PrepU Chapter 45
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?
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A nurse is caring for a patient receiving digoxin for ventricular arrhythmia. Which apical pulse rate indicates that the nurse should withhold the drug and report to the health care provider immediately?
58 beats/minute The nurse should withhold the drug and report to the primary health care provider whenever the patient's pulse rate falls below 60 beats/minute or rises to more than 120 beats/minute. Pulse rates of 68 beats/minute, 78 beats/minute, and 88 beats/minute fall within the normal range.
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? 3.8 mcg/mL 6.2 mcg/mL 4.1 mcg/mL 2.5 mcg/mL
6.2 mcg/mL The nurse should report to the health care provider immediately when the drug level is greater than 6 mcg/mL, which indicates possible cinchonism or quinidine toxicity. The effect of cinchonism is not seen with the lower levels.
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 Report any of the following to your health care provider: chest pain, difficulty breathing, palpitations, numbness, or tingling. The other options present the seriousness of the correct options.
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.) Heart palpations Dyspnea Diarrhea Chest pain Nausea
Chest pain Dyspnea Heart palpations Report any of the following to your health care provider: chest pain, difficulty breathing, palpitations, numbness, or tingling. The other options present the seriousness of the correct options.
A client is prescribed propranolol (Inderal). Which condition in the client's history may affect the treatment regimen? Elevated glucose Nausea Diarrhea Dizziness
Elevated glucose The client with diabetes may experience elevated glucose levels while taking propranolol, and the insulin or oral hypoglycemic drug dosages may need to be adjusted. Nausea, diarrhea, and dizziness are all adverse reactions to propranolol.
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 stimulates the sympathetic nervous system. It inhibits the increase of the refractory period of the cells. It produces skeletal muscle relaxation. It slows the conduction through the AV node.
It slows the conduction through the AV node. The major effect of amiodarone is that it slows the conduction through the AV node and prolongs the refractory period. It produces smooth muscle, not skeletal muscle, relaxation. It prolongs the refractory period; it does not inhibit the increase of the refractory period. It blocks the effects of the sympathetic nervous system instead of stimulating it.
What is the safest precaution to take when administering an antiarrhythmic drug intravenously (IV)? Choose the BEST response. Count the apical pulse before administration. Administer the drug through new IV line. Place the client on a cardiac monitor. Relocate the client's room next to the nurse's station.
Place the client on a cardiac monitor. Cardiac monitoring is recommended when drugs are given intravenously and allows for observation of ECG activity, since severe bradycardia and hypotension can occur. Relocating the client does not assess the client's heart activity. Counting the apical pulse before administration is appropriate, but cardiac monitoring allows for continued assessment throughout administration and beyond. Administering the drug through new IV line may be appropriate, but this action does not provide continued cardiac assessment.
A patient is receiving an intravenous infusion of amiodarone for treatment of ventricular fibrillation. Which is the most serious adverse effect of the medication? Vomiting Optic neuropathy Pulmonary toxicity Hypotension
Pulmonary toxicity Pulmonary toxicity is a potentially fatal adverse effect of amiodarone. Other potentially fatal effects associated with the drug are liver disease and exacerbation of the underlying arrhythmia. Vomiting, hypotension, and optical neuropathy are all potential adverse effects of the drug. Vomiting and optical neuropathy, however, are not life-threatening, and hypotension can typically be controlled by reducing the infusion rate of amiodarone.
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 Amiodarone has several adverse effects that are potentially fatal. Pulmonary toxicity is the most important of these serious adverse effects. Consequently, the nurse should prioritize respiratory assessments over musculoskeletal or neurological assessments.
Which physiological conditions are common triggers for the development of cardiac arrhythmias? Select all that apply. Faulty sinoventricular node Potassium imbalance Respiratory distress Decreased blood volume Metabolic acidosis
Respiratory distress Potassium imbalance Metabolic acidosis Faulty sinoventricular node Electrolyte disturbances, decreases in the oxygen delivered to the cells, structural damage in the conduction pathway, drug effects, acidosis, or the accumulation of waste products can trigger arrhythmias. A decrease in blood volume results in hypotension and ultimate cardiac arrest.
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: lidocaine. verapamil. acebutolol. amiodarone.
acebutolol Class II antiarrhythmics are the beta blockers. Of the other numerous drugs in this class, only acebutolol and esmolol are approved as Class II antiarrhythmics, though other beta blockers are used off label. Lidocaine is a Class IB drug; amiodarone is a Class III antiarrhythmic, and verapamil is a Class IV drug.
In some cases, low-dose amiodarone may be used to prevent recurrence of what cardiac disorder? angina pectoris atrial fibrillation mitral valve regurgitation ventricular hypertrophy
atrial fibrillation Low-dose amiodarone may be a pharmacologic choice for preventing recurrent atrial fibrillation after electrical or pharmacologic conversion. Potassium channel blockers such as amiodarone prolong duration of the action potential, slow repolarization, and prolong the refractory period in both the atria and ventricles. Potassium channel blockers are not effective in preventing valvular disorders, ventricular hypertrophy, or angina.
In some cases, low-dose amiodarone may be used to prevent recurrence of what cardiac disorder? angina pectoris atrial fibrillation mitral valve regurgitation ventricular hypertrophy`
atrial fibrillation Low-dose amiodarone may be a pharmacologic choice for preventing recurrent atrial fibrillation after electrical or pharmacologic conversion. Potassium channel blockers such as amiodarone prolong duration of the action potential, slow repolarization, and prolong the refractory period in both the atria and ventricles. Potassium channel blockers are not effective in preventing valvular disorders, ventricular hypertrophy, or angina.
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 patient should be instructed to avoid grapefruit and grapefruit juice because they may increase the verapamil level. The patient should also abstain from using alcohol and aspirin while taking this medication. Encouraging the patient to increase her fluid intake and include fresh fruit and fiber in her diet can help prevent constipation. Taking the medication with meals would not enhance its effect.
When describing the drugs classified as class IV antiarrhythmics, the nurse would identify these as: cardiac glycosides. beta blockers. vasodilators. calcium channel blockers.
calcium channel blockers. Class IV antiarrhythmics include calcium channel blockers. Beta blockers are class II antiarrhythmics. Cardiac glycosides, such as digoxin may be used as an antiarrhythmic, but are not classified as class I, II, III, or IV. Vasodilators are not used as antiarrhythmics.
A patient is receiving procainamide intravenously. The nurse understands that the initial dose should run over which time frame? 15 to 20 minutes 20 to 25 minutes 10 to 15 minutes 25 to 30 minutes
25 to 30 minutes Procainamide, when given IV, is administered initially over 25 to 30 minutes.
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. Ibutilide Propranolol Acebutolol Amiodarone Verapamil
Acebutolol Propranolol Acebutolol and propranolol are class II antiarrhythmics. Amiodarone and ibutilide are class III antiarrhythmic drugs. Verapamil is a calcium channel blocker.
When describing the action of antiarrhythmics, which effect would most likely be included? Reduction in cardiac output Reduction of peripheral resistance Enhancement of automaticity Alteration in conductivity
Alteration in conductivity Antiarrhythmic agents alter the conductivity or suppress automaticity of the heart.
The nurse would instruct a client receiving acebutolol about which adverse effect?
Bronchospasm Bronchospasm is a possible adverse effect of acebutolol, a class II antiarrhythmic. Other effects include hypotension, decreased libido, and decreased exercise tolerance.
A client is prescribed propranolol (Inderal). Which condition in the client's history may affect the treatment regimen? Diarrhea Dizziness Nausea Elevated glucose
Elevated glucose The client with diabetes may experience elevated glucose levels while taking propranolol, and the insulin or oral hypoglycemic drug dosages may need to be adjusted. Nausea, diarrhea, and dizziness are all adverse reactions to propranolol.
There are four primary classes of antidysrhythmic drugs. What class consists primarily of potassium channel blockers? I III II IV
III The class III antidysrhythmics are primarily potassium channel blockers. Class I drugs are sodium channel blockers; class II drugs are beta-adrenergic blockers; and class IV drugs are calcium channel blockers.
A patient is prescribed esmolol for treatment of supraventricular tachycardia. The nurse would expect to administer this drug by which route? Intravenous Subcutaneous Oral Intramuscular
Intravenous Esmolol is available only for IV administration.
A client is to receive esmolol. The nurse would expect to administer this agent by which route?
Intravenous Esmolol, a class II agent, is administered 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. It inhibits the increase of the refractory period of the cells. It stimulates the sympathetic nervous system. It produces skeletal muscle relaxation.
It slows the conduction through the AV node. Amiodarone is a class III antiarrhythmic. The major effect of amiodarone is that it slows the conduction through the AV node and prolongs the refractory period. It produces smooth muscle, not skeletal muscle, relaxation. It prolongs the refractory period; it does not inhibit the increase of the refractory period. It blocks the effects of the sympathetic nervous system instead of stimulating it.
A client is prescribed disopyramide. The nurse would expect to administer this drug by which route? Oral Subcutaneous Intravenous Intramuscular
Oral Disopyramide is administered orally.
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? Procainamide Quinidine Lidocaine Flecainide
Quinidine The nurse should consider the drug Quinidine as the cause for these adverse effects. Quinidine toxicity is called cinchonism. Some of its symptoms include ringing in the ears (tinnitus), hearing loss, headache, nausea, vomiting, abdominal pain, dizziness, vertigo, and light-headedness. Lidocaine, flecainide, and procainamide do not cause tinnitus or hearing loss as adverse effects.
Which would be a contraindication for the use of a class II antiarrhythmic? Sinus bradycardia Diabetes Thyroid dysfunction Hepatic dysfunction
Sinus bradycardia Class II antiarrhythmics are contraindicated in sinus bradycardia but should be used cautiously in clients with diabetes, thyroid dysfunction, and hepatic dysfunction.
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 The nurse should report to the health care provider any sudden change in mental status as a decrease in dosage may be necessary. A pulse rate above 120 bpm or below 60 bpm should be immediately reported to the health care provider. Dry mouth and gums is an expected adverse reaction for which the nurse should recommend the client take frequent sips of water or chew sugarless gum. Somnolence and not restlessness is a possible adverse reaction to antiarrhythmic drugs.
The nurse is preparing to administer quinidine intravenously. At what rate will the nurse administer this medication? 10 mL/min 25 mL/min 1 mL/min 15 mL/min
1 mL/min Quinidine is administered at a rate of 1 mL/min.
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 10 to 20 minutes 20 to 30 minutes 30 to 40 minutes
5 to 10 minutes Lidocaine, when given by intramuscular injection, has an onset of action between 5 to 10 minutes and peaks in 5 to 15 minutes.
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 Propafenone Disopyramide Amiodarone
Acebutolol The nurse should inform the nursing students that acebutolol acts by inhibiting the beta-adrenergic receptors of the heart and the kidney. Propafenone and amiodarone appear to act directly on the cardiac cell membrane, and on the beta-adrenergic receptors of the heart and the kidney. Disopyramide acts by decreasing the depolarization of the myocardial fibers, and not the beta-adrenergic receptors of the heart and the kidney.
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? Propafenone Acebutolol Disopyramide Amiodarone
Acebutolol The nurse should inform the nursing students that acebutolol acts by inhibiting the beta-adrenergic receptors of the heart and the kidney. Propafenone and amiodarone appear to act directly on the cardiac cell membrane, and on the beta-adrenergic receptors of the heart and the kidney. Disopyramide acts by decreasing the depolarization of the myocardial fibers, and not the beta-adrenergic receptors of the heart and the kidney.
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. Ibutilide Verapamil Amiodarone Acebutolol Propranolol
Acebutolol Propranolol Acebutolol and propranolol are class II antiarrhythmics. Amiodarone and ibutilide are class III antiarrhythmic drugs. Verapamil is a calcium channel blocker.
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? 10 minutes Immediately 90 minutes 2-3 days
Immediately The onset of IV amiodarone is immediate with the peak occurring in 20 minutes and a duration of 6-8 hours.
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 Increased restlessness Dry mouth and gums A pulse rate of 100 bpm
Sudden change in mental state The nurse should report to the health care provider any sudden change in mental status as a decrease in dosage may be necessary. A pulse rate above 120 bpm or below 60 bpm should be immediately reported to the health care provider. Dry mouth and gums is an expected adverse reaction for which the nurse should recommend the client take frequent sips of water or chew sugarless gum. Somnolence and not restlessness is a possible adverse reaction to antiarrhythmic drugs.
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 flecainide disopyramide mexiletine
lidocaine The nurse should administer lidocaine intravenously; disopyramide, flecainide, and mexiletine are administered orally.
The nurse should advocate for a lower-than-normal dose if the client prescribed quinidine has a history of what medical diagnosis? chronic obstructive pulmonary disease primary hypertension liver disease type 1 or type 2 diabetes
liver disease Hepatic impairment increases the plasma half-life of several antidysrhythmic drugs, including quinidine, and clients with hepatic impairment usually receive a reduced dosage. None of the pathophysiology of any of the other conditions would affect the half-life of quinidine since they are not affecting drug metabolism.
What is the primary goal of antidysrhythmic drug therapy for a client who has been successfully cardioverted?
maintenance of normal sinus rhythm (NSR) Maintaining NSR after conversion from atrial fibrillation or atrial flutter is one of the indications for antidysrhythmic drug therapy. This is not achieved solely by increasing contractility. Increased tissue perfusion is a valid goal, but increased blood pressure may or may not be desirable. Clinicians use drugs not just to suppress dysrhythmias but to prevent or relieve symptoms or prolong survival.
The risk for which outcome is increased when a client experiences a drug-to-drug interaction while on amiodarone therapy? hypersensitivity to amiodarone hypertensive crisis new dysrhythmias seizure activity
new dysrhythmias When oral amiodarone is used long term, it increases the effects of numerous drugs, worsening existing dysrhythmias or producing new dysrhythmias. Drugs that interact with amiodarone include beta-blockers, oral anticoagulants, digoxin, and phenytoin.
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 need to measure the radial pulse for 1 minute prior to each dose of propranolol the need to avoid taking over-the-counter antacids the importance of not stopping the medication abruptly the need to limit intake of high-potassium foods
the importance of not stopping the medication abruptly Clients need to realize that they should not stop taking propranolol abruptly because this action can cause the dysrhythmia to worsen. There is no need to restrict potassium intake, to avoid antacids, or to measure the radial pulse prior to each dose of propranolol.
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? 0.25 to 0.75 mg/min 10 to 20 mg/min 1 to 4 mg/min 6 to 8 mg/min
1 to 4 mg/min A continuous infusion of lidocaine IV after a bolus is 1 to 4 mg/minute. The administration of 0.25 to 0.75 mg/minute would be too small of a dosage. The administration of 10 to 20 or 6 to 8 mg/minute would be too large.
The nurse is preparing to administer quinidine intravenously. At what rate will the nurse administer this medication? 15 mL/min 1 mL/min 10 mL/min 25 mL/min
1 mL/min Quinidine is administered at a rate of 1 mL/min.
A client, diagnosed with a cardiac dysrhythmia, will not require medication therapy. The client expresses concern about the lack of proposed treatment. What response should the nurse provide to best address the client's concern?
"The dysrhythmia you have isn't interfering with getting oxygen to your body tissues so there is no need to treat it." Dysrhythmias become significant when they interfere with the perfusion of body tissues as evidenced by symptoms. When perfusion is impaired, medication therapy is prescribed. Attempting to assure the client that the cardiologist will prescribe medication when appropriate does not address the client's current concerns. None of the remaining options prove accurate information regarding medication therapy for dysrhythmias.
A client, diagnosed with a cardiac dysrhythmia, will not require medication therapy. The client expresses concern about the lack of proposed treatment. What response should the nurse provide to best address the client's concern? "You can be assured your cardiologist will prescribe medication therapy if the dysthymia gets progressively worse." "The dysrhythmia you have isn't interfering with getting oxygen to your body tissues so there is no need to treat it." "If the dysrhythmia causes bradycardia, you will be prescribed medication." "Dysrhythmias that cause tachycardia are the only that can be treated with medications."
"The dysrhythmia you have isn't interfering with getting oxygen to your body tissues so there is no need to treat it." Dysrhythmias become significant when they interfere with the perfusion of body tissues as evidenced by symptoms. When perfusion is impaired, medication therapy is prescribed. Attempting to assure the client that the cardiologist will prescribe medication when appropriate does not address the client's current concerns. None of the remaining options prove accurate information regarding medication therapy for dysrhythmias.
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? 2.5 mcg/mL 6.2 mcg/mL 4.1 mcg/mL 3.8 mcg/mL
6.2 mcg/mL The nurse should report to the health care provider immediately when the drug level is greater than 6 mcg/mL, which indicates possible cinchonism or quinidine toxicity. The effect of cinchonism is not seen with the lower levels.
A 68-year-old client is treated with lidocaine for frequent premature ventricular contractions after a myocardial infarction. The nurse needs to assess this client frequently for adverse reactions that are dose related. What is the most common mild adverse effect of lidocaine therapy? Mood changes Double vision Apprehension Hallucinations
Apprehension Adverse effects of lidocaine are seen particularly in the CV system and CNS. CV effects are related to serum levels; the most severe is cardiac depression coinciding with toxic levels of lidocaine. The most common CV effects are cardiac arrhythmias and hypotension. Other effects include bradycardia and CV collapse, which may lead to cardiac arrest. CNS adverse effects also are related to blood concentrations of lidocaine. The most common CNS effects are dizziness, lightheadedness, fatigue, drowsiness and apprehension. These common, mild effects are seen with low blood levels of lidocaine and resolve rapidly. As blood levels of lidocaine rise, nervousness, confusion, mood changes, hallucinations, euphoria, tinnitus, blurred or double vision, and a sensation of heat, cold, or numbness may occur.
A client receiving warfarin is prescribed disopyramide. The nurse would monitor for signs and symptoms of what as most important? Bleeding Disopyramide toxicity Renal dysfunction Arrhythmia
Bleeding The combination of disopyramide with warfarin increases the client's risk for bleeding. The combination of disopyramide with warfarin does not promote renal dysfunction. The combination of disopyramide with digoxin or beta blockers increases the client's risk for the development of arrhythmias.
Which statement would be true about the mechanism of action of class II antiarrhythmic agents? Block the influx of sodium into the cells Cause depression in phase 2 of repolarization Stimulate the uptake of potassium in the tissues Block the stimulation of the adrenergic receptors
Block the stimulation of the adrenergic receptors Class II antiarrhythmic drugs block adrenergic receptors (beta-blockers), producing antisympathetic effects that slow the heart rate, lengthen the time needed for conduction, and increase the force of contraction. The effect seen with class II antiarrhythmic drugs is depression of phase 4 of depolarization.
Which statement would be true about the mechanism of action of class II antiarrhythmic agents? Block the influx of sodium into the cells Block the stimulation of the adrenergic receptors Stimulate the uptake of potassium in the tissues Cause depression in phase 2 of repolarization
Block the stimulation of the adrenergic receptors Class II antiarrhythmic drugs block adrenergic receptors (beta-blockers), producing antisympathetic effects that slow the heart rate, lengthen the time needed for conduction, and increase the force of contraction. The effect seen with class II antiarrhythmic drugs is depression of phase 4 of depolarization.
When describing the action of class II antiarrhythmics, which would the nurse include? Membrane stabilization with depression of phase 0 action potential Interference with calcium ion movement across the membrane Blockage of potassium channels during phase 3 action potential Blockage of beta receptors in the heart and kidneys
Blockage of beta receptors in the heart and kidneys Class II antiarrhythmics are beta-adrenergic blockers that block the beta receptor sites in the heart and kidneys. Membrane stabilization and phase 0 depression occurs with class I antiarrhythmics. Blockage of potassium channels during phase 3 of the action potential occurs with class III antiarrhythmics. Blockage of calcium ion movement occurs with class IV antiarrhythmics.
A patient with type 1 diabetes is prescribed acebutolol. What would be most important to monitor?
Blood glucose levels The combination of insulin used for type 1 diabetes and acebutolol increases the patient's risk for hypoglycemia necessitating close monitoring of the patient's blood glucose levels.
A patient with type 1 diabetes is prescribed acebutolol. What would be most important to monitor? Serum electrolyte levels Electrocardiogram Blood glucose levels Liver function studies
Blood glucose levels The combination of insulin used for type 1 diabetes and acebutolol increases the patient's risk for hypoglycemia necessitating close monitoring of the patient's blood glucose levels.
A patient with type 1 diabetes is prescribed acebutolol. What would be most important to monitor? Serum electrolyte levels Liver function studies Blood glucose levels Electrocardiogram
Blood glucose levels The combination of insulin used for type 1 diabetes and acebutolol increases the patient's risk for hypoglycemia necessitating close monitoring of the patient's blood glucose levels.
A client with diabetes is given a prescription for propranolol (Inderal) to treat a cardiac arrhythmia. Which instruction by the nurse would be most appropriate? Check blood glucose once or twice daily. Stop taking diabetes medications. Eat a diet high in carbohydrates. Double the dose of diabetes medication.
Check blood glucose once or twice daily. Propranolol can cause hyperglycemia, and clients with diabetes should be advised to check blood sugar once or twice daily and report any elevated blood glucoses to the health care provider. Advising the client to stop taking diabetes medications or to double dose is an inappropriate response. All medications should be continued as prescribed unless changed by the provider. Eating a diet high in carbohydrates can cause increases in blood sugar, and not an appropriate diet.
A nurse is preparing to administer flecainide. The nurse identifies this drug as being classified as which type of antiarrhythmic? Class IA Class IC Class II Class IB
Class IC Flecainide is a class IC antiarrhythmic. Disopyramide is a class IA drug. Lidocaine is a class IB drug. Beta-adrenergic blockers are class II drugs.
A nurse is preparing to administer flecainide. The nurse identifies this drug as being classified as which type of antiarrhythmic? Class II Class IC Class IA Class IB
Class IC Flecainide is a class IC antiarrhythmic. Disopyramide is a class IA drug. Lidocaine is a class IB drug. Beta-adrenergic blockers are class II drugs.
Which best describes the action of class II antiarrhythmics?
Competitive block beta receptor sites in the heart and kidneys Class II antiarrhythmics are beta blockers that block beta receptors in the heart and kidneys causing a depression of phase 4 of the action potential. Class III antiarrhythmics block potassium channels and slow the outward movement of potassium during phase 3 of the action potential, prolonging it. Class IV antiarrhythmics block the movement of calcium ions across the cell membrane depressing the generation of action potentials delaying phases 1 and 2 of repolarization. Class I antiarrhythmics block sodium channels in the cell membrane during an action potential.
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? Assess for lidocaine administration in the client's history. Determine if the client has had a reaction to local anesthesia. Determine the client's ability to swallow. Assess the client's nutritional history for allergies.
Determine if the client has had a reaction to local anesthesia. Lidocaine is contraindicated in clients allergic to local anesthetic agents. It is important to determine if the client has been administered lidocaine in the past, but it is imperative to ascertain any untoward effects. The medication will be administered intravenously, so it is not necessary to assess the client's ability to swallow. However, swallowing can be impaired after administration and should be assessed. It is not necessary to do a nutritional assessment at this time.
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 the client's ability to swallow. Determine if the client has had a reaction to local anesthesia. Assess for lidocaine administration in the client's history. Assess the client's nutritional history for allergies.
Determine if the client has had a reaction to local anesthesia. Lidocaine is contraindicated in clients allergic to local anesthetic agents. It is important to determine if the client has been administered lidocaine in the past, but it is imperative to ascertain any untoward effects. The medication will be administered intravenously, so it is not necessary to assess the client's ability to swallow. However, swallowing can be impaired after administration and should be assessed. It is not necessary to do a nutritional assessment at this time.
A client diagnosed with chronic atrial fibrillation is concerned about not being prescribed medication to manage the situation. Upon what information should the nurse base his/her response to the client's concern? Drug treatment is believed to increase the risk of death in clients diagnosed with chronic atrial fibrillation. Attempts to pharmacologically manage this dysrhythmia are unlikely to be beneficial. Additional medications are given as tachydysrhythmias increase in frequency and severity. Medications are commonly prescribed to control only significant dysrhythmias.
Drug treatment is believed to increase the risk of death in clients diagnosed with chronic atrial fibrillation. Drug treatment increases the risk of nonfatal cardiac arrest and death in clients with recent myocardial infarction or chronic atrial fibrillation. This information makes the other options inaccurate statements.
A client is prescribed propranolol (Inderal). Which condition in the client's history may affect the treatment regimen? Diarrhea Nausea Elevated glucose Dizziness
Elevated glucose The client with diabetes may experience elevated glucose levels while taking propranolol, and the insulin or oral hypoglycemic drug dosages may need to be adjusted. Nausea, diarrhea, and dizziness are all adverse reactions to propranolol.
The nurse is assessing a client and suspects that the client is experiencing a dysrhythmia. What client assessments would support this condition? (Select all that apply.) Leg pain Mental confusion Shortness of breath Hypotension Polyuria
Hypotension Mental confusion Shortness of breath Clients who are experiencing a dysrhythmia often experience oliguria, hypotension, mental confusion or syncope, or shortness of breath. Leg pain is not a symptom of dysrhythmia.
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? 90 minutes Immediately 10 minutes 2-3 days
Immediately The onset of IV amiodarone is immediate with the peak occurring in 20 minutes and a duration of 6-8 hours.
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 Symptoms presenting suggest a cardiac condition. A diseased heart may not be able to maintain an adequate cardiac output with heart rates below 60 bpm above 120 bpm.
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 anticoagulant effects Increased digoxin level Decreased white blood cell count Decreased red blood cell count
Increased digoxin level The nurse would assess this client for digoxin toxicity because quinidine and digoxin interact, leading to an increased digoxin level.
A client is to receive esmolol. The nurse would expect to administer this agent by which route? Intramuscular Subcutaneous Intravenous Oral
Intravenous Esmolol, a class II agent, is administered intravenously.
A patient is prescribed esmolol for treatment of supraventricular tachycardia. The nurse would expect to administer this drug by which route?
Intravenous Esmolol is available only for IV administration.
Lidocaine (Xylocaine) is available in a variety of dosage forms. How should a nurse administer lidocaine to a client with a ventricular arrhythmia?
Intravenously The nurse should administer lidocaine intravenously for the treatment of ventricular arrhythmias.
A clinic nurse is following a 62-year-old woman who is taking quinidine for a cardiac arrhythmia. What nursing action will address the most common adverse effects of quinidine therapy? Monitor the client for facial erythema Monitor the client for signs and symptoms of GI upset Monitor normal serum calcium levels Monitor the client's level of consciousness
Monitor the client for signs and symptoms of GI upset The most common adverse effects of quinidine involve the GI system and include nausea, vomiting, abdominal pain, diarrhea, and anorexia. Calcium levels do not affect the action of the drug. Erythema and changes in LOC are not associated with quinidine.
A clinic nurse is following a 62-year-old woman who is taking quinidine for a cardiac arrhythmia. What nursing action will address the most common adverse effects of quinidine therapy? Monitor the client for signs and symptoms of GI upset Monitor normal serum calcium levels Monitor the client's level of consciousness Monitor the client for facial erythema
Monitor the client for signs and symptoms of GI upset The most common adverse effects of quinidine involve the GI system and include nausea, vomiting, abdominal pain, diarrhea, and anorexia. Calcium levels do not affect the action of the drug. Erythema and changes in LOC are not associated with quinidine.
Which is part of the nurse's evaluation of anti-arrhythmic drug therapy? (Select all that apply.) No evidence of injury seen. No evidence of infection is seen. Patient is free of nausea. Patient urinates adequately. Oral mucous membranes are intact and moist.
No evidence of injury seen. No evidence of infection is seen. Patient is free of nausea. Patient urinates adequately. Oral mucous membranes are intact and moist. Most of these are part of the nurse's evaluation of anti-arrhythmic drug therapy. Therapeutic response, identification of adverse reactions, and demonstration of client and family's understanding are also included in the nurse's evaluation of anti-arrhythmic drug therapy.
A patient with cardiac arrhythmia is prescribed verapamil. Which of the following possible adverse effects should the nurse inform the patient about? Peripheral edema Hyperactivity Hypertension Diarrhea
Peripheral edema The nurse should inform the patient that peripheral edema could be an adverse effect to verapamil therapy. Diarrhea, hyperactivity, and hypertension are not adverse effects associated with verapamil therapy. Other adverse effects associated with verapamil are constipation, mental depression, and hypotension.
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 The patient can be safely administered an anti-arrhythmic drug if the patient has premature ventricular contractions. Aortic stenosis, third-degree heart block, and severe congestive heart failure are contraindications for the use of anti-arrhythmic drugs.
A client is receiving adenosine for treatment of supraventricular tachycardia. The nurse understands that this drug results in: Prolonged refractory period Increased conduction through the atrioventricular node Slowed release of calcium leaving the cell Increased automaticity in the atrioventricular node
Prolonged refractory period Adenosine slows conduction through the atrioventricular node, prolongs the refractory period, and decreases automaticity through the atrioventricular node. Digoxin used as an antiarrhythmic slows calcium from leaving the cell, prolonging the action potential and slowing conduction and heart rate.
A patient is receiving an intravenous infusion of amiodarone for treatment of ventricular fibrillation. Which is the most serious adverse effect of the medication? Hypotension Pulmonary toxicity Optic neuropathy Vomiting
Pulmonary toxicity Pulmonary toxicity is a potentially fatal adverse effect of amiodarone. Other potentially fatal effects associated with the drug are liver disease and exacerbation of the underlying arrhythmia. Vomiting, hypotension, and optical neuropathy are all potential adverse effects of the drug. Vomiting and optical neuropathy, however, are not life-threatening, and hypotension can typically be controlled by reducing the infusion rate of amiodarone.
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 During anti-arrhythmic drug therapy, the nurse should closely monitor the patient's pulse rate. A change in the pulse rate and rhythm will help assess a response to drug therapy, the development of signs of CHF, the development of a new cardiac arrhythmia, or worsening of the arrhythmia being treated. It is not necessary to monitor the tendon reflexes, hydration or visual acuity when administering an anti-arrhythmic drug to the patient.
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 Flecainide Procainamide Lidocaine
Quinidine The nurse should consider the drug Quinidine as the cause for these adverse effects. Quinidine toxicity is called cinchonism. Some of its symptoms include ringing in the ears (tinnitus), hearing loss, headache, nausea, vomiting, abdominal pain, dizziness, vertigo, and light-headedness. Lidocaine, flecainide, and procainamide do not cause tinnitus or hearing loss as adverse effects.
Which factor would necessitate a reduction in the dosage of disopyramide?
Renal impairment As a general rule, dosage of several antidysrhythmic drugs, including disopyramide, should be reduced in clients with significant impairment of renal function to avoid toxicity.
A client has been prescribed disopyramide (Norpace) to treat a tachydysrhythmia. Which factor would necessitate that the dose be reduced?
Renal impairment Disopyramide is excreted in the kidneys and the liver in almost equal proportions. The dose must be reduced in renal insufficiency based on creatinine clearance. The dose does not need to be reduced in immobility, hypertension, or chronic diarrhea.
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? Monitor cardiac status at regularly after taking the final dose of propranolol. Be prepared to substitute an intramuscular propranolol for several months. Gradually replace the propranolol with newly prescribed metoprolol. Taper down the propranolol dose over a period of 2 weeks.
Taper down the propranolol dose over a period of 2 weeks. It is essential that propranolol not be discontinued abruptly after long-term therapy; a hypersensitivity to catecholamines may have developed, exacerbating ventricular dysrhythmias. Gradual tapering over a 2-week period, with client monitoring, is necessary. Replacement with a different beta-blocker is not necessarily indicated. Propranolol is not administered by the IM route. Monitoring alone is not sufficient treatment in this situation.
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. Gradually replace the propranolol with newly prescribed metoprolol. Monitor cardiac status at regularly after taking the final dose of propranolol. Be prepared to substitute an intramuscular propranolol for several months.
Taper down the propranolol dose over a period of 2 weeks. It is essential that propranolol not be discontinued abruptly after long-term therapy; a hypersensitivity to catecholamines may have developed, exacerbating ventricular dysrhythmias. Gradual tapering over a 2-week period, with client monitoring, is necessary. Replacement with a different beta-blocker is not necessarily indicated. Propranolol is not administered by the IM route. Monitoring alone is not sufficient treatment in this situation.
When describing the drugs classified as class IV antiarrhythmics, the nurse would identify these as:
calcium channel blockers. Class IV antiarrhythmics include calcium channel blockers. Beta blockers are class II antiarrhythmics. Cardiac glycosides, such as digoxin may be used as an antiarrhythmic, but are not classified as class I, II, III, or IV. Vasodilators are not used as antiarrhythmics.
A 75-year-old client presents to the physician with a cardiac dysrhythmia. The physician chooses to treat the dysrhythmia because of symptoms related to: diabetic neuropathy. MÉniÈre's disease. circulatory impairment. cardiomyopathy.
circulatory impairment. Cardiac dysrhythmias are common in older adults, but in general only those causing symptoms of circulatory impairment should be treated with antidysrhythmic drugs.
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 treat the client's ventricular tachycardia To resolve the client's uncompensated heart failure To convert the client's atrial fibrillation to normal sinus rhythm To treat sinus bradycardia accompanied by hypotension
To convert the client's atrial fibrillation to normal sinus rhythm Dofetilide is used to convert clients in atrial fibrillation to normal sinus rhythm and maintain them in sinus rhythm. This drug is not used in the treatment of bradycardia, heart failure, or ventricular arrhythmias.
The teaching plan for a client taking amiodarone should include which instruction? Urinary retention is common and no need for concern. Take this medication with grapefruit juice for optimal absorption. Drowsiness is common but will not interfere with any of your usual activities. Use a reliable form of birth control while taking this medication.
Use a reliable form of birth control while taking this medication. Amiodarone is a pregnancy category D drug. Because of a specific enzyme reaction, grapefruit or its juice should not be taken with amiodarone or calcium channel blockers. Urinary retention is an adverse reaction and should be reported to the health care provider. Drowsiness may occur, and the client should be instructed not to drive and to avoid hazardous tasks if drowsy.
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. amiodarone. verapamil. lidocaine.
acebutolol Class II antiarrhythmics are the beta blockers. Of the other numerous drugs in this class, only acebutolol and esmolol are approved as Class II antiarrhythmics, though other beta blockers are used off label. Lidocaine is a Class IB drug; amiodarone is a Class III antiarrhythmic, and verapamil is a Class IV drug.
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: verapamil. acebutolol. amiodarone. lidocaine.
acebutolol Class II antiarrhythmics are the beta blockers. Of the other numerous drugs in this class, only acebutolol and esmolol are approved as Class II antiarrhythmics, though other beta blockers are used off label. Lidocaine is a Class IB drug; amiodarone is a Class III antiarrhythmic, and verapamil is a Class IV drug.
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 level of consciousness oxygen saturation levels peripheral pulses
blood pressure When caring for clients who are receiving diltiazem, the nurse monitors carefully for changes in blood pressure and cardiac rhythm as well as output. Checking the blood pressure is especially important if the client is taking nitrates concurrently.
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? oxygen saturation levels level of consciousness peripheral pulses blood pressure
blood pressure When caring for clients who are receiving diltiazem, the nurse monitors carefully for changes in blood pressure and cardiac rhythm as well as output. Checking the blood pressure is especially important if the client is taking nitrates concurrently.
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? peripheral pulses oxygen saturation levels level of consciousness blood pressure
blood pressure When caring for clients who are receiving diltiazem, the nurse monitors carefully for changes in blood pressure and cardiac rhythm as well as output. Checking the blood pressure is especially important if the client is taking nitrates concurrently.
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 Propafenone may cause new dysrhythmias or aggravate preexisting dysrhythmias, sometimes causing sustained ventricular tachycardia or ventricular fibrillation. As a result, continuous ECG monitoring is necessary at the initiation of treatment. This is a priority over serial potassium levels or echocardiography. Blood pressure should ideally be monitored more frequently than every 10 minutes.
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: increased quinidine effect. bleeding. renal dysfunction. digoxin toxicity.
digoxin toxicity. Quinidine interacts with digoxin (classically prescribed for atrial fibrillation , possibly leading to increased digoxin levels and digoxin toxicity. The effects of digoxin, not quinidine, are increased. Bleeding may occur if class I antiarrhythmics are given with oral anticoagulants such as warfarin. Renal dysfunction is unrelated to the use of both drugs.
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: renal dysfunction. increased quinidine effect. digoxin toxicity. bleeding.
digoxin toxicity. Quinidine interacts with digoxin (classically prescribed for atrial fibrillation , possibly leading to increased digoxin levels and digoxin toxicity. The effects of digoxin, not quinidine, are increased. Bleeding may occur if class I antiarrhythmics are given with oral anticoagulants such as warfarin. Renal dysfunction is unrelated to the use of both drugs.
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 sulfonylureas. hypersensitivity to beta blockers. idiosyncratic reaction to cinchona derivatives. chronic heart failure secondary to a tachyarrhythmia.
hypersensitivity to beta blockers. Propranolol would be contraindicated in a patient with hypersensitivity to beta blockers since it blocks the beta-adrenergic receptor sites. For the same reason, it would not be contraindicated in chronic heart failure secondary to a tachyarrhythmia, treatable with beta blockers. It would also not be contraindicated in a client with an idiosyncratic reaction to cinchona derivatives or in a client with hypersensitivity to sulfonylureas because it is not a cinchona derivative and does not contain sulfonylurea.
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: idiosyncratic reaction to cinchona derivatives. hypersensitivity to sulfonylureas. hypersensitivity to beta blockers. chronic heart failure secondary to a tachyarrhythmia.
hypersensitivity to beta blockers. Propranolol would be contraindicated in a patient with hypersensitivity to beta blockers since it blocks the beta-adrenergic receptor sites. For the same reason, it would not be contraindicated in chronic heart failure secondary to a tachyarrhythmia, treatable with beta blockers. It would also not be contraindicated in a client with an idiosyncratic reaction to cinchona derivatives or in a client with hypersensitivity to sulfonylureas because it is not a cinchona derivative and does not contain sulfonylurea.
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. Verapamil acts by inhibiting the movement of calcium ions across the cardiac and arterial muscle cell membrane. It works preferentially in "slow response" myocardial tissue, such as the SA and AV nodes. Beta blockers inhibit adrenergic receptors and Class IB antiarrhythmics are among the drugs that decrease sodium and potassium conduction. Lidocaine weakens phase 4 diastolic depolarization and decreases the action potential duration and the effective refractory period of Purkinje fibers and ventricular muscle.
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 the need to measure the radial pulse for 1 minute prior to each dose of propranolol the need to limit intake of high-potassium foods the need to avoid taking over-the-counter antacids
the importance of not stopping the medication abruptly Clients need to realize that they should not stop taking propranolol abruptly because this action can cause the dysrhythmia to worsen. There is no need to restrict potassium intake, to avoid antacids, or to measure the radial pulse prior to each dose of propranolol.
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 need to limit intake of high-potassium foods the need to measure the radial pulse for 1 minute prior to each dose of propranolol the importance of not stopping the medication abruptly the need to avoid taking over-the-counter antacids
the importance of not stopping the medication abruptly Clients need to realize that they should not stop taking propranolol abruptly because this action can cause the dysrhythmia to worsen. There is no need to restrict potassium intake, to avoid antacids, or to measure the radial pulse prior to each dose of propranolol.
