Question 1

A patient is admitted to the telemetry unit with a diagnosis of cardiovascular disease.When performing the initial assessment,the nurse records blood pressure in the left arm of 142/84,blood pressure in the right arm of 138/80,temperature of 98.8° F,and radial pulse of 80 that is weak and irregular.The nurse should notify the physician regarding

A) both blood pressure and pulse.
B) blood pressure only.
C) pulse only.
D) both blood pressure and temperature.

pulse only.

Accepted Answer

Irregular pulse rate and rhythm should be reported.A systolic pressure variance of 5 to 10 mm Hg is normal; readings reflecting a variance of more than 10 mm Hg should be reported for further evaluation.Temperature is within normal limits.

Question 2

A patient who is started on phenytoin (Dilantin),who is also taking amiodarone (Cordarone),should be assessed for what possible effect?&#10;A) Central nervous system depression and sedation&#10;B) Decrease in effectiveness of phenytoin&#10;C) Respiratory depression&#10;D) Increase in serum phenytoin levels

Accepted Answer

Elevation of phenytoin serum levels (200% to 300%)is observed over several weeks.The dosage of phenytoin must be gradually reduced based on patient response.The combination of phenytoin and amiodarone does not produce sedation and depression,decrease the effectiveness of either drug,or produce respiratory depression.

Question 3

The nurse is preparing to administer procainamide hydrochloride for the first time to a patient newly diagnosed with atrial fibrillation.Before administering this medication,the nurse will assess&#10;A) cardiac rhythm.&#10;B) blood pressure.&#10;C) oxygen saturation.&#10;D) blood glucose levels.&#10;E) liver function tests.

Accepted Answer

The nurse should assess cardiac rhythm,vital signs,and oxygen saturation to use as a baseline for subsequent evaluation to response.Blood glucose levels and liver function tests are not essential assessments prior to providing procainamide hydrochloride for the first time.

Question 4

A patient is admitted to the acute care telemetry unit with a diagnosis of atrial fibrillation.The physician orders dofetilide (Tikosyn).Before initiating this medication,the nurse will&#10;A) hold anticoagulant medications.&#10;B) remove ECG leads.&#10;C) assess potassium level.&#10;D) ensure QTc interval is more than 440 to 500 msec.

Accepted Answer

Hypokalemia must be corrected before initiation of dofetilide therapy.Before dofetilide (Tikosyn)is initiated on patients with atrial fibrillation,anticoagulation must occur.Patients with atrial fibrillation must be admitted to a unit with continuous ECG monitoring available.The QTc interval must be assessed; if it is more than 440 to 500 msec,dofetilide is contraindicated.

Question 5

A patient is taking amiodarone (Cordarone)for hypertrophic cardiomyopathy and begins to complain of dizziness.What will the nurse instruct the patient to do?&#10;A) Discontinue the medication immediately.&#10;B) Decrease the medication dosage for 1 week, and then resume the original order.&#10;C) Change positions slowly.&#10;D) Increase the dosage per health care provider directions.

Accepted Answer

Many adverse effects are dose related and resolve with reducing the dosage or discontinuing therapy.Patients should be taught to rise slowly from a supine or sitting position and sit or lie down if feeling faint.Medication should be discontinued only for serious adverse effects and with the consent of the health care provider.Changes in dose should be done only with the consent of the health care provider.Increasing the dose will likely increase the symptoms.

Question 6

The nurse is preparing to mix a lidocaine infusion for a patient.Which consideration(s)should the nurse take into account before administration?&#10;A) Lidocaine with preservatives should be used.&#10;B) Dextrose 5% is the solution to mix with lidocaine.&#10;C) Therapeutic blood levels should be 1 to 5 mg/L.&#10;D) The rate of administration is 1 to 4 mg/min.&#10;E) Monitor for changes in neurologic status.

Accepted Answer

Lidocaine for infusion should be mixed with dextrose 5% solution.Lidocaine administration rate should be 1 to 4 mg/min.Additional nursing considerations include monitoring of therapeutic blood levels (1 to 5 mg/L)and observing for adverse effects to report to the health care provider.Lidocaine for IV use for dysrhythmias is different from lidocaine used as a local anesthetic.For use with dysrhythmias,check the label carefully to be certain it says "lidocaine for dysrhythmias" or "lidocaine without preservatives."

Question 7

Which statement is true regarding the antidysrhythmic agent adenosine (Adenocard)?&#10;A) It is synthesized from petroleum products.&#10;B) It is created through recombinant DNA.&#10;C) It is extracted from plants.&#10;D) It is a naturally occurring chemical in the body.

Accepted Answer

Adenosine is a naturally occurring chemical found in every cell within the body.Adenosine is not synthesized from petroleum products,is not created through recombinant DNA,and is not extracted from plants.

Question 8

How many milligrams of lidocaine will the nurse administer via intravenous (IV)bolus to a 30-year-old patient with ventricular tachycardia who weighs 75 kg after a myocardial infarction?&#10;A) 10&#10;B) 25&#10;C) 50&#10;D) 75

Accepted Answer

The initial lidocaine bolus is 1 to 1.5 mg/kg,decreased by half in older adults,patients with hepatic disease,and patients with heart failure.Doses of 10,25,and 50 mg are too low for a patient of this weight.

Question 9

What is the action of amiodarone (Cordarone),a class III agent used to treat cardiac dysrhythmias?&#10;A) It acts as a myocardial depressant by inhibiting sodium ion movement.&#10;B) It prolongs the duration of the electrical stimulation on cells and the refractory time between electrical impulses.&#10;C) It acts as a beta-adrenergic agent.&#10;D) It slows the rate of electrical conduction and prolongs the time between contractions.

Accepted Answer

Class I antidysrhythmic drugs act as a myocardial depressant by inhibiting sodium ion movement.Class II antidysrhythmic drugs act as beta-adrenergic agents.Class III agents slow the rate of electrical conduction and prolong the time between contractions.Class IV antidysrhythmic drugs prolong the duration of the electrical stimulation on cells and the refractory time between electrical impulses.

Question 10

The patient recently prescribed quinidine is at highest risk for which common adverse effect?&#10;A) Chills&#10;B) Diarrhea&#10;C) Nausea&#10;D) Rash

Accepted Answer

Diarrhea is common during initiation of quinidine therapy.Chills,nausea,and rash are not common adverse effects that occur during initiation of quinidine therapy.

Question 11

The nurse is assessing a patient who was recently admitted to the emergency department with dysrhythmias and shortness of breath.Which baseline nursing assessment(s)should be the priority(ies)?(Select all that apply.)

A) ECG monitoring
B) Medication history
C) Oxygen saturation
D) Presence of chest pain, dyspnea, and fatigue
E) Mental status
F) Sleep pattern

Accepted Answer

The answer of The nurse is assessing a patient who...

Question 12

The nurse is preparing to administer adenosine to a patient with supraventricular tachycardia.Which consideration(s)should the nurse take into account before administration?&#10;A) Constant ECG monitoring is necessary.&#10;B) Initial recommended dosage is 12 mg IV bolus.&#10;C) Rapid IV bolus administration is recommended.&#10;D) Saline flush following bolus is necessary.&#10;E) Long half-life of adenosine may prolong adverse medication effects.

Accepted Answer

The answer of The nurse is preparing to administer adenosine...

Question 13

Amiodarone is contraindicated for patients with which condition?&#10;A) Pulmonary edema&#10;B) Severe sinus node dysfunction causing bradycardia&#10;C) Atrial fibrillation&#10;D) Premature ventricular contractions (PVCs)

Accepted Answer

The answer of Amiodarone is contraindicated for patients with which...

Question 14

Patients who are on neuromuscular blocking agents and lidocaine must be closely observed for which complication?&#10;A) Hyperkalemia&#10;B) Respiratory depression&#10;C) Neurotoxicity&#10;D) Seizures

Accepted Answer

The answer of Patients who are on neuromuscular blocking agents...

Question 15

Which symptom will the nurse encourage the patient taking flecainide to report to the health care provider?&#10;A) Headache&#10;B) Dizziness&#10;C) Constipation&#10;D) Weight gain

Accepted Answer

The answer of Which symptom will the nurse encourage the...

Question 16

Which lidocaine preparation is appropriate for the treatment of cardiac dysrhythmias?&#10;A) 0.1% lidocaine with preservative&#10;B) 2% lidocaine for topical use&#10;C) Lidocaine patch&#10;D) Injectable lidocaine without preservative

Accepted Answer

The answer of Which lidocaine preparation is appropriate for the...

Deck 23: Drugs Used to Treat Dysrhythmias