Pharm201 CH39
A nurse has been caring for a 49-year-old man who was hospitalized with recurrent ventricular fibrillation and received IV amiodarone. The man is now scheduled to be discharged on oral amiodarone, and the nurse has just completed discharge instructions. Which statements made by the client indicates that further instruction is necessary?
"I am going on a cruise next week and plan to just lie in the sun all day and relax."
After the nurse has administered a bolus of lidocaine, the nurse should run a continuous infusion at which rate?
1-4 mg/min
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
The care team is applying the findings of the Cardiac Arrhythmia Suppression Trial (CAST). What client is receiving treatment that best aligns with the findings of the CAST?
A client who is receiving short term treatment for a life-threatening arrhythmia
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
Which best describes the action of class II antiarrhythmics?
Competitive block beta receptor sites in the heart and kidneys
A client is prescribed propranolol (Inderal). Which condition in the client's history may affect the treatment regimen?
Elevated glucose
There are several classes of antiarrhythmic drugs. What class of antiarrhythmics drugs block potassium channels, prolonging phase 3 of the action potential, and slowing the rate and conduction of the heart?
III
When describing the effects of antiarrhythmics, which is associated with all antiarrhythmic medications? Select all that apply.
New arrhythmias Worsen existing arrhythmias Increased blood pressure
Which of the following drugs, when given with lidocaine, would increase lidocaine levels?
Propranolol
Which factor would necessitate a reduction in the dosage of disopyramide?
Renal impairment
The nurse suspects drug toxicity in the client who has been receiving lidocaine by infusion to control a ventricular arrhythmia. What assessment should the nurse perform to determine the accuracy of the suspicion of toxicity?
Serum lidocaine level
In some cases, low-dose amiodarone may be used to prevent recurrence of what cardiac disorder?
atrial fibrillation
The risk for which outcome is increased when a client experiences a drug-to-drug interaction while on amiodarone therapy?
new dysrhythmias
What is the mechanism of action for medications prescribed to treat a rapid dysrhythmia?
reducing automaticity
The nurse is teaching a class for newly hired cardiac care nurses and is discussing dronedarone (Multaq). What statement, if made by the nurse, is accurate? Select all that apply.
"Dronedarone has properties of all four classes of antiarrhythmics." "Dronedarone reduces the risk of hospitalization in clients in atrial fibrillation." "Dronedarone has many drug-drug interactions that need to be reviewed."
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."
A client reports difficulty swallowing an antiarrhythmic capsule. What is the nurse's best response?
"You can try a different form of the medication."
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
The nurse administers a bolus of lidocaine to a client with a life-threatening ventricular arrythmia and follows it with a continuous infusion at what rate?
1 to 4 mg/min
The hospital nurse who works with the resuscitation team is responding to a code for an unresponsive client. The Advanced Cardiac Life Support protocol has been implemented. The nurse should prepare for administration of what medication?
Amiodarone
The nurse assesses a client for urinary retention during administration of disopyramide based on the understanding that this is the result of which adverse reaction?
Anticholinergic effects
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?
Apprehension
A client taking verapamil (Calan) complains of a sore throat. What is the nurse's first action?
Assess for fever, chills, or bruising.
The nurse is caring for a lactating client who has been prescribed a class II antiarrythmic. What is the nurse's best action?
Assess the client and administer the drug as prescribed
The nurse is caring for a client receiving propranolol. What problems, reported by the client, should nurse suspect are being caused by the drug? Select all that apply
Atrioventricular (AV) block Bronchospasm Bizarre dreams
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
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.
The nurse is caring for a client who takes an antidysrhythmic. What would be a priority nursing action before administering this drug?
Check the client's apical and radial pulses.
A client with impaired renal function is to receive dofetilide (Tikosyn) for conversion of atrial fibrillation. Which should the nurse do before administering the drug?
Check the client's creatinine level.
What class of antiarrhythmic agents does the nurse administer to slow the outward movement of potassium during phase 3 of the action potential?
Class III
A client has started therapy for arrhythmias with quinidine. The nurse should tell the client to return to the clinic during the first few months of therapy to have which lab test drawn?
Complete blood count (CBC)
A cardiac care nurse is monitoring a client who is receiving lidocaine (Xylocaine) per IV infusion pump for an acute ventricular arrhythmia associated with an acute MI. Which client manifestations would cause the nurse to notify the physician immediately?
Confusion
What is an adverse effect of propranolol therapy?
Diarrhea
When performing discharge teaching for a client taking an antiarrhythmic, which instruction would the nurse include? Select all that apply.
Do not take any nonprescription medications without permission of the health care provider. Keep all appointments with the health care provider. To relieve dry mouth take frequent sips or water or chew (sugar-free) gum
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.
Lidocaine (Xylocaine) is available in a variety of dosage forms. How should a nurse administer lidocaine to a client with a ventricular arrhythmia?
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.
A critical care nurse is caring for a client after open-heart surgery. What nursing intervention would the nurse initiate to help detect life-threatening dysrhythmias and manage and minimize any that occur?
Monitor cardiac rhythm continuously
Which antiarrhythmic drug is also used to treat a myocardial infarction?
Propranolol (Inderal)
A nurse is caring for a client who has had disopyramide (Norpace) ordered. Before administering the disopyramide (Norpace), what will the nurse do to ensure the client's safety?
Raise all side rails.
A 6-year old client is prescribed lidocaine to treat a ventricular arrhythmia after cardiac surgery. Which nursing intervention is especially important for the safety of this client as long as the therapy is continued? (Select all that apply.)
Regular monitoring of serum lidocaine levels Continuous cardiac monitoring
A client has been prescribed disopyramide (Norpace) to treat a tachydysrhythmia. Which factor would necessitate that the dose be reduced?
Renal impairment
Which factor would necessitate that the dosage of disopyramide (Norpace) be reduced?
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
The nurse is discussing possible adverse effects of quinidine with a client who has been prescribed the drug. Which of the following should the nurse include in the discussion?
Ringing in the ears
A 32 year old client has been admitted to the hospital for cardiac dysrhythmias. When providing client education, the nurse should tell include that the heart has a specialized electrical system, with the pacemaker of the heart in what location?
Sinoatrial node
The nurse administering a Class I antiarrhythmic drug understands that the action of this drug is to:
Stabilize or anesthetize the membranes of cardiac cells
What would the nurse teach the client to monitor for when beginning an antidysrhythmic drug regimen?
Syncope
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 assigned to care for a client who has to be administered an antiarrhythmic drug. Under what conditions would its use be contraindicated? Select all that apply.
The client has hypotension. The client has aortic stenosis. The client has cardiogenic shock.
The nurse caring for a client diagnosed with cinchonism should monitor for which signs or symptoms? Select all that apply.
Tinnitus Headache Vertigo Hearing loss
The nurse is caring for a 3-year-old awaiting a heart transplant who requires an antiarrhythmic agent to control a supraventricular arrhythmia. What drug, if ordered, should the nurse question?
Verapamil
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.
A client with a cardiac arrhythmia is admitted to a health care facility. The client is also experiencing myocardial infarction. Which drugs is the health care provider most likely to prescribe for the client?
amiodarone
A client has questions about the new medication prescribed for cardiac rhythm after having cardioversion performed. How does a sodium channel blocker decrease the likelihood of dysrhythmias ?
by prolonging the heart's refractory period
When describing the drugs classified as class IV antiarrhythmics, the nurse would identify these as:
calcium channel blockers.
When caring for a client with a cardiac dysrhythmia, the most appropriate goal for the client is to maintain:
cardiac output.
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
A stable client with atrial flutter is symptomatic from the arrhythmia. The health care provider administers dofetilide (Tikosyn) IV in an attempt to:
convert the arrhythmia to a sinus rhythm.
A client is receiving an antidysrhythmic medication intravenously. How often should the client's blood pressure be assessed?
every 1 to 5 minutes
Which assessment would be considered a priority for a client receiving amiodarone?
heart rate checks
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.
The nurse is administering lidocaine to a client with ventricular tachycardia. The nurse will need to observe for adverse effects, including
hypotension.
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.
What is the primary goal of antidysrhythmic drug therapy for a client who has been successfully cardioverted?
maintenance of normal sinus rhythm (NSR)
The nurse's subsequent cardiac assessments and monitoring of a client prescribed disopyramide should be planned in the knowledge that this drug ncreases the client's risk for developing what health problem?
new dysrhythmias
The nurse is giving an intravenous infusion of amiodarone (Cordarone). The nurse should be aware of the:
possible development of very serious cardiac arrhythmias.
Initiation of the heart's electrical impulses depends predominantly on what electrolyte movement? Select all that apply.
potassium ions out of a myocardial cell sodium and ions into a myocardial cell calcium ions into a myocardial cell
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
A 92-year-old male client is being sent home on disopyramide (Norpace) for a ventricular arrhythmia. The client asks why he must continue to take this drug. The nurse's best response would be that a ventricular arrhythmia may:
result in death.
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
