Deck 37: Pharmacotherapy of Dysrhythmias

Question 1

A client diagnosed with atrial fibrillation is prescribed a calcium channel blocker to help control the ventricular rate.The nurse plans to monitor the client's cardiac rhythm strip for which change?

A)Widening of the QRS complex
B)Widening of the QT interval
C)Inverted T waves
D)Prolongation of the PR interval

Answer 1

Prolongation of the PR interval

Question 2

The nurse is writing a care plan for a client who is prescribed an antiarrhythmic drug for complaints of chest pain and palpitations.The client says,I can't do what I once did.I just do not have any energy." Which nursing diagnoses would the nurse likely include in this care plan?
Select all that apply.

A)Cardiac Output,Decreased
B)Breathing Pattern,Ineffective
C)Activity Intolerance
D)Coping,Ineffective
E)Gas Exchange,Impaired

Answer 2

Cardiac Output,Decreased
Activity Intolerance

Question 3

A client is admitted to the emergency department (ED)with new-onset atrial fibrillation.Which cardiac rhythm history would be a contraindication for the use of a sodium channel blocker antidysrhythmic medication?

A)Occasional premature ventricular contractions (PVCs)
B)Multiple premature atrial contractions (PACs)
C)Elevated blood sugar
D)Second-degree AV block

Answer 3

Second-degree AV block

Question 4

A client with a history of congestive heart failure is prescribed propranolol (Inderal)for control of ventricular tachycardia.Which instruction is most important for the nurse to provide to this client?

A)Report nausea to your health care provider."
B)Immediately report an increase of shortness of breath or weight gain of 2 pounds over 1 day."
C)Weigh yourself each day at approximately the same time,with the same amount of clothing."
D)Exercise at least 30 minutes daily."

Question 5

A client is prescribed an additional once-daily antidysrhythmic drug to control persistent atrial fibrillation.Which instructions should the nurse provide for this client?
Select all that apply.

A)Take your first dose of this new medication before you go to bed tonight."
B)Do not eat or drink anything for 2 hours after taking the new medication."
C)Before you get out of bed in the morning,sit up on the side of the bed for a few minutes."
D)Plan to return to the clinic to have your electrolytes checked in 2 weeks."
E)Contact the clinic if you notice any loss of hair from your head."

Question 6

The nurse and a home health client have established this expected outcome: The client will be free from adverse effects of administration of diltiazem (Cardizem)." Which finding indicates this outcome has not been met?
Select all that apply.

A)The client complains of headache at each visit by the nurse.
B)The client has 3+ edema in the ankles and feet.
C)The client says,Everything I eat tastes like metal."
D)The client says,I got so dizzy yesterday that I had to lie down for a while."
E)The client's face is flushed.

Question 7

A client is prescribed dofetilide (Tikosyn)for conversion of atrial fibrillation.The nurse plans to monitor for which adverse effect?

A)Widening of the QT interval
B)Inverted T waves
C)Widening of the PR interval
D)Widening of the QRS complex

Question 8

A client who underwent cardioversion for atrial fibrillation is prescribed amiodarone (Cordarone).Which testing should the nurse ensure has been completed before the client starts this medication?

A)A hearing test
B)A fasting blood sugar
C)A pulmonary lung function test
D)A 24-hour urine test for creatinine

Question 9

The nurse in a heart failure clinic explains the effect of cardiac dysrhythmia on the body to a group of clients.What is the most important information to include in this teaching?

A)Cardiac rhythm disturbances cause the amount of blood pumped out of your heart to decrease."
B)Most cardiac rhythm disturbances do not affect the body at all."
C)The biggest problem with most cardiac rhythm disturbances is that they cause nervousness and irritability."
D)Cardiac rhythm disturbances often cause gastrointestinal upset."

Question 10

A client is prescribed oral verapamil (Calan)for the treatment of atrial fibrillation.Which statement indicates that the client understands the medication teaching provided by the nurse?

A)I should not take the medication with grapefruit."
B)This medication will slow my heart rate so I will not get so fatigued."
C)This medication will allow my heart to go back into normal,regular rhythm."
D)Taking this medication might cause me to need a pacemaker."

Question 11

A client scheduled for a catheter ablation to treat atrial fibrillation says,I am not sure about this procedure.Can they just treat me with medicine?" Which response by the nurse is the most appropriate?

A)Many people do take drugs for atrial fibrillation.Your case must be different."
B)Catheter ablation is more successful and has fewer long-term adverse effects than drug therapy."
C)Most of the medications used for atrial fibrillation have been taken off the market."
D)Atrial fibrillation is too dangerous to be treated with medications alone."

Question 12

A client is prescribed a calcium channel blocker for control of hypertension is now prescribed a beta blocker to control a fast ventricular rate.What should the nurse include in instructions regarding the medications?

A)Eat a high-fiber,low-carbohydrate diet.
B)Do not take this medication with grapefruit juice.
C)Maintain a daily exercise regimen.
D)Report irregular heart rate or shortness of breath to the health care provider.

Question 13

A client is started on sotalol (Betapace)for conversion of atrial fibrillation.Which finding requires immediate nursing action?

A)A widening of the QRS complex
B)Complaints of a flutter" feeling in the chest
C)Complaints of headache
D)Increased blood glucose level

Question 14

A client is receiving an intravenous lidocaine infusion after being converted from ventricular tachycardia.The client begins to display signs of confusion,anxiety,agitation,and restlessness.What should the nurse do first?

A)Increase the rate of lidocaine infusion.
B)Turn off the lidocaine infusion.
C)Administer oxygen at 4 L per nasal cannula.
D)Notify the client's health care provider.

Question 15

A client experienced a myocardial infarction (MI)12 hours ago.It is most important for the nurse to monitor which aspect of this client's care?

A)Breath sounds
B)Cardiac rhythm
C)Cardiac enzymes
D)Serum glucose level

Question 16

A client presents to the emergency department (ED)with dyspnea,diaphoresis,and lightheadedness.The cardiac monitor reveals paroxysmal supraventricular tachycardia (SVT).Which class of antiarrhythmic drug does the nurse anticipate will be administered?

A)A calcium channel blocker
B)A class IC drug
C)A class IB drug
D)A class IA drug

Question 17

The nurse is preparing to administer procainamide (Pronestyl)intravenously for conversion of atrial flutter.How should the nurse position the client?

A)In Trendelenburg position
B)Prone
C)Supine
D)With the head of the bed elevated

Question 18

The nurse admits a client to the emergency department with new-onset atrial fibrillation and a heart rate of 168 beats per minute.The client is complaining of dizziness and shortness of breath.The nurse starts an intravenous line in anticipation of administering which drug?

A)Digoxin (Lanoxin)
B)Disopyramide (Norpace)
C)Ibutilide (Corvert)
D)Lidocaine (Xylocaine)

Question 19

A client in the emergency department complains of chest pain,diaphoresis,shortness of breath,lightheadedness,and dizziness.The cardiac monitor displays ventricular tachycardia at 180 beats per minute.What is the nurse's most immediate concern for this client?

A)The client may be experiencing a posterior myocardial infarction.
B)The client may suffer a cerebral vascular accident.
C)The client is at risk for development of a pulmonary embolism.
D)The client is at risk for cardiac death.

Question 20

Discharge orders for a client who suffered a myocardial infarction 5 days ago state,Continue home medications." The client's medications include flecainide (Tambocor).How should the nurse proceed?

A)Include instructions for the client to rise slowly to an upright position.
B)Instruct the client to limit alcohol intake to very moderate amounts.
C)Contact the health care provider to verify whether the client is to restart the flecainide.
D)Instruct the client to carry a medic alert card at all times with instructions for flecainide.

Question 21

A client who has been taking medication for a month for an atrial dysrhythmia returns to the clinic for a checkup.Which statements indicate the nurse should plan extra time with the client for additional teaching?
Select all that apply.

A)Since I can't drink coffee anymore,I have started drinking diet cola in the mornings."
B)I have found that a glass of wine after work and one with dinner helps me to relax from my stressful job."
C)We have celebrated several birthdays since I saw you last.I love chocolate birthday cake."
D)I have really worked at stopping my smoking since I was last here."
E)My friends and I have found several restaurants in our area that offer good,low-fat meals."

Question 22

The nurse is providing information for a client who will self-administer a twice-daily antidysrhythmic medication at home.Which client statements would the nurse evaluate as indicating good understanding of this process?
Select all that apply.

A)If I get the flu,I should stop taking the medication until my fever goes down."
B)I should take my doses as close to 12 hours apart as I can."
C)If I forget a dose of medication I should take two pills for the next dose."
D)If I can't take the medication for a couple of days because I am sick,I should call the clinic for advice."
E)I should get my prescription refilled before I am completely out of medicine."

Question 23

A client who is admitted to the hospital for treatment of premature ventricular contractions (PVCs)says,I took a medicine called procainamide years ago when I had PVCs and it worked great.I quit taking it because I did not think I needed it anymore.Maybe the doctor can give me some of that." Which responses by the nurse are appropriate?
Select all that apply.

A)You must be confused,because procainamide is not given orally."
B)I will be certain to let the doctor know that.He might just restart your medication."
C)Procainamide is given for arrhythmias that come from a different part of the heart than yours."
D)Procainamide is no longer the drug of choice for your type of arrhythmia."
E)Procainamide has some serious side effects and we have better drugs for your condition now."

Question 24

A client is prescribed potassium channel blocker for 4 weeks.Which statements would indicate to the nurse that additional time for teaching about the medication should be planned?
Select all that apply.

A)I got some sunglasses like you said.Do you like them?"
B)Do you have any idea what this rash on my neck and arm is?"
C)I must be getting cataracts.I can't see anything anymore."
D)I wear sunscreen whenever I am outdoors."
E)I think that medicine is making my hair gray."