Question 1

A patient is taking digoxin [Lanoxin] and develops a dysrhythmia. The nurse reports this finding to the prescriber, who will most likely order what?&#10;A) Amiodarone&#10;B) Diltiazem&#10;C) Phenytoin [Dilantin]&#10;D) Quinidine&#10;E) Serum electrolytes

Accepted Answer

Phenytoin is an antiseizure medication used to treat digoxin-induced dysrhythmias. Because digoxin-induced dysrhythmias can be caused by hypokalemia, it is appropriate to evaluate the serum electrolyte levels. Amiodarone, diltiazem, and quinidine increase digoxin levels.

Question 2

A nurse is teaching a group of nursing students about antidysrhythmic medications. Which statement by a student indicates understanding of the teaching?&#10;A) &#34;Antidysrhythmic drugs can cause new dysrhythmias or worsen existing ones.&#34;&#10;B) &#34;Adverse effects of these drugs are mainly noncardiac in nature.&#34;&#10;C) &#34;For most antidysrhythmic drugs, there is evidence of reduced mortality.&#34;&#10;D) &#34;Use of these drugs may be necessary even if the benefits are unknown.&#34;

Accepted Answer

Because antidysrhythmic drugs have prodysrhythmic actions, they can exacerbate existing dysrhythmias or generate new ones. Most adverse effects are cardiac related. There is evidence of increased mortality with many of these drugs. Use of these drugs should be limited to situations in which there is a clear benefit and only if that benefit outweighs any risks.

Question 3

A nursing student asks a nurse how digoxin causes dysrhythmias. The nurse correctly states that digoxin:&#10;A) reduces automaticity in the AV node.&#10;B) increases automaticity in the Purkinje fibers.&#10;C) increases automaticity in the SA node.&#10;D) speeds up AV conduction.

Accepted Answer

Digoxin increases automaticity in the Purkinje fibers, which contributes to dysrhythmias caused by digoxin. Decreased automaticity in the AV node is a desired effect of digoxin. Digoxin does not increase automaticity in the SA node. It does not increase AV node conduction.

Question 4

A prescriber has ordered propranolol [Inderal] for a patient with recurrent ventricular tachycardia. The nurse preparing to administer this drug will be concerned about what in the patient's history?&#10;A) Asthma&#10;B) Exercise-induced tachyarrhythmias&#10;C) Hypertension&#10;D) Paroxysmal atrial tachycardia associated with emotion

Accepted Answer

Propranolol is contraindicated in patients with asthma, because it is a nonselective beta-adrenergic antagonist and can cause bronchoconstriction and exacerbate asthma. It is used to treat tachyarrhythmias and paroxysmal atrial tachycardia evoked by emotion, so it is not contraindicated for patients with these conditions. It lowers blood pressure, so it would be helpful in patients with hypertension.

Question 5

The nurse is teaching a group of nursing students about dofetilide [Tikosyn] to treat dysrhythmias. Which statement by a student indicates understanding of the teaching?&#10;A) &#34;Dofetilide is a first-line medication to treat atrial flutter or atrial fibrillation.&#34;&#10;B) &#34;Dofetilide carries a lower risk of causing torsades de pointes than other drugs.&#34;&#10;C) &#34;Dofetilide is used for patients with severe symptoms of atrial dysrhythmias.&#34;&#10;D) &#34;Dofetilide may be safely used as outpatient therapy to treat atrial fibrillation.&#34;

Accepted Answer

Dofetilide is used for patients with severe, highly symptomatic atrial dysrhythmias because of its higher than usual risk of torsades de pointes. It is used only when other medications have not been effective. It is used for hospitalized patients with close ECG monitoring.

Question 6

A patient with atrial fibrillation is taking verapamil [Calan]. The patient has read about the drug on the internet and wants to know why a drug that affects the rate of ventricular contraction is used to treat an abnormal atrial contraction. What will the nurse tell the patient?

A) "Drugs that treat ventricular dysrhythmias help to restore normal sinus rhythm."
B) "Atrial dysrhythmias can have life-threatening effects on ventricular function."
C) "Treating ventricular dysrhythmias helps prevent the likelihood of stroke."
D) "When ventricular contraction slows, atrial contraction is also slowed."

Accepted Answer

Dysrhythmic activity in the atria does not significantly reduce cardiac output but can be dangerous when dysrhythmic impulses cross the AV node, causing ventricular dysrhythmias, which can be life threatening. Treating ventricular dysrhythmia helps improve ventricular pumping. These drugs do not restore normal sinus rhythm. To prevent stroke, an anticoagulant, such as warfarin, is used. Slowing ventricular contraction does not affect the rate of atrial contraction. Restoring normal sinus rhythm requires cardioversion, short-term treatment with amiodarone or sotalol, or RF ablation of the dysrhythmia source.

Question 7

A prescriber is considering prescribing the amiodarone derivative dronedarone [Multaq] for a patient with atrial flutter. The nurse should be concerned about which of the following?&#10;A) History of asthma&#10;B) History of hypothyroidism&#10;C) PR interval of 260 msec&#10;D) QT interval of 520 msec

Accepted Answer

Because dronedarone prolongs the QT interval by about 10 msec, it should not be used in patients with a QT interval of more than 500 msec. It does not have significant pulmonary or thyroid toxicity. It should not be used in patients with a PR interval of more than 280 msec.

Question 8

A nurse is providing teaching to a patient who is admitted to the hospital for initiation of treatment with amiodarone [Cordarone] for atrial fibrillation that has been refractory to other medications. Which statement by the patient indicates a need for further teaching?

A) "I may have itching, malaise, and jaundice, but these symptoms will subside."
B) "I need to use sunblock to help keep my skin from turning bluish gray."
C) "I should not drink grapefruit juice while taking this medication."
D) "I should report shortness of breath and cough and stop taking the drug immediately."

Accepted Answer

Amiodarone has many toxic effects. Liver toxicity is rare but serious and should be reported and the drug discontinued. Dermatologic toxicity can occur, and sunblock helps protect the skin, which, with prolonged exposure to the sun, can turn bluish gray. Drinking grapefruit juice can increase amiodarone levels. Pulmonary toxicity is the greatest concern, and patients with pulmonary symptoms should report these to the provider.

Question 9

The nurse is teaching a class on dysrhythmias and associated therapy. The nurse asks the class, "Which cardiac dysrhythmia would result in the lowest cardiac output, and what treatment would be effective?" The class best demonstrates understanding by responding that ____ results in the lowest cardiac output, and treatment includes ____.

A) atrial flutter; lidocaine
B) tachycardia; atropine
C) first-degree heart block; verapamil [Calan]
D) ventricular fibrillation; defibrillation

Accepted Answer

With ventricular fibrillation there is no cardiac output, because the pumping action of the heart stops. Treatment with electrical countershock is indicated to restore cardiac function. Atrial flutter, tachycardia, and first-degree heart block do not result in the lowest cardiac output.

Question 10

A prescriber orders verapamil [Covera-HS] for a patient who is taking digoxin [Lanoxin] and warfarin. The nurse will expect the prescriber to ____ the dose of ____.&#10;A) lower; digoxin&#10;B) increase; digoxin&#10;C) lower; warfarin&#10;D) increase; warfarin

Accepted Answer

Calcium channel blockers, such as verapamil, can increase levels of digoxin, so patients taking these drugs may need to have their digoxin dose reduced. Increasing the dose of digoxin can result in digoxin toxicity. Verapamil does not affect warfarin levels.

Question 11

A patient is in the intensive care unit after a myocardial infarction. The nurse notes that the QT interval on this patient's electrocardiogram has been elongating. The nurse is concerned that which cardiac dysrhythmia may occur?

A) AV block
B) Bradycardia
C) Supraventricular tachycardia
D) Torsades de pointes

Accepted Answer

The answer of A patient is in the intensive care...

Question 12

A patient is taking digoxin [Lanoxin] and quinidine to treat sustained ventricular tachycardia. Before giving medications, the nurse reviews the patient's electrocardiogram (ECG) and notes a QRS complex that has widened by 50% from the baseline ECG. What will the nurse do?

A) Administer the medications as ordered, because this indicates improvement.
B) Contact the provider to discuss reducing the digoxin dose.
C) Contact the provider to request an increase in the quinidine dose.
D) Withhold the quinidine and contact the provider to report the ECG finding.

Accepted Answer

The answer of A patient is taking digoxin [Lanoxin] and...

Question 13

A nurse is discussing adenosine with a nursing student. Which statement by the student indicates a need for further teaching?&#10;A) &#34;Adenosine acts by suppressing action potentials in the SA and AV nodes.&#34;&#10;B) &#34;Adenosine can be used to prevent paroxysmal supraventricular tachycardia and Wolff-Parkinson-White syndrome.&#34;&#10;C) &#34;Adenosine has a half-life that lasts only a few seconds and must be given intravenously.&#34;&#10;D) &#34;Adenosine is not effective for treating atrial fibrillation, atrial flutter, or ventricular dysrhythmias.&#34;

Accepted Answer

The answer of A nurse is discussing adenosine with a...

Question 14

A patient with diabetes develops ventricular tachycardia and is in the hospital for evaluation of this condition. The nurse reviews the history and learns that the patient takes mexiletine [Mexitil] for pain caused by peripheral neuropathy. What should the nurse do?

A) Discuss common side effects associated with taking mexiletine with cardiac agents.
B) Understand that this drug will help with both peripheral neuropathy and dysrhythmias.
C) Notify the provider to request that another drug be used for peripheral neuropathy pain.
D) Request an order for renal function and hepatic function tests.

Accepted Answer

The answer of A patient with diabetes develops ventricular tachycardia...

Question 15

Which two classes of antidysrhythmic drugs have nearly identical cardiac effects?&#10;A) Beta blockers and calcium channel blockers&#10;B) Beta blockers and potassium channel blockers&#10;C) Calcium channel blockers and sodium channel blockers&#10;D) Sodium channel blockers and potassium channel blockers

Accepted Answer

The answer of Which two classes of antidysrhythmic drugs have...

Question 16

A patient will be taking amiodarone [Cordarone]. Which baseline tests are necessary before this medication is started?&#10;A) Chest radiograph and pulmonary function tests&#10;B) Complete blood count with differential&#10;C) Ophthalmologic examination&#10;D) Renal function tests&#10;E) Thyroid function tests

Accepted Answer

The answer of A patient will be taking amiodarone [Cordarone]....

Question 17

A nurse is caring for a patient in the intensive care unit who is receiving intravenous lidocaine. The patient is drowsy and confused and reports numbness of the fingers and toes. Which standing order will the nurse initiate at this time?

A) Administer diazepam.
B) Reduce the rate of infusion.
C) Discontinue the infusion.
D) Prepare for mechanical ventilation.

Accepted Answer

The answer of A nurse is caring for a patient...

Question 18

A nurse provides teaching for a patient who will begin taking procainamide [Procanbid] for long-term suppression of a dysrhythmia. Which statement by the patient indicates a need for further teaching?&#10;A) &#34;I need to take this drug at evenly spaced intervals around the clock.&#34;&#10;B) &#34;I may have increased bruising, but this is a temporary side effect.&#34;&#10;C) &#34;I should report pain and swelling in my joints when taking this drug.&#34;&#10;D) &#34;I will need to have blood tests at regular intervals while taking this drug.&#34;

Accepted Answer

The answer of A nurse provides teaching for a patient...

Question 19

The nurse educator is providing patient education about the Cardiac Arrhythmia Suppression Trial (CAST). The nurse correctly explains that the trial demonstrated what effect from the pharmacologic suppression of dysrhythmias?

A) It reduced mortality by 50% but increased morbidity.
B) It significantly reduced the risk of a second myocardial infarction (MI).
C) It doubled the risk of a second MI.
D) It should be used in all patients who have had an MI, regardless of rhythm.

Accepted Answer

The answer of The nurse educator is providing patient education...

Question 20

A nurse is teaching a patient who is about to undergo direct-current (DC) cardioversion to treat atrial flutter. The patient has been taking verapamil and warfarin for 6 months. Which statement by the patient indicates understanding of the teaching?

A) "I may need long-term therapy with another cardiac medication after the procedure."
B) "I should stop taking warfarin a few days before the procedure."
C) "I will need to take a beta blocker after the procedure to prevent recurrence of atrial flutter."
D) "I will not have to take antidysrhythmic medications after the procedure."

Accepted Answer

The answer of A nurse is teaching a patient who...

Deck 49: Antidysrhythmic Drugs