Deck 15: Antidysrhythmic Drugs

Question 1

A patient asks the nurse why an intravenous (IV)line must be used to receive the antidysrhythmic drug lidocaine (Xylocaine).What is the nurse's best response?

A) "The drug companies have not developed an oral form of this drug."
B) "This drug can also be given by endotracheal tube in the ICU."
C) "The drug in oral form would be destroyed by the liver making it ineffective."
D) "This drug does not work when given by any other route."

Answer 1

"The drug in oral form would be destroyed by the liver making it ineffective."

Question 2

A patient who has been prescribed acebutolol (Sectral)develops a heart rate of 48 beats per minute,dizziness,difficulty breathing,and bluish fingernails.What is the nurse's best action?

A) Instruct the patient to take several slow deep breaths.
B) Document these findings as expected with this drug.
C) Place the patient in high Fowler's position.
D) Hold the drug and notify the prescriber.

Answer 2

Hold the drug and notify the prescriber.

Question 3

A patient is prescribed digoxin.The patient's apical heart rate is 58 beats per minute.What is the nurse's best action?

A) Give the drug as ordered.
B) Document the finding because this is an expected effect of the drug.
C) Recheck the heart rate and blood pressure after 30 minutes.
D) Hold the drug and notify the prescriber.

Answer 3

Hold the drug and notify the prescriber.

Question 4

Which laboratory result for a patient receiving sotalol (Betapace)does the nurse immediately report to the prescriber?

A) Blood urea nitrogen (BUN) 21 mg/dL
B) Potassium (K) 3.4 mEq/L
C) Sodium (Na) 147 mEq/L
D) Creatinine 2.4 mg/dL

Question 5

A patient's heart rate is regular at 68 beats per minute.The electrocardiogram (ECG)tracing shows P waves before every QRS complex.What is the likely pacemaker of the heart?

A) SA node
B) AV node
C) Bundle of His
D) Purkinje fibers

Question 6

A patient with an upper respiratory infection reports feeling like the heart is pounding.After checking that the patient is not having chest pain or difficulty breathing,what is the most important question the nurse must ask the patient?

A) "How long have you had upper respiratory infection symptoms?"
B) "Are you using any over-the-counter cold or cough drugs?"
C) "Is this the first time you have felt like this?"
D) "What exercise have you done today?"

Question 7

A patient who is prescribed oral quinidine (Quinaglute)for a tachydysrhythmia is on a cardiac monitor,which shows lengthening PR intervals.What is the nurse's best action?

A) Perform a 12-lead electrocardiogram (ECG).
B) Send a serum potassium level to the laboratory.
C) Document this as an expected action of the drug.
D) Notify the prescriber immediately.

Question 8

A patient is to receive propafenone (Rythmol).What important question does the nurse ask the patient before giving the first dose?

A) "Do you have any hearing problems?"
B) "Are you having difficulty reading?"
C) "Have you ever had a problem with bronchospasm?"
D) "What other problems are being treated by your prescriber?"

Question 9

Which statement by a patient who has been prescribed quinidine (Quinaglute)indicates to the nurse the need for additional teaching?

A) "I use over-the-counter St. John's wort to help with my memory."
B) "I am careful not to eat too much food that is high in alkaline ash."
C) "I check my heart rate and blood pressure at least once a day."
D) "I weigh myself every morning at the same time."

Question 10

A 70-year-old patient who has been taking digoxin (Lanoxin)for 4 years has all of the following laboratory blood tests.For which test value does the nurse notify the prescriber immediately?

A) Sodium (Na) 132 mEq/L
B) Potassium (K) 2.1 mEq/L
C) Blood urea nitrogen (BUN) 9 mg/dL
D) International normalized ratio (INR) 1.5

Question 11

Nausea,vomiting,and an irregular heart rate develop in a patient who takes oral digoxin every morning.What is the nurse's best action?

A) Give prescribed diphenhydramine (Phenergan) as needed.
B) Check the patient's cardiac monitor strip.
C) Assess the apical pulse for a full minute.
D) Check laboratory results for a digoxin level.

Question 12

A patient's heart monitor shows ventricular fibrillation.What is the nurse's best first action?

A) Check the patient.
B) Call a code.
C) Begin CPR
D) Defibrillate the patient.

Question 13

A patient with unstable ventricular dysrhythmia is prescribed lidocaine 200 mg by intravenous (IV)piggyback in 100 mL of IV solution.With an IV infusion set that has a drop factor of 15 gtt/mL,how many drops per minute does the nurse set the IV rate to deliver the correct dose in the specified time?

A) 10
B) 25
C) 50
D) 100

Question 14

A patient given atropine (Atropine Sulfate)intravenously as a one-time dose for bradycardia now reports a very dry mouth.What is the nurse's best response?

A) Notify the prescriber immediately.
B) Document the report as the only action.
C) Reassure the patient that this is a normal drug response.
D) Offer the patient the opportunity to brush his or her teeth and rinse the mouth.

Question 15

A patient who has a history of depression is prescribed propranolol (Inderal).Which precaution is most important for the nurse to teach the patient?

A) "You should expect a decrease in depression symptoms while you are taking propranolol."
B) "While taking propranolol you may notice that your depression gets worse."
C) "Stop taking propranolol whenever you experience depression symptoms."
D) "Propranolol may cause difficulty with the ability to perform sexually."

Question 16

What is the most important action for the nurse when caring for a patient with type 2 diabetes mellitus who is prescribed a beta blocker?

A) Assess the patient's feet daily.
B) Monitor for infection.
C) Administer oral diabetic drugs.
D) Regularly check the patient's blood glucose.

Question 17

A patient whose heart rate is 52 beats per minute reports feeling dizzy and light-headed.What is the nurse's best first action?

A) Start an IV line.
B) Ask if the patient has experienced this before.
C) Notify the prescriber immediately.
D) Check the patient's blood pressure.

Question 18

An older adult patient with frequent premature ventricular contractions (PVCs)is receiving intravenous (IV)lidocaine (Xylocaine)by continuous infusion.The patient becomes confused and sees insects on the walls.What is the nurse's best action?

A) Reorient the patient to person, place, and time.
B) Ask the patient's family about alcohol use or abuse.
C) Check the patient's chart for a history of dementia.
D) Notify the prescriber immediately.

Question 19

A patient on a telemetry monitor reports feeling like the heart is skipping beats,and asks the nurse what could be causing this.What is the nurse's best response?

A) "Have you been exercising recently?"
B) "Do you notice any other symptoms when your heart skips beats?"
C) "You will have to tell your prescriber about this and ask him or her what is the cause."
D) "Let me first listen to your heart, measure your blood pressure, and check your heart monitor."

Question 20

A patient who has been prescribed propafenone (Rythmol)asks the nurse how the drug works.What is the nurse's best response?

A) "It shows the conduction of electrical impulses in your heart."
B) "It increases your heart rate and the blood flow to your tissues."
C) "It prevents your heart muscle from sensing electrical impulses."
D) "It keeps the conduction of electrical impulses completely normal."

Question 21

A patient is prescribed intravenous (IV)adenosine (Adenocard)for treatment of supraventricular tachycardia.Which safety precaution is most important for the nurse to perform before this drug is administered?

A) Bring the crash cart and defibrillator to the patient's bedside.
B) Make sure that all four bed side rails are in the upright position.
C) Place the patient's bed in the lowest position.
D) Continuously monitor blood pressure.

Question 22

A pediatric patient is prescribed 0.008 mg of digoxin (Lanoxin).The drug on hand is digoxin 0.05 mg/mL.How many drops (gtt)will the nurse administer?
_____ gtt

Question 23

Which foods does the nurse teach a patient are good sources of magnesium?

A) Baked potato
B) Bran cereal
C) Yogurt
D) Whole grain rice
E) Bananas

Question 24

Which are signs of IV line patency?

A) Blood return
B) Swelling
C) Easy flush of line
D) Redness
E) Pain
F) Warmth

Question 25

A patient who has been prescribed verapamil (Calan)develops skin lesions,itching,achy joints,and a temperature of 101 ^$\circ$ F.What is the nurse's best action?

A) Administer the as-needed dose of diphenhydramine (Benadryl).
B) Contact the prescriber and request an order for acetaminophen 650 mg.
C) Draw a set of blood cultures to detect any infection.
D) Hold the drug and notify the prescriber.

Question 26

A patient who is prescribed sotalol (Betapace)develops the following assessment findings.For which finding does the nurse immediately notify the prescriber?

A) Heart rate of 60 beats per minute
B) Difficulty sleeping
C) Cold hands and feet
D) Chest discomfort

Question 27

A patient prescribed amiodarone (Cordarone)tells the nurse that his scrotum is swollen and painful.What is the nurse's best action?

A) Instruct the patient that this side effect is reversible and will go away over several months.
B) Document this expected side effect as the only action.
C) Support the patient's scrotum on a pillow.
D) Hold the drug and notify the prescriber.

Question 28

A patient who received an intravenous (IV)dose of magnesium sulfate has developed diarrhea.What is the nurse's best response?

A) Reassure the patient that diarrhea is a common side effect of magnesium sulfate.
B) Order a bedside commode so that the patient does not have to walk to the bathroom.
C) Hold the drug and notify the prescriber.
D) Document the finding as the only action.

Question 29

An older patient with a history of liver impairment is prescribed diltiazem (Cardizem)SR 120 mg twice a day for supraventricular tachycardia.What is the nurse's best action before giving the first dose?

A) Hold the drug and contact the prescriber.
B) Administer the drug as ordered.
C) Give 60 mg four times a day.
D) Give an XR capsule of 240 mg.

Question 30

A patient is prescribed an oral loading dose of amiodarone (Cordarone)1600 mg.Amiodarone is available in 400-mg tablets.How many tablets does the nurse give?

A) 2
B) 4
C) 6
D) 8

Question 31

Why does the nurse give adenosine (Adenocard)to a patient rapidly by intravenous (IV)push?

A) If given slowly, the heart rate will dramatically increase.
B) When given slowly, the drug is eliminated before it can act on the heart.
C) Slow administration can lead to tissue irritation and IV infiltration.
D) The drug is given rapidly so that within a minute, second or third doses may be given if needed.

Question 32

Which antidysrhythmic drugs may be given by the endotracheal tube route?

A) atropine (Atropine Sulfate)
B) digoxin (Lanoxin)
C) epinephrine (Adrenalin)
D) lidocaine (Xylocaine)
E) procainamide (Pronestyl)