submerge your pacemaker. Only take showers." b. "Report any pulse rates lower than your pacemaker settings." c. "If you feel weak, apply pressure over your generator." d. "Have your pacemaker turned off before having magnetic resonance imaging (MRI)." e. "Do not lift your left arm above the level of your shoulder for 8 weeks."

ANS: A, B, E The client should not submerge in water until the site has healed; after the incision is healed, the client may take showers or baths without concern for the pacemaker. The client should be instructed to report changes in heart rate or rhythm, such as rates lower than the pacemaker setting or greater than 100 beats/min. The client should be advised of restrictions on physical activity for 8 weeks to allow the pacemaker to settle in place. The client should never apply pressure over the generator and should avoid tight clothing. The client should never have MRI because, whether turned on or off, the pacemaker contains metal. The client should be advised to inform all health care providers that he or she has a pacemaker.

A nurse cares for a client with congestive heart failure who has a regular cardiac rhythm of 128 beats/min. For which physiologic alterations should the nurse assess? (Select all that apply.) a. Decrease in cardiac output b. Increase in cardiac output c. Decrease in blood pressure d. Increase in blood pressure e. Decrease in urine output f. Increase in urine output

ANS: A, D, E Elevated heart rates in a healthy client initially cause blood pressure and cardiac output to increase. However, in a client who has congestive heart failure or a client with long-term tachycardia, ventricular filling time, cardiac output, and blood pressure eventually decrease. As cardiac output and blood pressure decrease, urine output will fall.

A nurse is assessing clients on a medical-surgical unit. Which client should the nurse identify as being at greatest risk for atrial fibrillation? a. A 45-year-old who takes an aspirin daily b. A 50-year-old who is post coronary artery bypass graft surgery c. A 78-year-old who had a carotid endarterectomy d. An 80-year-old with chronic obstructive pulmonary disease

ANS: B Atrial fibrillation occurs commonly in clients with cardiac disease and is a common occurrence after coronary artery bypass graft surgery. The other conditions do not place these clients at higher risk for atrial fibrillation.

A nurse evaluates prescriptions for a client with chronic atrial fibrillation. Which medication should the nurse expect to find on this client's medication administration record to prevent a common complication of this condition? a. Sotalol (Betapace) b. Warfarin (Coumadin) c. Atropine (Sal-Tropine) d. Lidocaine (Xylocaine)

ANS: B Atrial fibrillation puts clients at risk for developing emboli. Clients at risk for emboli are treated with anticoagulants, such as heparin, enoxaparin, or warfarin. Sotalol, atropine, and lidocaine are not appropriate for this complication.

A nurse cares for a client who has a heart rate averaging 56 beats/min with no adverse symptoms. Which activity modification should the nurse suggest to avoid further slowing of the heart rate? a. "Make certain that your bath water is warm." b. "Avoid straining while having a bowel movement." c. "Limit your intake of caffeinated drinks to one a day." d. "Avoid strenuous exercise such as running."

ANS: B Bearing down strenuously during a bowel movement is one type of Valsalva maneuver, which stimulates the vagus nerve and results in slowing of the heart rate. Such a response is not desirable in a person who has bradycardia. The other instructions are not appropriate for this condition.

A nurse assesses a client with atrial fibrillation. Which manifestation should alert the nurse to the possibility of a serious complication from this condition? a. Sinus tachycardia b. Speech alterations c. Fatigue d. Dyspnea with activity

ANS: B Clients with atrial fibrillation are at risk for embolic stroke. Evidence of embolic events includes changes in mentation, speech, sensory function, and motor function. Clients with atrial fibrillation often have a rapid ventricular response as a result. Fatigue is a nonspecific complaint. Clients with atrial fibrillation often have dyspnea as a result of the decreased cardiac output caused by the rhythm disturbance.

A nurse assists with the cardioversion of a client experiencing acute atrial fibrillation. Which action should the nurse take prior to the initiation of cardioversion? a. Administer intravenous adenosine. b. Turn off oxygen therapy. c. Ensure a tongue blade is available. d. Position the client on the left side.

ANS: B For safety during cardioversion, the nurse should turn off any oxygen therapy to prevent fire. The other interventions are not appropriate for a cardioversion. The client should be placed in a supine position.

After assessing a client who is receiving an amiodarone intravenous infusion for unstable ventricular tachycardia, the nurse documents the findings and compares these with the previous assessment findings: Vital Signs Nursing Assessment Time: 0800 Temperature: 98° F Heart rate: 68 beats/min Blood pressure: 135/60 mm Hg Respiratory rate: 14 breaths/min Oxygen saturation: 96% Oxygen therapy: 2 L nasal cannula Time: 1000 Temperature: 98.2° F Heart rate: 50 beats/min Blood pressure: 132/57 mm Hg Respiratory rate: 16 breaths/min Oxygen saturation: 95% Oxygen therapy: 2 L nasal cannula Time: 0800 Client alert and oriented. Cardiac rhythm: normal sinus rhythm. Skin: warm, dry, and appropriate for race. Respirations equal and unlabored. Client denies shortness of breath and chest pain. Time: 1000 Client alert and oriented. Cardiac rhythm: sinus bradycardia. Skin: warm, dry, and appropriate for race. Respirations equal and unlabored. Client denies shortness of breath and chest pain. Client voids 420 mL of clear yellow urine. Based on the assessments, which action should the nurse take? a. Stop the infusion and flush the IV. b. Slow the amiodarone infusion rate. c. Administer IV normal saline. d. Ask the client to cough and deep breathe.

ANS: B IV administration of amiodarone may cause bradycardia and atrioventricular (AV) block. The correct action for the nurse to take at this time is to slow the infusion, because the client is asymptomatic and no evidence reveals AV block that might require pacing. Abruptly ceasing the medication could allow fatal dysrhythmias to occur. The administration of IV fluids and encouragement of coughing and deep breathing exercises are not indicated, and will not increase the client's heart rate.

A nurse cares for a client with an intravenous temporary pacemaker for bradycardia. The nurse observes the presence of a pacing spike but no QRS complex on the client's electrocardiogram. Which action should the nurse take next? a. Administer intravenous diltiazem (Cardizem). b. Assess vital signs and level of consciousness. c. Administer sublingual nitroglycerin. d. Assess capillary refill and temperature.

ANS: B In temporary pacing, the wires are threaded onto the epicardial surface of the heart and exit through the chest wall. The pacemaker spike should be followed immediately by a QRS complex. Pacing spikes seen without subsequent QRS complexes imply loss of capture. If there is no capture, then there is no ventricular depolarization and contraction. The nurse should assess for cardiac output via vital signs and level of consciousness. The other interventions would not determine if the client is tolerating the loss of capture.

After teaching a client who has an implantable cardioverter-defibrillator (ICD), a nurse assesses the client's understanding. Which statement by the client indicates a correct understanding of the teaching? a. "I should wear a snug-fitting shirt over the ICD." b. "I will avoid sources of strong electromagnetic fields." c. "I should participate in a strenuous exercise program." d. "Now I can discontinue my antidysrhythmic medication."

ANS: B The client being discharged with an ICD is instructed to avoid strong sources of electromagnetic fields. Clients should avoid tight clothing, which could cause irritation over the ICD generator. The client should be encouraged to exercise but should not engage in strenuous activities that cause the heart rate to meet or exceed the ICD cutoff point because the ICD can discharge inappropriately. The client should continue all prescribed medications.

The nurse is caring for a client on the medical-surgical unit who suddenly becomes unresponsive and has no pulse. The cardiac monitor shows the rhythm below: After calling for assistance and a defibrillator, which action should the nurse take next? a. Perform a pericardial thump. b. Initiate cardiopulmonary resuscitation (CPR). c. Start an 18-gauge intravenous line. d. Ask the client's family about code status.

ANS: B The client's rhythm is ventricular fibrillation. This is a lethal rhythm that is best treated with immediate defibrillation. While the nurse is waiting for the defibrillator to arrive, the nurse should start CPR. A pericardial thump is not a treatment for ventricular fibrillation. If the client does not already have an IV, other members of the team can insert one after defibrillation. The client's code status should already be known by the nurse prior to this event.

A telemetry nurse assesses a client with third-degree heart block who has wide QRS complexes and a heart rate of 35 beats/min on the cardiac monitor. Which assessment should the nurse complete next? a. Pulmonary auscultation b. Pulse strength and amplitude c. Level of consciousness d. Mobility and gait stability

ANS: C A heart rate of 40 beats/min or less with widened QRS complexes could have hemodynamic consequences. The client is at risk for inadequate cerebral perfusion. The nurse should assess for level of consciousness, light-headedness, confusion, syncope, and seizure activity. Although the other assessments should be completed, the client's level of consciousness is the priority.

A nurse administers prescribed adenosine (Adenocard) to a client. Which response should the nurse assess for as the expected therapeutic response? a. Decreased intraocular pressure b. Increased heart rate c. Short period of asystole d. Hypertensive crisis

ANS: C Clients usually respond to adenosine with a short period of asystole, bradycardia, hypotension, dyspnea, and chest pain. Adenosine has no conclusive impact on intraocular pressure.

A nurse cares for a client with atrial fibrillation who reports fatigue when completing activities of daily living. What interventions should the nurse implement to address this client's concerns? a. Administer oxygen therapy at 2 liters per nasal cannula. b. Provide the client with a sleeping pill to stimulate rest. c. Schedule periods of exercise and rest during the day. d. Ask unlicensed assistive personnel to help bathe the client.

ANS: C Clients who have atrial fibrillation are at risk for decreased cardiac output and fatigue when completing activities of daily living. The nurse should schedule periods of exercise and rest during the day to decrease fatigue. The other interventions will not assist the client with self-care activities.

The nurse asks a client who has experienced ventricular dysrhythmias about substance abuse. The client asks, "Why do you want to know if I use cocaine?" How should the nurse respond? a. "Substance abuse puts clients at risk for many health issues." b. "The hospital requires that I ask you about cocaine use." c. "Clients who use cocaine are at risk for fatal dysrhythmias." d. "We can provide services for cessation of substance abuse."

ANS: C Clients who use cocaine or illicit inhalants are particularly at risk for potentially fatal dysrhythmias. The other responses do not adequately address the client's question.

A nurse performs an admission assessment on a 75-year-old client with multiple chronic diseases. The client's blood pressure is 135/75 mm Hg and oxygen saturation is 94% on 2 liters per nasal cannula. The nurse assesses the client's rhythm on the cardiac monitor and observes the reading shown below: Which action should the nurse take first? a. Begin external temporary pacing. b. Assess peripheral pulse strength. c. Ask the client what medications he or she takes. d. Administer 1 mg of atropine.

ANS: C This client is stable and therefore does not require any intervention except to determine the cause of the bradycardia. Bradycardia is often caused by medications. Clients who have multiple chronic diseases are often on multiple medications that can interact with each other. The nurse should assess the client's current medications first.

A nurse assesses a client's electrocardiograph tracing and observes that not all QRS complexes are preceded by a P wave. How should the nurse interpret this observation? a. The client has hyperkalemia causing irregular QRS complexes. b. Ventricular tachycardia is overriding the normal atrial rhythm. c. The client's chest leads are not making sufficient contact with the skin. d. Ventricular and atrial depolarizations are initiated from different sites.

ANS: D Normal rhythm shows one P wave preceding each QRS complex, indicating that all depolarization is initiated at the sinoatrial node. QRS complexes without a P wave indicate a different source of initiation of depolarization. This finding on an electrocardiograph tracing is not an indication of hyperkalemia, ventricular tachycardia, or disconnection of leads.

A nurse assesses a client's electrocardiogram (ECG) and observes the reading shown below: How should the nurse document this client's ECG strip? a. Ventricular tachycardia b. Ventricular fibrillation c. Sinus rhythm with premature atrial contractions (PACs) d. Sinus rhythm with premature ventricular contractions (PVCs)

ANS: D Sinus rhythm with PVCs has an underlying regular sinus rhythm with ventricular depolarization that sometimes precede atrial depolarization. Ventricular tachycardia and ventricular fibrillation rhythms would not have sinus beats present. Premature atrial contractions are atrial contractions initiated from another region of the atria before the sinus node initiates atrial depolarization.

A nurse prepares to defibrillate a client who is in ventricular fibrillation. Which priority intervention should the nurse perform prior to defibrillating this client? a. Make sure the defibrillator is set to the synchronous mode. b. Administer 1 mg of intravenous epinephrine. c. Test the equipment by delivering a smaller shock at 100 joules. d. Ensure that everyone is clear of contact with the client and the bed.

ANS: D To avoid injury, the rescuer commands that all personnel clear contact with the client or the bed and ensures their compliance before delivery of the shock. A precordial thump can be delivered when no defibrillator is available. Defibrillation is done in asynchronous mode. Equipment should not be tested before a client is defibrillated because this is an emergency procedure; equipment should be checked on a routine basis. Epinephrine should be administered after defibrillation.

The patient asks the nurse, "My doctor said I need cardioversion for my dysrhythmia. Why can't I just take medication?" What is the nurse's best response? 1. "Antidysrhythmic medications have many side effects; cardioversion is considered safer." 2. "Special diets are necessary with antidysrhythmic medications and they are hard to follow." 3. "Antidysrhythmic medications don't really work very well for most dysrhythmias." 4. "There is a high risk of seizures when you take antidysrhythmic medications."

Correct Answer: 1 Rationale 1: Antidysrhythmic medications can cause serious side effects and are normally reserved for patients with overt symptoms, or for patients whose condition cannot be controlled by other means, such as cardioversion. Medications are effective for dysrhythmias; however they have many side effects. There is no indication for a special diet when a patient is taking an antidysrhythmic drug. Antidysrhythmic drugs do not commonly cause seizures. Rationale 2: Antidysrhythmic medications can cause serious side effects and are normally reserved for patients with overt symptoms, or for patients whose condition cannot be controlled by other means, such as cardioversion. Medications are effective for dysrhythmias; however they have many side effects. There is no indication for a special diet when a patient is taking an antidysrhythmic drug. Antidysrhythmic drugs do not commonly cause seizures. Rationale 3: Antidysrhythmic medications can cause serious side effects and are normally reserved for patients with overt symptoms, or for patients whose condition cannot be controlled by other means, such as cardioversion. Medications are effective for dysrhythmias; however they have many side effects. There is no indication for a special diet when a patient is taking an antidysrhythmic drug. Antidysrhythmic drugs do not commonly cause seizures. Rationale 4: Antidysrhythmic medications can cause serious side effects and are normally reserved for patients with overt symptoms, or for patients whose condition cannot be controlled by other means, such as cardioversion. Medications are effective for dysrhythmias; however they have many side effects. There is no indication for a special diet when a patient is taking an antidysrhythmic drug. Antidysrhythmic drugs do not commonly cause seizures.

The patient receives verapamil (Calan). The patient tells the nurse that he is nervous about taking this medicine. What is the best response by the nurse? 1. "This medicine is safe, and most patients do very well with it." 2. "This medicine increases your blood pressure, but we will be monitoring that." 3. "This medicine has many side effects, but you should be okay." 4. "This medicine is a potassium channel blocker and is considered safe."

Correct Answer: 1 Rationale 1: Calcium channel blockers are safe medications that are well tolerated by most patients. All medications have side effects, but telling the patient that he should be okay is not very reassuring. Verapamil (Calan) is a calcium channel blocker, not a potassium channel blocker. Verapamil (Calan) lowers, not increases, blood pressure and decreases cardiac workload. Rationale 2: Calcium channel blockers are safe medications that are well tolerated by most patients. All medications have side effects, but telling the patient that he should be okay is not very reassuring. Verapamil (Calan) is a calcium channel blocker, not a potassium channel blocker. Verapamil (Calan) lowers, not increases, blood pressure and decreases cardiac workload. Rationale 3: Calcium channel blockers are safe medications that are well tolerated by most patients. All medications have side effects, but telling the patient that he should be okay is not very reassuring. Verapamil (Calan) is a calcium channel blocker, not a potassium channel blocker. Verapamil (Calan) lowers, not increases, blood pressure and decreases cardiac workload. Rationale 4: Calcium channel blockers are safe medications that are well tolerated by most patients. All medications have side effects, but telling the patient that he should be okay is not very reassuring. Verapamil (Calan) is a calcium channel blocker, not a potassium channel blocker. Verapamil (Calan) lowers, not increases, blood pressure and decreases cardiac workload.

Which drug would be indicated for treating ventricular tachycardia? 1. Lidocaine (Xylocaine) 2. Verapamil (Calan) 3. Diltiazem (Cardizem) 4. Atropine (Atropair)

Correct Answer: 1 Rationale 1: Lidocaine is a sodium channel blocker, and is indicated for ventricular dysrhythmias. Verapamil and diltiazem are calcium channel blockers indicated for atrial dysrhythmias. Atropine is a cholinergic-blocking agent, and causes an increase in heart rate. Rationale 2: Lidocaine is a sodium channel blocker, and is indicated for ventricular dysrhythmias. Verapamil and diltiazem are calcium channel blockers indicated for atrial dysrhythmias. Atropine is a cholinergic-blocking agent, and causes an increase in heart rate. Rationale 3: Lidocaine is a sodium channel blocker, and is indicated for ventricular dysrhythmias. Verapamil and diltiazem are calcium channel blockers indicated for atrial dysrhythmias. Atropine is a cholinergic-blocking agent, and causes an increase in heart rate. Rationale 4: Lidocaine is a sodium channel blocker, and is indicated for ventricular dysrhythmias. Verapamil and diltiazem are calcium channel blockers indicated for atrial dysrhythmias. Atropine is a cholinergic-blocking agent, and causes an increase in heart rate.

The patient says to the nurse, "My neighbor said my antidysrhythmic drug can actually cause me to have irregular heartbeats. How can this be?" What is the nurse's best answer? 1. "Your medication blocks the flow of the electrolytes in your heart, and this can cause irregular beats." 2. "It is better to discuss you medication concerns with a professional, not a lay person like your neighbor." 3. "You must take two baby aspirins every other day to avoid the irregular heartbeats." 4. "Your medication is not the problem; it is when you mix it with over-the-counter (OTC) drugs that you develop irregular beats."

Correct Answer: 1 Rationale 1: Most antidysrhythmic drugs act by interfering with myocardial action potentials, blocking the action of sodium, potassium, and calcium channels and causing some irregular beats. Mixing the medication with over-the-counter (OTC) medications might result in irregular beats, but this is not the best answer. Anticoagulant medication is sometimes indicated, but it does not require taking two doses of baby aspirin. Although it is best to discuss medications with a professional, this response does not answer the patient's question. Rationale 2: Most antidysrhythmic drugs act by interfering with myocardial action potentials, blocking the action of sodium, potassium, and calcium channels and causing some irregular beats. Mixing the medication with over-the-counter (OTC) medications might result in irregular beats, but this is not the best answer. Anticoagulant medication is sometimes indicated, but it does not require taking two doses of baby aspirin. Although it is best to discuss medications with a professional, this response does not answer the patient's question. Rationale 3: Most antidysrhythmic drugs act by interfering with myocardial action potentials, blocking the action of sodium, potassium, and calcium channels and causing some irregular beats. Mixing the medication with over-the-counter (OTC) medications might result in irregular beats, but this is not the best answer. Anticoagulant medication is sometimes indicated, but it does not require taking two doses of baby aspirin. Although it is best to discuss medications with a professional, this response does not answer the patient's question. Rationale 4: Most antidysrhythmic drugs act by interfering with myocardial action potentials, blocking the action of sodium, potassium, and calcium channels and causing some irregular beats. Mixing the medication with over-the-counter (OTC) medications might result in irregular beats, but this is not the best answer. Anticoagulant medication is sometimes indicated, but it does not require taking two doses of baby aspirin. Although it is best to discuss medications with a professional, this response does not answer the patient's question.

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

Correct Answer: 1 Rationale 1: Propranolol (Inderal) should be used cautiously in patients with type 1 diabetes mellitus due to its hypoglycemic effects. Peripheral circulation should not be affected by propranolol (Inderal). Activities of daily living are important for any patient, but should not be affected by propranolol (Inderal). Propranolol (Inderal) should not affect the patient's appetite; the patient should not decrease calories. Rationale 2: Propranolol (Inderal) should be used cautiously in patients with type 1 diabetes mellitus due to its hypoglycemic effects. Peripheral circulation should not be affected by propranolol (Inderal). Activities of daily living are important for any patient, but should not be affected by propranolol (Inderal). Propranolol (Inderal) should not affect the patient's appetite; the patient should not decrease calories. Rationale 3: Propranolol (Inderal) should be used cautiously in patients with type 1 diabetes mellitus due to its hypoglycemic effects. Peripheral circulation should not be affected by propranolol (Inderal). Activities of daily living are important for any patient, but should not be affected by propranolol (Inderal). Propranolol (Inderal) should not affect the patient's appetite; the patient should not decrease calories. Rationale 4: Propranolol (Inderal) should be used cautiously in patients with type 1 diabetes mellitus due to its hypoglycemic effects. Peripheral circulation should not be affected by propranolol (Inderal). Activities of daily living are important for any patient, but should not be affected by propranolol (Inderal). Propranolol (Inderal) should not affect the patient's appetite; the patient should not decrease calories.

The male patient has been receiving propranolol (Inderal) for treatment of a dysrhythmia for 6 weeks. What is an important question for the nurse to ask the patient when assessing medication compliance? 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?"

Correct Answer: 1 Rationale 1: Side effects such as diminished libido and impotence may result in noncompliance in male patients. Change in bowel function is not an adverse effect of propranolol (Inderal). Appetite is not affected by propranolol (Inderal). Ability to concentrate is not an adverse effect of propranolol (Inderal) except in the elderly who are receiving high doses. Rationale 2: Side effects such as diminished libido and impotence may result in noncompliance in male patients. Change in bowel function is not an adverse effect of propranolol (Inderal). Appetite is not affected by propranolol (Inderal). Ability to concentrate is not an adverse effect of propranolol (Inderal) except in the elderly who are receiving high doses. Rationale 3: Side effects such as diminished libido and impotence may result in noncompliance in male patients. Change in bowel function is not an adverse effect of propranolol (Inderal). Appetite is not affected by propranolol (Inderal). Ability to concentrate is not an adverse effect of propranolol (Inderal) except in the elderly who are receiving high doses. Rationale 4: Side effects such as diminished libido and impotence may result in noncompliance in male patients. Change in bowel function is not an adverse effect of propranolol (Inderal). Appetite is not affected by propranolol (Inderal). Ability to concentrate is not an adverse effect of propranolol (Inderal) except in the elderly who are receiving high doses.

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)

Correct Answer: 1 Rationale 1: Verapamil is a calcium channel blocker that is often used to treat angina by dilating coronary arteries. Rationale 2: Verapamil is a calcium channel blocker that is often used to treat angina by dilating coronary arteries. Rationale 3: Verapamil is a calcium channel blocker that is often used to treat angina by dilating coronary arteries. Rationale 4: Verapamil is a calcium channel blocker that is often used to treat angina by dilating coronary arteries.

A patient who has been taking medication for a month for an atrial dysrhythmia returns to the clinic for a checkup. Which statements indicate the nurse should plan extra time with the patient for additional teaching? Standard Text: 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."

Correct Answer: 1,2,3 Rationale 1: Unless the diet cola is decaffeinated, it should also be avoided. Rationale 2: Alcohol should be limited when taking medications for atrial arrhythmias. Rationale 3: Chocolate contains caffeine, which should be avoided when taking medications for atrial arrhythmias. Rationale 4: Smoking cessation should be encouraged in patients taking medications for atrial dysrhythmia. Rationale 5: Lowered fat intake is encouraged in patients taking medications for atrial arrhythmias.

The nurse and a home health patient have established this expected outcome: "The patient will be free from adverse effects of administration of diltiazem (Cardizem)." Which finding indicates this outcome has not been met? Standard Text: Select all that apply. 1. The patient complains of headache at each visit by the nurse. 2. The patient has 3+ edema in the ankles and feet. 3. The patient says, "Everything I eat tastes like metal." 4. The patient says, "I got so dizzy yesterday that I had to lie down for a while." 5. The patient's face is flushed.

Correct Answer: 1,2,4 Rationale 1: Headache is a potential adverse effect of diltiazem. Rationale 2: Edema of the ankles and feet is a potential adverse effect of diltiazem. Rationale 3: Metallic taste is not an expected adverse effect of diltiazem. Rationale 4: Dizziness is an expected adverse effect of diltiazem. Rationale 5: Facial flushing is not an expected adverse effect of diltiazem.

The nurse is writing a care plan for a patient who has been started on an antiarrhythmic drug for complaints of chest pain and palpitations. The patient says, "I can't do what I once did. I just do not have any energy." Which nursing diagnoses would the nurse likely include in this care plan? Standard Text: Select all that apply. 1. Decreased Cardiac Output 2. Ineffective Breathing Pattern 3. Activity Intolerance 4. Ineffective Individual Coping 5. Impaired Gas Exchange

Correct Answer: 1,3 Rationale 1: Decreased cardiac output is a common occurrence in patients who have palpitations and may be the etiology of the patient's chest pain. Rationale 2: There is no evidence that this patient is not breathing effectively and not enough information to decide that the patient is at risk of developing problems breathing. Rationale 3: The statement "I can't do what I once did" is an indicator that the patient is not tolerating normal amounts of activity. Rationale 4: There is no evidence that this patient is not coping with the illness. Rationale 5: To support this nursing diagnosis, the patient must have alterations in arterial blood gases.

A patient is prescribed an additional once-daily antidysrhythmic drug to control persistent atrial fibrillation. What instructions should the nurse provide for this patient? Standard Text: Select all that apply. 1. "Take your first dose of this new medication before you go to bed tonight." 2. "Do not eat or drink anything for 2 hours after taking the new medication." 3. "Before you get out of bed in the morning, sit up on the side of the bed for a few minutes." 4. "Plan to return to the clinic to have your electrolytes checked in 2 weeks." 5. "Contact the clinic if you notice any loss of hair from your head."

Correct Answer: 1,3,4 Rationale 1: The addition of a second medication makes the patient prone to hypotension. Taking the drug right before bedtime is a safety precaution. Rationale 2: There is no reason to avoid oral intake for 2 hours after an antidysrhythmic medication. Rationale 3: Orthostatic hypotension can be an adverse effect of antidysrhythmic medications, particularly when multiple drugs are taken. Sitting on the side of the bed before arising is a safety precaution. Rationale 4: Electrolyte imbalance can occur secondary to drug therapy for dysrhythmia. Electrolyte levels should be monitored. Rationale 5: Hair loss is not an expected adverse effect of antidysrhythmic medications.

Which of the following drugs is the primary agent for paroxysmal supraventricular tachycardia (PSVT)? 1. Flecainide (Tambocor) 2. Adenosine (Adenocard) 3. Lidocaine (Xylocaine) 4. Procainamide (Pronestyl)

Correct Answer: 2 Rationale 1: Adenosine is the drug of choice for PSVT. Procainamide may be used for supraventricular dysrhythmias, but is not the primary drug for PSVT. Lidocaine and flecainide are indicated for ventricular dysrhythmias. Rationale 2: Adenosine is the drug of choice for PSVT. Procainamide may be used for supraventricular dysrhythmias, but is not the primary drug for PSVT. Lidocaine and flecainide are indicated for ventricular dysrhythmias. Rationale 3: Adenosine is the drug of choice for PSVT. Procainamide may be used for supraventricular dysrhythmias, but is not the primary drug for PSVT. Lidocaine and flecainide are indicated for ventricular dysrhythmias. Rationale 4: Adenosine is the drug of choice for PSVT. Procainamide may be used for supraventricular dysrhythmias, but is not the primary drug for PSVT. Lidocaine and flecainide are indicated for ventricular dysrhythmias.

Which of the following statements best explains what happens to cardiac output when the heart rate gets extremely high? 1. Cardiac output is not generally affected by rapid heart rates. 2. Cardiac output lowers when the rapid rate doesn't allow enough time for complete filling of the heart chambers. 3. Cardiac output will continue to increase as long as the heart rate continues to increase. 4. Cardiac output will increase until the heart rate reaches 150 bpm, at which time it will no longer be affected.

Correct Answer: 2 Rationale 1: Cardiac output lowers when the rapid rate doesn't allow enough time for complete filling of the heart chambers. Rationale 2: Cardiac output lowers when the rapid rate doesn't allow enough time for complete filling of the heart chambers. Rationale 3: Cardiac output lowers when the rapid rate doesn't allow enough time for complete filling of the heart chambers. Rationale 4: Cardiac output lowers when the rapid rate doesn't allow enough time for complete filling of the heart chambers.

A person with a heart rate of 170 bpm and a normal QRS duration would most likely be experiencing a 1. yachydysrhythmia originating from the bundle branches. 2. tachydysrhythmia originating from the atria. 3. tachydysrhythmia originating from the ventricles. 4. tachydysrhythmia originating from the Purkinje fibers.

Correct Answer: 2 Rationale 1: Given a normal QRS duration, the rhythm is not coming from the ventricles but from the atria. Rationale 2: Given a normal QRS duration, the rhythm is not coming from the ventricles but from the atria. Rationale 3: Given a normal QRS duration, the rhythm is not coming from the ventricles but from the atria. Rationale 4: Given a normal QRS duration, the rhythm is not coming from the ventricles but from the atria.

The physician has ordered amiodarone (Cordarone). Prior to starting this medication, the nurse would alert the physician to which laboratory result? 1. Sodium 140 mEq/L 2. Potassium 3.1 mEq/L 3. Potassium 5.1 mEq/L 4. International normalized ratio (INR) of 12 seconds

Correct Answer: 2 Rationale 1: Hypokalemia and hypomagnesemia should be corrected prior to initiating therapy with amiodarone (Cordarone). 5.1 mEq/L is a normal potassium level. 140 mEq/L is a normal sodium level. Twelve seconds is a normal international normalized ratio (INR) level. Rationale 2: Hypokalemia and hypomagnesemia should be corrected prior to initiating therapy with amiodarone (Cordarone). 5.1 mEq/L is a normal potassium level. 140 mEq/L is a normal sodium level. Twelve seconds is a normal international normalized ratio (INR) level. Rationale 3: Hypokalemia and hypomagnesemia should be corrected prior to initiating therapy with amiodarone (Cordarone). 5.1 mEq/L is a normal potassium level. 140 mEq/L is a normal sodium level. Twelve seconds is a normal international normalized ratio (INR) level. Rationale 4: Hypokalemia and hypomagnesemia should be corrected prior to initiating therapy with amiodarone (Cordarone). 5.1 mEq/L is a normal potassium level. 140 mEq/L is a normal sodium level. Twelve seconds is a normal international normalized ratio (INR) level.

In a person with a sinus rhythm, the primary purpose of the AV node is to 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. inhibit the impulse from the SA node.

Correct Answer: 2 Rationale 1: The AV node delays the impulse as it travels from the atria to the ventricles. The AV junction does pace the heart at 40-60 bpm, but not when the SA node is pacing the heart. Rationale 2: The AV node delays the impulse as it travels from the atria to the ventricles. The AV junction does pace the heart at 40-60 bpm, but not when the SA node is pacing the heart. Rationale 3: The AV node delays the impulse as it travels from the atria to the ventricles. The AV junction does pace the heart at 40-60 bpm, but not when the SA node is pacing the heart. Rationale 4: The AV node delays the impulse as it travels from the atria to the ventricles. The AV junction does pace the heart at 40-60 bpm, but not when the SA node is pacing the heart.

The patient tells the nurse, "My doctor says I have atrial fibrillation. Is this serious and how is it treated?" What is (are) the best response(s) by the nurse? Standard Text: 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 upon your symptoms, your doctor may use an electrical shock." 4. "This is quite serious; did your doctor mention a heart transplant?" 5. "It is very serious, even more serious than a ventricular dysrhythmia."

Correct Answer: 2,3 Rationale 1: Atrial fibrillation is the most common type of dysrhythmia. The physician will determine whether to use nonpharmalogical techniques such as cardioversion, or an implantable cardioverter defibrillator (ICD), or medication. Medications can cause serious side effects and are normally reserved for patients with overt symptoms, or for patients whose condition cannot be controlled by other means. Ventricular dysrhythmias are more serious than atrial dysrhythmias because they are more likely to interfere with the normal function of the heart. Heart transplants are not indicated for patients with dysrhythmias. Rationale 2: Atrial fibrillation is the most common type of dysrhythmia. The physician will determine whether to use nonpharmalogical techniques such as cardioversion, or an implantable cardioverter defibrillator (ICD), or medication. Medications can cause serious side effects and are normally reserved for patients with overt symptoms, or for patients whose condition cannot be controlled by other means. Ventricular dysrhythmias are more serious than atrial dysrhythmias because they are more likely to interfere with the normal function of the heart. Heart transplants are not indicated for patients with dysrhythmias. Rationale 3: Atrial fibrillation is the most common type of dysrhythmia. The physician will determine whether to use nonpharmalogical techniques such as cardioversion, or an implantable cardioverter defibrillator (ICD), or medication. Medications can cause serious side effects and are normally reserved for patients with overt symptoms, or for patients whose condition cannot be controlled by other means. Ventricular dysrhythmias are more serious than atrial dysrhythmias because they are more likely to interfere with the normal function of the heart. Heart transplants are not indicated for patients with dysrhythmias. Rationale 4: Atrial fibrillation is the most common type of dysrhythmia. The physician will determine whether to use nonpharmalogical techniques such as cardioversion, or an implantable cardioverter defibrillator (ICD), or medication. Medications can cause serious side effects and are normally reserved for patients with overt symptoms, or for patients whose condition cannot be controlled by other means. Ventricular dysrhythmias are more serious than atrial dysrhythmias because they are more likely to interfere with the normal function of the heart. Heart transplants are not indicated for patients with dysrhythmias. Rationale 5: Atrial fibrillation is the most common type of dysrhythmia. The physician will determine whether to use nonpharmalogical techniques such as cardioversion, or an implantable cardioverter defibrillator (ICD), or medication. Medications can cause serious side effects and are normally reserved for patients with overt symptoms, or for patients whose condition cannot be controlled by other means. Ventricular dysrhythmias are more serious than atrial dysrhythmias because they are more likely to interfere with the normal function of the heart. Heart transplants are not indicated for patients with dysrhythmias.

The patient tells 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?" What is (are) the nurse's best response(s)? Standard Text: 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."

Correct Answer: 2,3,4 Rationale 1: Conduction through the heart originates in the sinoatrial (SA) node, travels through the atrioventricular (AV) node through the bundle of His to the right and left bundle branches to the Purkinje fibers. Conduction through the atrioventricular (AV) node is the slowest in the heart. The sinoatrial (SA) node is located in the right atrium. Rationale 2: Conduction through the heart originates in the sinoatrial (SA) node, travels through the atrioventricular (AV) node through the bundle of His to the right and left bundle branches to the Purkinje fibers. Conduction through the atrioventricular (AV) node is the slowest in the heart. The sinoatrial (SA) node is located in the right atrium. Rationale 3: Conduction through the heart originates in the sinoatrial (SA) node, travels through the atrioventricular (AV) node through the bundle of His to the right and left bundle branches to the Purkinje fibers. Conduction through the atrioventricular (AV) node is the slowest in the heart. The sinoatrial (SA) node is located in the right atrium. Rationale 4: Conduction through the heart originates in the sinoatrial (SA) node, travels through the atrioventricular (AV) node through the bundle of His to the right and left bundle branches to the Purkinje fibers. Conduction through the atrioventricular (AV) node is the slowest in the heart. The sinoatrial (SA) node is located in the right atrium. Rationale 5: Conduction through the heart originates in the sinoatrial (SA) node, travels through the atrioventricular (AV) node through the bundle of His to the right and left bundle branches to the Purkinje fibers. Conduction through the atrioventricular (AV) node is the slowest in the heart. The sinoatrial (SA) node is located in the right atrium.

A patient has been taking a potassium channel blocker for 4 weeks. Which statements would indicate to the nurse that additional time for teaching about the medication should be planned? Standard Text: Select all that apply. 1. "I got some sunglasses like you said. Do you like them?" 2. "Do you have any idea what this rash on my neck and arm is?" 3. "I must be getting cataracts. I can't see anything anymore." 4. "I wear sunscreen whenever I am outdoors." 5. "I think that medicine is making my hair gray."

Correct Answer: 2,3,5 Rationale 1: Potassium channel blockers can cause photosensitivity, and wearing sunglasses protects the eyes. Rationale 2: Potassium channel blockers can cause skin rashes. Rationale 3: Potassium channel blockers may cause blurred vision. Rationale 4: Potassium channel blockers cause increased risk of sunburn. Rationale 5: There is no connection between potassium channel blockers and the development of gray hair.

The nurse is providing information for a patient who will self-administer a twice-daily antidysrhythmic medication at home. Which patient statement would the nurse evaluate as indicating good understanding of this process? Standard Text: 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 medication I should take two pills for the next dose." 4. "If I can't take the medication 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."

Correct Answer: 2,4,5 Rationale 1: Antidysrhythmic medications should not be stopped abruptly. Rationale 2: Doses of antidysrhythmic medications should be evenly spaced. Rationale 3: Antidysrhythmic medications should not be double-dosed to make up for missed doses. Rationale 4: The health care provider should be consulted if the patient is going to miss medication for more than 1 day. Rationale 5: Abrupt discontinuation of antidysrhythmic medications can have serious side effects, so an adequate supply of the medication should be available.

The nurse is teaching a class on rhythm abnormalities to patients who have experienced dysrhythmias. The nurse knows that teaching has been effective when a patient makes which statement? 1. "Dysrhythmias cause serious electrolyte imbalances; this results in heart block." 2. "Dysrhythmias are the result of long-standing, 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."

Correct Answer: 3 Rationale 1: All dysrhythmias cause a defect in the generation or conduction of electrical impulses across the myocardium. Lack of synchronization of the atria and ventricles may have profound consequences such as decreasing cardiac output. Dysrhythmias do not alter blood flow through the heart. Some dysrhythmias may result in heart block, but dysrhythmias do not cause electrolyte imbalances. Dysrhythmias do not result from hypertension. Rationale 2: All dysrhythmias cause a defect in the generation or conduction of electrical impulses across the myocardium. Lack of synchronization of the atria and ventricles may have profound consequences such as decreasing cardiac output. Dysrhythmias do not alter blood flow through the heart. Some dysrhythmias may result in heart block, but dysrhythmias do not cause electrolyte imbalances. Dysrhythmias do not result from hypertension. Rationale 3: All dysrhythmias cause a defect in the generation or conduction of electrical impulses across the myocardium. Lack of synchronization of the atria and ventricles may have profound consequences such as decreasing cardiac output. Dysrhythmias do not alter blood flow through the heart. Some dysrhythmias may result in heart block, but dysrhythmias do not cause electrolyte imbalances. Dysrhythmias do not result from hypertension. Rationale 4: All dysrhythmias cause a defect in the generation or conduction of electrical impulses across the myocardium. Lack of synchronization of the atria and ventricles may have profound consequences such as decreasing cardiac output. Dysrhythmias do not alter blood flow through the heart. Some dysrhythmias may result in heart block, but dysrhythmias do not cause electrolyte imbalances. Dysrhythmias do not result from hypertension.

The patient receives amiodarone (Cordarone). The nurse would be concerned about which additional medication that a consulting physician might order? 1. Oxycodone (OxyContin) 2. Omeprazole (Prilosec) 3. Digoxin (Lanoxin) 4. Fluoxetine (Prozac)

Correct Answer: 3 Rationale 1: Amiodarone (Cordarone) can increase serum digoxin (Lanoxin) levels by as much as 70%, resulting in digoxin (Lanoxin) toxicity. Oxycodone (OxyContin) has no interactions with amiodarone (Cordarone). Fluoxetine (Prozac) has no interactions with amiodarone (Cordarone). Omeprazole (Prilosec) has no interactions with amiodarone (Cordarone). Rationale 2: Amiodarone (Cordarone) can increase serum digoxin (Lanoxin) levels by as much as 70%, resulting in digoxin (Lanoxin) toxicity. Oxycodone (OxyContin) has no interactions with amiodarone (Cordarone). Fluoxetine (Prozac) has no interactions with amiodarone (Cordarone). Omeprazole (Prilosec) has no interactions with amiodarone (Cordarone). Rationale 3: Amiodarone (Cordarone) can increase serum digoxin (Lanoxin) levels by as much as 70%, resulting in digoxin (Lanoxin) toxicity. Oxycodone (OxyContin) has no interactions with amiodarone (Cordarone). Fluoxetine (Prozac) has no interactions with amiodarone (Cordarone). Omeprazole (Prilosec) has no interactions with amiodarone (Cordarone). Rationale 4: Amiodarone (Cordarone) can increase serum digoxin (Lanoxin) levels by as much as 70%, resulting in digoxin (Lanoxin) toxicity. Oxycodone (OxyContin) has no interactions with amiodarone (Cordarone). Fluoxetine (Prozac) has no interactions with amiodarone (Cordarone). Omeprazole (Prilosec) has no interactions with amiodarone (Cordarone).

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

Correct Answer: 3 Rationale 1: An action potential begins when sodium and calcium flow into the cell, resulting in depolarization. Rationale 2: An action potential begins when sodium and calcium flow into the cell, resulting in depolarization. Rationale 3: An action potential begins when sodium and calcium flow into the cell, resulting in depolarization. Rationale 4: An action potential begins when sodium and calcium flow into the cell, resulting in depolarization.

The nurse completes medication education with a patient who receives propranolol (Inderal). The nurse evaluates the education as effective when the patient makes which statement? 1. "I must take my pulse every day and call my doctor if it is higher than 100." 2. "I must call my doctor if my anxiety increases and I start worrying again." 3. "I must take my pulse every day and call my doctor if it is less than 60." 4. "I must call my doctor if I lose more than three pounds a week."

Correct Answer: 3 Rationale 1: Beta blockers decrease contractions of the myocardium and decrease the speed of conduction through the atrioventricular (AV) node. This can result in a significant decrease in heart rate, and the patient should let the physician know if his heart rate falls below 60. Beta blockers decrease, not increase, the heart rate. Beta blockers predispose the patient to weight gain, not weight loss. Beta blockers actually decrease, not increase, anxiety. Rationale 2: Beta blockers decrease contractions of the myocardium and decrease the speed of conduction through the atrioventricular (AV) node. This can result in a significant decrease in heart rate, and the patient should let the physician know if his heart rate falls below 60. Beta blockers decrease, not increase, the heart rate. Beta blockers predispose the patient to weight gain, not weight loss. Beta blockers actually decrease, not increase, anxiety. Rationale 3: Beta blockers decrease contractions of the myocardium and decrease the speed of conduction through the atrioventricular (AV) node. This can result in a significant decrease in heart rate, and the patient should let the physician know if his heart rate falls below 60. Beta blockers decrease, not increase, the heart rate. Beta blockers predispose the patient to weight gain, not weight loss. Beta blockers actually decrease, not increase, anxiety. Rationale 4: Beta blockers decrease contractions of the myocardium and decrease the speed of conduction through the atrioventricular (AV) node. This can result in a significant decrease in heart rate, and the patient should let the physician know if his heart rate falls below 60. Beta blockers decrease, not increase, the heart rate. Beta blockers predispose the patient to weight gain, not weight loss. Beta blockers actually decrease, not increase, anxiety.

The nurse has been teaching a class on dysrhythmias to a group of patients with this disorder. The nurse determines that teaching has been effective when a patient makes which statement? 1. "Our sodium, potassium, and magnesium levels must be okay for our hearts to have an electrical impulse." 2. "Potassium is the most important electrolyte when it comes to the electrical impulse in our hearts." 3. "Our sodium, potassium, and calcium levels must be okay for our hearts to have an electrical impulse." 4. "Enhancing potassium and sodium is how our medications will work to prevent dysrhythmias."

Correct Answer: 3 Rationale 1: Changes in sodium, potassium, and calcium levels generate the action potential in myocardial cells. For this to occur, the patient must have normal levels of sodium, potassium, and calcium. Changes in sodium, potassium, and calcium, not magnesium, levels generate the action potential in myocardial cells. Antidysrhythmic drugs work by blocking, not enhancing, potassium, sodium, or calcium channels. Sodium, potassium, and calcium are equally important when it comes to the myocardial action potential. Rationale 2: Changes in sodium, potassium, and calcium levels generate the action potential in myocardial cells. For this to occur, the patient must have normal levels of sodium, potassium, and calcium. Changes in sodium, potassium, and calcium, not magnesium, levels generate the action potential in myocardial cells. Antidysrhythmic drugs work by blocking, not enhancing, potassium, sodium, or calcium channels. Sodium, potassium, and calcium are equally important when it comes to the myocardial action potential. Rationale 3: Changes in sodium, potassium, and calcium levels generate the action potential in myocardial cells. For this to occur, the patient must have normal levels of sodium, potassium, and calcium. Changes in sodium, potassium, and calcium, not magnesium, levels generate the action potential in myocardial cells. Antidysrhythmic drugs work by blocking, not enhancing, potassium, sodium, or calcium channels. Sodium, potassium, and calcium are equally important when it comes to the myocardial action potential. Rationale 4: Changes in sodium, potassium, and calcium levels generate the action potential in myocardial cells. For this to occur, the patient must have normal levels of sodium, potassium, and calcium. Changes in sodium, potassium, and calcium, not magnesium, levels generate the action potential in myocardial cells. Antidysrhythmic drugs work by blocking, not enhancing, potassium, sodium, or calcium channels. Sodium, potassium, and calcium are equally important when it comes to the myocardial action potential.

The patient is receiving procainamide hydrochloride (Pronestyl) for treatment of a dysrhythmia. What is the best patient outcome for medication compliance? 1. The patient will take his medication with food. 2. The patient will take his medication on an empty stomach. 3. The patient will take his medication as directed, even if he is feeling well. 4. The patient will monitor his pulse and hold his medication if his pulse is less than 60.

Correct Answer: 3 Rationale 1: It is very important for patients to understand that medication must be taken as directed, even if the patient is feeling well. Procainamide hydrochloride (Pronestyl) drug can be taken on an empty stomach. The beta-adrenergic blocking drugs cause bradycardia, not Group 1A cardiac antiarrhythmic drugs like procainamide hydrochloride (Pronestyl). Procainamide hydrochloride (Pronestyl) can be taken with food. Rationale 2: It is very important for patients to understand that medication must be taken as directed, even if the patient is feeling well. Procainamide hydrochloride (Pronestyl) drug can be taken on an empty stomach. The beta-adrenergic blocking drugs cause bradycardia, not Group 1A cardiac antiarrhythmic drugs like procainamide hydrochloride (Pronestyl). Procainamide hydrochloride (Pronestyl) can be taken with food. Rationale 3: It is very important for patients to understand that medication must be taken as directed, even if the patient is feeling well. Procainamide hydrochloride (Pronestyl) drug can be taken on an empty stomach. The beta-adrenergic blocking drugs cause bradycardia, not Group 1A cardiac antiarrhythmic drugs like procainamide hydrochloride (Pronestyl). Procainamide hydrochloride (Pronestyl) can be taken with food. Rationale 4: It is very important for patients to understand that medication must be taken as directed, even if the patient is feeling well. Procainamide hydrochloride (Pronestyl) drug can be taken on an empty stomach. The beta-adrenergic blocking drugs cause bradycardia, not Group 1A cardiac antiarrhythmic drugs like procainamide hydrochloride (Pronestyl). Procainamide hydrochloride (Pronestyl) can be taken with food.

The patient receives verapamil (Calan). The patient asks the nurse if it is okay to take herbal supplements with this medicine. What is the best response by the nurse? 1. "Using herbal supplements may increase your blood pressure too much." 2. "Herbal supplements are okay as long as you take calcium salts with them." 3. "Using herbal supplements may lower your blood pressure too much." 4. "Most herbal supplements are okay, but you should avoid St. John's wort."

Correct Answer: 3 Rationale 1: Verapamil (Calan) should be used with caution with herbal supplements, such as hawthorn, because of the potential for additive hypotensive effects. All herbal supplements, not just St. John's wort, should be avoided. Taking calcium salts with herbal supplements will not affect the interactions with verapamil (Calan). Herbal supplements may lower, not increase, blood pressure. Rationale 2: Verapamil (Calan) should be used with caution with herbal supplements, such as hawthorn, because of the potential for additive hypotensive effects. All herbal supplements, not just St. John's wort, should be avoided. Taking calcium salts with herbal supplements will not affect the interactions with verapamil (Calan). Herbal supplements may lower, not increase, blood pressure. Rationale 3: Verapamil (Calan) should be used with caution with herbal supplements, such as hawthorn, because of the potential for additive hypotensive effects. All herbal supplements, not just St. John's wort, should be avoided. Taking calcium salts with herbal supplements will not affect the interactions with verapamil (Calan). Herbal supplements may lower, not increase, blood pressure. Rationale 4: Verapamil (Calan) should be used with caution with herbal supplements, such as hawthorn, because of the potential for additive hypotensive effects. All herbal supplements, not just St. John's wort, should be avoided. Taking calcium salts with herbal supplements will not affect the interactions with verapamil (Calan). Herbal supplements may lower, not increase, blood pressure.

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

Correct Answer: 4 Rationale 1: All antidysrhythmic agents can worsen existing dysrhythmias or create new ones. Rationale 2: All antidysrhythmic agents can worsen existing dysrhythmias or create new ones. Rationale 3: All antidysrhythmic agents can worsen existing dysrhythmias or create new ones. Rationale 4: All antidysrhythmic agents can worsen existing dysrhythmias or create new ones.

The nurse is managing care for a group of patients receiving antidysrhythmic medication. Which assessment data will the nurse report to the physician? 1. Depression, irritability, fatigue, and nausea 2. Anorexia, insomnia, confusion, and 11 pitting peripheral edema 3. Low-grade fever, diaphoresis, weakness, and dry mucous membranes 4. Palpitations, chest pain, weakness, and fatigue

Correct Answer: 4 Rationale 1: Side effects of antidysrhythmic medications include palpitations, chest pain, weakness, and fatigue. Low-grade fever, diaphoresis, weakness, and dry mucous membranes are not side effects of antidysrhythmic medications. Anorexia, insomnia, confusion, and 11 pitting peripheral edema are not side effects of antidysrhythmic medications. Depression, irritability, fatigue, and nausea are not side effects of antidysrhythmic medications. Rationale 2: Side effects of antidysrhythmic medications include palpitations, chest pain, weakness, and fatigue. Low-grade fever, diaphoresis, weakness, and dry mucous membranes are not side effects of antidysrhythmic medications. Anorexia, insomnia, confusion, and 11 pitting peripheral edema are not side effects of antidysrhythmic medications. Depression, irritability, fatigue, and nausea are not side effects of antidysrhythmic medications. Rationale 3: Side effects of antidysrhythmic medications include palpitations, chest pain, weakness, and fatigue. Low-grade fever, diaphoresis, weakness, and dry mucous membranes are not side effects of antidysrhythmic medications. Anorexia, insomnia, confusion, and 11 pitting peripheral edema are not side effects of antidysrhythmic medications. Depression, irritability, fatigue, and nausea are not side effects of antidysrhythmic medications. Rationale 4: Side effects of antidysrhythmic medications include palpitations, chest pain, weakness, and fatigue. Low-grade fever, diaphoresis, weakness, and dry mucous membranes are not side effects of antidysrhythmic medications. Anorexia, insomnia, confusion, and 11 pitting peripheral edema are not side effects of antidysrhythmic medications. Depression, irritability, fatigue, and nausea are not side effects of antidysrhythmic medications.