Deck 39: Pharmacotherapy of Dysrhythmias

Question 1

The nurse is caring for a client 12 hours status post-myocardial infarction.There was a complete blockage to the left anterior descending coronary artery.The client's ejection fraction post-MI is 30%.It is most important for the nurse to monitor:
1)Serum blood glucose levels.
2)Nitroglycerin titration.
3)Cardiac rhythm.
4)Cardiac enzymes.

Answer 1

3

Question 2

A client with atrial fibrillation has been started on a calcium channel blocker to help control the ventricular rate.The nurse knows that calcium channel blockers slow the heart rate and prolong the refractory period, and that what might be noted on the EKG?
1)Widening of the PR interval
2)Widening of the QRS complex
3)Widening of the QT interval
4)Inverted T waves

Answer 2

1

Question 3

A client started on procainamide (Pronestyl)two weeks ago is being seen for follow-up at the physician's office.The nurse will include which of the following in the client's work-up?
1)A blood glucose level
2)A 12-lead EKG
3)Thyroid function tests
4)Instructions to obtain an eye exam

Answer 3

2

Question 4

A client who is taking a calcium channel blocker for control of hypertension is now prescribed a beta blocker to control a fast ventricular rate.Which of the following should be included in instructions regarding the medications?
1)Do not take this medication with grapefruit juice.
2)Report palpitations, dizziness, lightheadedness, and dyspnea to the health care provider.
3)Eat a high-fiber, low-carbohydrate diet.
4)Maintain an exercise regimen daily.

Question 5

A client complains of tinnitus, headache, blurred vision, dysrhythmias, and hearing loss.The client's medications include Diovan, Lasix, Diabeta, quinidine, and a potassium supplement.Which of the following actions should the nurse take?
1)Take no action.These are expected side effects.
2)Have the client reduce the dose of Lasix.
3)Hold all medications and call the health care provider immediately.
4)Obtain an order to start an IV and give a bolus of 500 cc of NS.

Question 6

The nurse is caring for a patient who was just started on dofetilide (Tikosyn)for conversion of atrial fibrillation.The nurse must take care to watch for which of the following?
1)Widening of the PR interval
2)Widening of the QRS complex
3)Widening of the QT interval
4)Inverted T waves

Question 7

A client is started on sotalol (Betapace)for conversion of atrial fibrillation.Which of the following should be reported to the primary health care provider?
1)A heart rate of 58
2)A K+ level of 3.5
3)A widening of the QRS complex on EKG
4)Complaints of a "flutter" feeling in the chest

Question 8

The nurse is caring for a client on a lidocaine drip after emergency treatment for ventricular tachycardia.The nurse notes the patient becoming confused and anxious, and complaining of numbness of the face and upper arms.The nurse's best action would be to:
1)Stop the lidocaine, call the physician, and monitor the client.
2)Decrease the lidocaine rate and monitor for continuation of symptoms.
3)Increase IV fluids by adding NS at 125 cc/hour to dilute the lidocaine dose.
4)Prepare to give Narcan to reverse the effects.

Question 9

The nurse admits a client to the ED 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 can anticipate giving which of the following medications?
1)Ibutilide (Corvert)
2)Disopyramide (Norpace)
3)Lidocaine (Xylocaine)
4)Digoxin (Lanoxin)

Question 10

A client newly started on procainamide (Pronestyl)indicates understanding of discharge instructions by which of the following statements?
1)"I may drink a small amount of alcohol on occasion, as long as it is rare."
2)"If I miss a dose, I should double the next dose."
3)"I should carry a medic alert drug identification and information card."
4)"I might have weakness, palpitations, and unexplained fatigue until I adjust to the medication."

Question 11

A client is brought to the ED with complaints of chest pain, diaphoresis, shortness of breath, lightheadedness, and dizziness.The cardiac monitor displays ventricular tachycardia at 180 beats per minute.The nurse is concerned with:
1)Deterioration into cardiac death.
2)Development of a pulmonary embolism.
3)A posterior myocardial infarction.
4)A cerebral vascular accident.

Question 12

An employee brings a co-worker to the ED after the co-worker fainted.The co-worker is non-responsive to verbal commands; peripheral pulses are weak and thready; the skin is cool, clammy, and moist; respirations are shallow and tachypneic; BP is 80/40; and the cardiac monitor shows third-degree AV block.The nurse should anticipate which of the following first?
1)Give epinephrine IV push.
2)Insertion of a temporary pacemaker
3)Give adenosine (Adenocard)rapid IV push.
4)Prepare to administer electrocardiac shock.

Question 13

A client with a history of congestive heart failure is started on a low-dose beta blocker for control of ventricular tachycardia.Which of the following instructions would be most important for this client?
1)Report nausea to your health care provider.
2)Exercise at least 30 minutes daily.
3)Weigh each day at approximately the same time, with the same amount of clothing.
4)Immediately report an increase of shortness of breath or weight gain of two pounds over one day.

Question 14

A client is admitted to the ED with new-onset atrial fibrillation.Which of the following would be a contraindication for the use of a sodium channel blocker antidysrhythmic medication?
1)Second-degree AV block
2)Occasional PVCs
3)Elevated blood sugar
4)Multiple PACs

Question 15

A client who underwent cardioversion for atrial fibrillation is to start amiodarone.Which of the following must the nurse obtain prior to the client starting the amiodarone?
1)A fasting blood sugar
2)A hearing test
3)A pulmonary lung function test
4)A 24-hour urine test for creatinine

Question 16

A client monitored while on a lidocaine drip status post-conversion from ventricular tachycardia begins to display signs of confusion, anxiousness, agitation, and restlessness.The first course of action of the nurse should be:
1)Decrease the rate of the lidocaine infusion.
2)Turn off the lidocaine infusion.
3)Administer oxygen at 4 L per nasal cannula.
4)Increase the rate of lidocaine infusion.

Question 17

The nurse cares for a client seen in the cardiology office for atrial fibrillation.The client remains asymptomatic except for increased heart rate with an increase in fatigue and shortness of breath upon exertion.The health care provider prescribes verapamil (Calan).Which of the following statements indicates the client understands why the medication is prescribed?
1)"I should not take the medication with grapefruit."
2)"Taking this medication might cause me to need a pacemaker."
3)"This medication will allow my heart to go back into normal sinus rhythm."
4)"This medication will slow my heart rate so I won't get so fatigued."

Question 18

The nurse is caring for a client seen is the ED for complaints of lightheadedness, dizziness, and shortness of breath for the past 24 hours.The client has a history of hypertension, benign prostatic hypertrophy, type II diabetes, and congestive heart failure.The cardiac monitor shows the patient to be in atrial fibrillation with a ventricular rate of 156.Which of the following is most likely to promote formation of cardiac rhythm abnormalities for this client?
1)Hypertension
2)Benign prostatic hypertrophy
3)Type II diabetes
4)Congestive heart failure

Question 19

The nurse is preparing to administer procainamide (Pronestyl)IV for conversion of atrial flutter.The client should be positioned:
1)Prone.
2)With the head of the bed elevated.
3)Supine.
4)In Trendelenburg position.

Question 20

The nurse is caring for a client who is three days status post-myocardial infarction.Discharge instructions state to continue medications taken previous to admission.The client's medications include flecainide (Tambocor).The nurse should:
1)Contact the health care provider to verify whether the client is to restart the Tambocor.
2)Instruct the client to carry a medic alert card at all times with instructions for Tambocor.
3)Instruct the client to limit alcohol intake to very moderate amounts.
4)Instruct the client to rise slowly to an upright position.