Pharmacology II Prep U Chapter 45: Antiarrhythmic Agents

A client diagnosed with heart disease is prescribed an antiarrhythmic drug. Further teaching is needed when the client makes which of the following statements?

"I know I must take my medication every day to be cured."

The nurse is preparing to administer quinidine intravenously. At what rate will the nurse administer this medication?

1 mL/min

A client experiencing a ventricular dysrhythmia has received a bolus of lidocaine. What is the recommended rate for continuous infusion of lidocaine IV now prescribed for this client?

1 to 4 mg/min

A physician has ordered lidocaine IV for a patient with a ventricular dysrhythmia. The nurse has administered a bolus of lidocaine. What is the recommended rate for continuous infusion of lidocaine IV?

1-4 mg/min

A patient receives lidocaine IV. The nurse would expect the drug to exert its effects for how long?

10 to 20 minutes

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?

4

A client receives lidocaine by intramuscular injection. The nurse would expect the drug to begin to exert its therapeutic effects within which time frame?

5 to 10 minutes

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?

6.2 mcg/mL

When educating a group of nursing students on the mechanism of the action of various anti-arrhythmic drugs, the nurse identifies which drugs as inhibiting the beta-adrenergic receptors of the heart and the kidney?

Acebutolol

When educating a group of nursing students on the mechanism of the action of various anti-arrhythmic drugs, the nurse identifies which of the following drugs as inhibiting the beta-adrenergic receptors of the heart and the kidney?

Acebutolol

When describing the action of antiarrhythmics, which effect would most likely be included?

Alteration in conductivity

When teaching a group of students about antiarrhythmic therapy, the instructor determines that the teaching was successful when the students identify which of the following as the goal of antiarrhythmics?

Altered conductivity

A client receiving warfarin is prescribed disopyramide. The nurse would monitor for signs and symptoms of what as most important?

Bleeding

Which statement would be true about the mechanism of action of class II antiarrhythmic agents?

Block the stimulation of the adrenergic receptors

When describing the action of class II antiarrhythmics, which of the following would the nurse include?

Blockage of beta receptors in the heart and kidneys

When describing the action of class II antiarrhythmics, which would the nurse include?

Blockage of beta receptors in the heart and kidneys

A patient with type 1 diabetes is prescribed acebutolol. What would be most important to monitor?

Blood glucose levels

A patient with type 1 diabetes is prescribed acebutolol. Which of the following would be most important to monitor?

Blood glucose levels

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?

Breast-feeding must be discontinued and other forms of feeding should be introduced.

The nurse would instruct a client receiving acebutolol about which adverse effect?

Bronchospasm

The nurse would instruct a client receiving acebutolol about which of the following adverse effects?

Bronchospasm

When describing the drugs classified as class IV antiarrhythmics, the nurse would identify these as which of the following?

Calcium channel blockers

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?

Determine if the client has had a reaction to local anesthesia.

The health care provider orders quinidine for a client who is receiving digoxin. The nurse would monitor this client for which of the following?

Digoxin toxicity

A client is admitted to the critical care unit after experiencing a myocardial infarction and subsequent serious dysrhythmias. He is treated successfully for ventricular dysrhythmia, and the physician orders continuous IV therapy. What may cause further development of dysrhythmias?

Electrolyte imbalances

A client is prescribed propranolol (Inderal). Which condition in the client's history may affect the treatment regimen?

Elevated glucose

There are four primary classes of antidysrhythmic drugs. What class consists primarily of potassium channel blockers?

III

A client has been prescribed IV amiodarone for emergency treatment of a serious ventricular arrhythmia. The nurse monitors the client's ECG anticipating a noted change how long after the medication is delivered?

Immediately

An ED patient presents with dyspnea, tachycardia, and chest pain. The patient has a history of cardiomyopathy. The nursing assessment reveals hypotension with an apical pulse of 134 bpm. What would the nurse conclude might be causing the symptoms?

Inadequate cardiac output

Your ED patient presents with dyspnea, tachycardia, and chest pain. He has a history of cardiomyopathy. Your assessment reveals hypotension with an apical pulse of 134 bpm. What would you conclude might be causing the symptoms?

Inadequate cardiac output

The nurse is administering quinidine to a client who is also taking digoxin. The nurse will assess this client for which important adverse effect?

Increased digoxin level

The nurse is administering quinidine to a client who is also taking digoxin. The nurse will assess this client for which most important adverse effect?

Increased digoxin level

A client is to receive esmolol. The nurse would expect to administer this agent by which route?

Intravenous

A patient is prescribed esmolol for treatment of supraventricular tachycardia. The nurse would expect to administer this drug by which route?

Intravenous

Lidocaine (Xylocaine) is available in a variety of dosage forms. How should a nurse administer lidocaine to a client with a ventricular arrhythmia?

Intravenously

Lidocaine (Xylocaine) is available in a variety of dosage forms. How should a nurse administer lidocaine to a client with a ventricular arrhythmia? (Choose one)

Intravenously

A client is admitted to the emergency department in ventricular fibrillation. The client is administered amiodarone hydrochloride (Cordarone). What is the major effect of this medication?

It slows the conduction through the AV node.

You are administering intravenous amiodarone to a patient in the emergency department. Which of the following tasks would you need to prioritize?

Monitoring the patient's blood pressure

A client is started on antiarrhythmic therapy to treat atrial fibrillation. The nurse caring for this client knows which occurrence is a potential side effect of this medication?

Other arrhythmias

A patient with cardiac arrhythmia is prescribed verapamil. Which of the following possible adverse effects should the nurse inform the patient about?

Peripheral edema

After a cardiac muscle responds to an adequate electrical stimulus, it contracts. What happens chemically to prepare the muscle cells for the next contraction?

Potassium ions return to the intracellular space.

A patient is admitted to the cardiology unit of a health care facility for ventricular arrhythmia. In which condition can an anti-arrhythmic drug be safely administered?

Premature ventricular contraction

A patient is admitted to the cardiology unit of a health care facility for ventricular arrhythmia. In which of the following conditions can an anti-arrhythmic drug be safely administered?

Premature ventricular contraction

Which agent would be classified as a class Ia antiarrhythmic?

Procainamide

A client is receiving adenosine for treatment of supraventricular tachycardia. The nurse understands that this drug results in which of the following?

Prolonged refractory period

Which one of the following antidysrhythmic drugs is also used to treat a myocardial infarction?

Propranolol (Inderal)

A patient is receiving an intravenous infusion of amiodarone for treatment of ventricular fibrillation. Which is the most serious adverse effect of the medication?

Pulmonary toxicity

Your patient is receiving an intravenous infusion of amiodarone for treatment of ventricular fibrillation. Which of the following is the most serious adverse effect of the medication?

Pulmonary toxicity

A patient, admitted to a health care facility with cardiac arrhythmia, is prescribed propranolol. Which factor should the nurse closely monitor as a part of the ongoing assessment during the therapy?

Pulse rate

A patient, admitted to a health care facility with cardiac arrhythmia, is prescribed propranolol. Which of the following factors should the nurse closely monitor as a part of the ongoing assessment during the therapy?

Pulse rate

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?

Quinidine

A client has been prescribed disopyramide (Norpace) to treat a tachydysrhythmia. Which factor would necessitate that the dose be reduced?

Renal impairment

A patient has been prescribed disopyramide (Norpace) to treat a tachydysrhythmia. Which of the following factors would necessitate that the dose be reduced?

Renal impairment

Which factor would necessitate a reduction in the dosage of disopyramide?

Renal impairment

Which of the following factors would necessitate a reduction in the dosage of disopyramide?

Renal impairment

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?

Respiratory assessment

A patient has a complex cardiac history that includes recurrent ventricular fibrillation. After the failure of more conservative treatments, his care team has introduced oral amiodarone. What assessments should be prioritized by the nurse who is providing care for this patient?

Respiratory assessment

Which would be a contraindication for the use of a class II antiarrhythmic?

Sinus bradycardia

A client is admitted with arrhythmias and placed on cardiac monitoring and prescribed an antiarrhythmic. Which finding on ongoing assessment should the nurse immediately notify the primary health care provider? Select all that apply.

Sudden change in mental state

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?

Taper down the propranolol dose over a period of 2 weeks.

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?

To convert the client's atrial fibrillation to normal sinus rhythm

The teaching plan for a client taking amiodarone should include which instruction?

Use a reliable form of birth control while taking this medication.

After successful treatment for a myocardial infarction, a 69-year-old man has developed a ventricular arrhythmia. His care team has opted for treatment with a Class II antiarrhythmic. The nurse would understand that this client is likely to be prescribed:

acebutolol.

In some cases, low-dose amiodarone may be used to prevent recurrence of what cardiac disorder?

atrial fibrillation

A female patient diagnosed with chronic atrial flutter has been prescribed verapamil in conjunction with digoxin to control ventricular rate. To enhance the therapeutic effect of the drug, the nurse will instruct the patient to:

avoid grapefruit and grapefruit juice.

The nurse notes that a client's current medications include both diltiazem for a dysrhythmia and nitroglycerin. The nurse should recognize the need to closely monitor the which client assessment datum?

blood pressure

When describing the drugs classified as class IV antiarrhythmics, the nurse would identify these as:

calcium channel blockers

An adult client with no known history of cardiovascular disease presents with atrial flutter. The client is prescribed propafenone PO 150 mg every 8 hours for 24 hours. What is the cardiac care nurse's priority assessment during this period?

continuous ECG monitoring

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:

digoxin toxicity

Which class IV calcium channel blocker is exclusively administered to treat acute supraventricular tachycardia?

diltiazem

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:

hypersensitivity to beta blockers.

Propranolol is ordered for a patient who has a cardiac arrhythmia. It will be important for the nurse to determine if the patient has a history of

hypersensitivity to beta blockers.

A client is administered diltiazem IV, followed by propranolol IV. The nurse should assess for what potential side effect of this medication combination?

impaired myocardial contractility

A 70-year-old woman with a history of atrial fibrillation takes digoxin and verapamil to control her health problem. Verapamil achieves a therapeutic effect by

inhibiting the movement of calcium ions across the cardiac muscle cell membrane.

A 70-year-old woman with a history of atrial fibrillation takes digoxin and verapamil to control her health problem. Verapamil achieves a therapeutic effect by:

inhibiting the movement of calcium ions across the cardiac muscle cell membrane.

The primary health care provider prescribes a class I sodium channel blocker to be given intravenously. Which drug would the nurse most likely administer?

lidocaine

What is the primary goal of antidysrhythmic drug therapy for a client who has been successfully cardioverted?

maintenance of normal sinus rhythm (NSR)

A client with a cardiac arrhythmia is admitted to a health care facility. The client is also experiencing myocardial infarction. Which drug is the health care provider most likely to prescribe for the client?

propanolol

Oral quinidine is prescribed for a client with a diagnosis of chronic ventricular tachycardia without heart block. In order to assess for the safety and efficacy of this treatment, the nurse should prioritize which assessment?

serum drug levels

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?

the importance of not stopping the medication abruptly

A nurse is preparing an in-service presentation about arrhythmias. As part of the presentation, the nurse is planning to include factors that contribute to arrhythmias. Which would the nurse include? (Select all that apply.)

• Accumulation of waste products • Electrolyte imbalances • Structural damage to conduction pathways • Drug effects

After reviewing antiarrhythmic drugs, a group of nursing students demonstrate understanding of the drugs when they identify which as a class II antiarrhythmic? Select all that apply.

• Acebutolol • Propranolol

Lidocaine is the prototype of class IB antidysrhythmics used for treating serious ventricular dysrhythmias associated with what conditions? (Select all that apply.)

• Cardiac catheterization • Cardiac surgery • Digitalis-induced ventricular dysrhythmias

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.)

• Chest pain • Dyspnea • Heart palpations

The nurse is administering lidocaine to a client and anticipates a reduced dosage if the client also has which conditions? (Select all that apply.)

• Liver disorders • Right-sided heart failure

Class IB anti-arrhythmics result in which of the following? Select all that apply:

• Shorting of the action potential duration • Depression of cardiac conduction

A cardiovascular assessment before administration of an antiarrhythmic medication includes which of the following? Select all that apply.

• Vital signs • Client's general status • Subjective symptoms • Apical pulse

When educating a group of nursing students on the classification of various antiarrhythmic drugs, the nurse cites propafenone (Rythmol) as an example of class IC drugs. Which are the general modes of action of drugs in this class? Select all that apply.

• profound slowing of conduction • slight effect on repolarization • shortening of the action potential duration • selective depression of cardiac conduction