Deck 21: Vasopressors,inotropes,and Antiarrhythmic Agents

Question 1

Your patient requires a dose of adenosine for confirmed supraventricular tachycardia (SVT).His only line is a peripheral intravenous line in the right arm.How should you proceed?

A)Slowly administer the dose over 30 seconds.
B)Administer the dose quickly and immediately follow with a saline flush.
C)Hold the patient's right arm in an upright position while administering the dose.
D)Both B and C.

Answer 1

Both B and C.

Question 2

Your patient is experiencing heart failure secondary to decreased contractility and has a confirmed severe allergy to sulfites.Which of the following inotropic medications would you not recommend?

A)Dobutamine
B)Milrinone
C)Digoxin
D)Inamrinone

Answer 2

Dobutamine

Question 3

Cardiac output depends on which of the following factors?
1)Venous return
2)Heart rate
3)Systemic vascular resistance
4)Pulmonary vascular resistance
5)Stroke volume

A)2 and 5 only
B)1 and 3 only
C)2 and 4 only
D)3 and 5 only

Answer 3

2 and 5 only

Question 4

According to the Vaughan Williams classification system,which class of antiarrhythmic agents consists of the only two calcium channel blockers (CCBs)used in the management of supraventricular arrhythmias and ventricular rate control for atrial fibrillation?

A)Class I
B)Class II
C)Class III
D)Class IV

Question 5

You are treating a patient who has severe asthma.Which classification of drugs may pose some risk of bronchoconstriction and should be used carefully in patients with asthma and chronic obstructive pulmonary disease?

A)β-adrenergic cardiac stimulants
B)Cardiac glycosides
C)β blockers
D)Antiarrhythmics

Question 6

The innate pacemaker of the heart is known as the

A)atrioventricular (AV)node.
B)bundle of His.
C)sinoatrial (SA)node.
D)purkinje fibers.

Question 7

Which of the following are considered inotropic agents?
1)Dobutamine
2)Milrinone
3)Digoxin
4)Lidocaine

A)1 and 2 only
B)2 and 3 only
C)1,2,and 3 only
D)1,2,3,and 4

Question 8

Cardiac glycosides

A)reduce ventricular arrhythmias.
B)decrease blood pressure.
C)increase heart rate.
D)increase myocardial contractility.

Question 9

Atropine is given to

A)increase blood pressure.
B)increase heart rate.
C)treat ventricular arrhythmias.
D)improve cardiac contractility.

Question 10

Your patient is a 67-year-old homeless man with malnutrition.Laboratory test results show that he has hypomagnesemia.What arrhythmia should you monitor for until a dose of magnesium sulfate can be administered?

A)Ventricular fibrillation
B)Atrial fibrillation
C)Torsades de pointes
D)Asystole

Question 11

Which of the following agents is a parasympatholytic used in cardiac resuscitation for asystole?

A)Epinephrine
B)Magnesium
C)Atropine
D)Vasopressin

Question 12

According to the Vaughan Williams classification system,which class of antiarrhythmic agents consists mainly of $\beta$ blockers?

A)Class I
B)Class II
C)Class III
D)Class IV

Question 13

According to the Vaughan Williams classification system,which class of agents blocks fast sodium channels in the myocardium,specifically in the atrium?

A)Class I
B)Class II
C)Class III
D)Class IV

Question 14

Complications of pulmonary artery catheterization include which of the following?
1)Pneumothorax
2)Fluid overload
3)Dehydration
4)Infection
5)Thrombus formation

A)3 only
B)2,3,and 5 only
C)1,4,and 5 only
D)1,2,and 4 only

Question 15

Class IB antiarrhythmics are limited to treating

A)atrial arrhythmias.
B)ventricular arrhythmias.
C)tachycardia.
D)congestive heart failure.

Question 16

Your patient is experiencing heart failure and is in need of an inotropic agent.Which of the following would you recommend,barring any other cardiac issues?
1)Lidocaine
2)Digoxin
3)Milrinone
4)Dobutamine

A)2,3,and 4
B)1,2,and 3
C)1 and 2
D)2 and 4

Question 17

Which of the following is considered the mainstay for improving hypotensive episodes?

A)Vasopressors
B)Inotropes
C)Fluids
D)Catecholamines

Question 18

Class IA anti-arrhythmic agents are effective in treating

A)bradycardia.
B)atrioventricular node delays.
C)ectopic beats.
D)atrial and ventricular arrhythmias.

Question 19

The most important factor in the management of sudden cardiac death is

A)the age of the patient.
B)the underlying disease process.
C)timely and efficient cardiopulmonary resuscitation (CPR)and defibrillation.
D)fluid status.

Question 20

Lidocaine is used to treat

A)ventricular arrhythmias.
B)atrial arrhythmias.
C)atrioventricular node delays.
D)supraventricular tachycardia.

Question 21

Your patient is experiencing bronchospasm secondary to asthma and is unresponsive to bronchodilator therapy.Her current medications include propafenone,lidocaine,and albuterol.Which of these medications could be contributing to her unresponsiveness to therapy?

A)Propafenone
B)Lidocaine
C)Albuterol
D)None could cause this unresponsiveness

Question 22

Digoxin toxicity may include which of the following manifestations?
1)Hyperkalemia
2)Premature ventricular contractions
3)Bigeminal rhythm
4)Nausea
5)Abdominal pain

A)2 and 5 only
B)1,2,and 3 only
C)1,2,3,4,and 5
D)1,2,3,and 5 only

Question 23

How does digoxin exert an inotropic effect on the myocardium?

A)By reversibly inhibiting the Na⁺/K⁺-ATPase pump
B)By stimulating the vagus nerve
C)By increasing extracellular sodium concentrations
D)By pumping calcium out of the cell

Question 24

Place the five phases of a myocardial action potential in correct order.
1)Fast sodium channels are inactivated
2)Cell returns to its "resting" state
3)"Plateau" phase
4)Initial rapid depolarization of myocardial tissues
5)Calcium channels close

A)1,3,2,5,4
B)4,1,3,5,2
C)1,2,3,4,5
D)4,1,2,5,3

Question 25

Which cardiac agent may be administered endotracheally?

A)Lidocaine
B)Epinephrine
C)Atropine
D)All of the above

Question 26

Your patient has a decrease in his CVP,PCWP,and CO,with an increased HR following a laceration to his liver in a motor vehicle crash.Which shock state is he experiencing?

A)Septic shock
B)Hypovolemic shock
C)Neurogenic shock
D)Cardiogenic shock

Question 27

Signs and symptoms of vasopressor-induced extravasation include which of the following?
1)Hyperkalemia
2)Pain
3)Swelling
4)Depression of reflexes
5)Erythema

A)2 and 5 only
B)2,3,and 5 only
C)1,2,3,4,and 5
D)2,3,and 4 only

Question 28

Implantable cardioverter-defibrillators (ICDs)are indicated for the following conditions:
1)Cardiac arrest caused by pulseless ventricular tachycardia (VT)
2)Spontaneous sustained VT
3)Asystole
4)Pulseless electrical activity
5)Electrophysiologically inducible VT or ventricular fibrillation (VF)not suppressed by class I antiarrhythmics

A)1 only
B)1,2,and 5 only
C)1,2,3,and 4 only
D)1,2,3,4,5

Question 29

When should intravenous access and medication be considered during pulseless ventricular tachycardia?

A)After beginning cardiopulmonary resuscitation (CPR)and attempting defibrillation
B)Before beginning CPR and attempting defibrillation
C)When the patient has an established advanced airway
D)Intravenous access and medication are not a part of the treatment algorithm for pulseless ventricular tachycardia

Question 30

Magnesium toxicity may include which of the following manifestations?
1)Hyperkalemia
2)Sweating
3)Hypothermia
4)Depression of reflexes
5)Abdominal pain

A)2 and 5 only
B)1,2,and 3 only
C)1,2,3,4,and 5
D)2,3,and 4 only

Question 31

Your patient is experiencing torsades de pointes.What is the proper medication,dose,and route to treat her arrhythmias?

A)Propafenone,1 g,IV
B)Lidocaine,1 g,PO
C)Sodium bicarbonate,1 mEq/kg,IV
D)Magnesium sulfate,1 to 2 g,IV

Question 32

Ablation with radiofrequency current is effective in the treatment of

A)atrial fibrillation (AF)caused by multiple circuits.
B)asystole.
C)sinus rhythm.
D)AF caused by single primary circuit.