Question 1

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.

The client is at risk for cardiac death.

Accepted Answer

Rationale 1: While a myocardial infarction may occur, this is not the most immediate concern.
Rationale 2: A cerebral vascular accident may occur, but this is not the most immediate concern.
Rationale 3: Prevention of an embolism is not first priority.
Rationale 4: The most vital concern is deterioration into cardiac arrest. If not treated quickly, the client will die due to lack of circulation of oxygen.

Question 2

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

Second-degree AV block

Accepted Answer

Rationale 1: Sodium channel blockers may be used to control PVCs.
Rationale 2: Sodium channel blockers may be used to control PACs.
Rationale 3: Sodium channel blockers do not have a direct correlation with blood sugar levels.
Rationale 4: Sodium channel blockers slow the action potential and delay conduction, therefore risking complete heart block and cardiac arrest if used on a client with a history of existing second- or third-degree block.

Question 3

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?&#10;A) &#34;Cardiac rhythm disturbances cause a decrease in the amount of blood pumped out of your heart with each contraction&#34;&#10;B) &#34;Most cardiac rhythm disturbances do not affect the body at all.&#34;&#10;C) &#34;The biggest problem with most cardiac rhythm disturbances is that they cause nervousness and irritability.&#34;&#10;D) &#34;Cardiac rhythm disturbances often cause gastrointestinal upset.&#34;&#10;

Accepted Answer

Rationale 1: One of the biggest results of cardiac rhythm disturbance is decreased cardiac output.
Rationale 2: Any disturbance of rhythm has some effect in the body. The effects may be minor or major.
Rationale 3: Clients with cardiac rhythm disturbances may experience nervousness or irritability, but this is not the major effect or concern.
Rationale 4: Some cardiac rhythm disturbances do cause gastrointestinal upset, but this is not the major effect or concern.

Question 4

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 teaching?

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."

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Accepted Answer

Rationale 1: Antidysrhythmic medications should not be stopped abruptly.
Rationale 2: Doses of antidysrhythmic medications should be evenly spaced.
Rationale 3: Antidysrhythmic medications should not be double-dosed to make up for missed doses.
Rationale 4: The health care provider should be consulted if the client is going to miss medication for more than 1 day.
Rationale 5: Abrupt discontinuation of antidysrhythmic medications can have serious side effects, so an adequate supply of the medication should be available.

Question 5

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?

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) "I have had chocolate birthday cake a few times to celebrate birthdays over the last few weeks."
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."

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Accepted Answer

Rationale 1: Unless the diet cola is decaffeinated, it should also be avoided.
Rationale 2: Alcohol should be limited when taking medications for atrial arrhythmias.
Rationale 3: Chocolate contains caffeine, which should be avoided when taking medications for atrial arrhythmias.
Rationale 4: Smoking cessation should be encouraged in clients taking medications for atrial dysrhythmia.
Rationale 5: Lowered fat intake is encouraged in clients taking medications for atrial arrhythmias.

Question 6

A nursing student is preparing to give amiodarone(Cordarone) to a client with a resistant ventricular tachycardia. Her instructor asks her to identify amiodarone's mechanism of action. What is the best response by the student?

A) Decreases automaticity of the SA node
B) It inhibits the flow of calcium into myocardial cells thus slowing conduction velocity.
C) Amiodarone works by prolonging the refectory period of the heart?
D) Slows conduction through the AV node and decreases automaticity of the SA node.

Accepted Answer

Rationale 1 This is the action of Digoxin.
Rationale 2 This is the action of a calcium channel blocker.
Rationale 3 Potassium channel blockers are a class III medications, they delay repolarization of the myocardial cells and lengthen the refractory period, which stabilizes dysrhythmias. 
Rationale 4 This is the action of adenosine.

Question 7

The nurse is caring for a client experiencing ventricular tachycardia. She is preparing her client for a non pharmacological procedure that will reset conduction through the AV node. What is the nurse preparing her client for?

A) Implanted cardiac defibrillator
B) Catheter ablation
C) Pacemaker
D) Defibrillation

Accepted Answer

Rationale 1 This would be a long term plan for clients having recurrent episodes of ventricular tachycardia, not for an acute episode.
Rationale 2 Catheter ablation is destruction of myocardial cells responsible for dysrhythmias, and is usually used for 
Rationale 3 A pacemaker alone would not be used for ventricular tachycardia, it would be used for heart block or bradydysrhythmias. It is also used together with an implantable defibrillator.
Rationale 4 The electrical shock momentarily stops all electrical impulses in the heart, both normal and abnormal. Under ideal conditions, the temporary cessation of electrical activity will allow the SA node to automatically return conduction to a normal sinus rhythm.

Question 8

Which of the following is considered the antidote for overdose of Clopidogrel (Plavix)?&#10;A) Platelets&#10;B) Vitamin K&#10;C) Protamine Sulphate&#10;D) Factor VIII&#10;

Accepted Answer

Rationale 1: Overdose with risk for hemorrhage may be treated with platelet infusions.
Rationale 2: This is the antidote for warfarin.
Rationale 3: This is the antidote for heparin.
Rationale 4: Factor VIII is not the antidote for Plavix.

Question 9

A client has been taking oral anticoagulant therapy for a number of years secondary to atrial fibrillation. He asks about taking Ibuprofen to manage arthritic pain in his knees. What is a reason that Ibuprofen should be avoided?

A) "Ibuprofen enhances the absorption of vitamin K."
B) "Ibuprofen inhibits the absorption of vitamin K."
C) "Warfarin inhibits the anti-inflammatory actions of Ibuprofen."
D) "Warfarin and Ibuprofen compete for protein binding sites."

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Accepted Answer

Rationale 1: Ibuprofen does not affect the actions of Vitamin K.
Rationale 2: Ibuprofen does not affect the actions of Vitamin K.
Rationale 3: Warfarin does not inhibit the anti-inflammatory actions of Ibuprofen.
Rationale 4: Extensive protein binding is responsible for numerous drug-drug interactions, some of which include NSAIDs, diuretics, selective serotonin reuptake inhibitors (SSRIs) and other antidepressants, steroids, antibiotics, vaccines, and vitamins (e.g., vitamin K). Concurrent use with NSAIDs may increase bleeding risk.

Question 10

A nurse who works in an outpatient chemotherapy unit has received an order to administer filgrastim (Neupogen) to a client who received chemotherapy this morning. The client's white blood cell count is dropping rapidly. The nurse asks the client to return to the unit tomorrow for the filgrastim. What is the rationale for the nurse's request?

A) If given today, the increase in the white blood cell count will occur too rapidly.
B) The actions of the filgrastim and chemotherapy drugs will oppose each other.
C) If the filgrastim is given today, the risk of liver damage will increase.
D) There is an increased risk of adverse reaction to both drugs.

Accepted Answer

Rationale 1: The white cell count will not increase rapidly, and it might not increase at all.
Rationale 2: Because antineoplastic drugs and CSFs produce opposite effects, filgrastim is not administered until at least 24 hours after a chemotherapy session.
Rationale 3: There is no increase in the risk of liver damage if these two drugs are given closely together.
Rationale 4: Both drugs have adverse reactions, but they do not potentiate each other.

Question 11

The nurse is reviewing lab work prior to administering a client's regularly scheduled subcutaneous injection of epoetin alfa. The nurse notes that the client's hematocrit has dropped from the last time lab was drawn. Which action by the nurse is the most appropriate?

A) Discuss this finding with the client's health care provider immediately.
B) Schedule another hematocrit test tomorrow.
C) Give the epoetin alfa and hold pressure on the injection site for 5 minutes.
D) Ask the client, "How have you been feeling?"
E) Ask the lab to verify the lab results.

Accepted Answer

The answer of The nurse is reviewing lab work prior...

Question 12

A client who is a strict vegetarian is prescribed cyanocobalamin (Vitamin B ¹²) for vitamin B12 deficiency. Which information should the nurse provide for this client? A) "Your medication is in the form of a nasal spray." B) "Nutrient-fortified breakfast cereals will help support your vitamin B12 levels." C) "Your health care provider may want to do an intradermal test dose of the medication before you start taking it." D) "Adverse effects of this drug are rare." E) "Constipation is a concern with this drug."

Accepted Answer

The answer of A client who is a strict vegetarian...

Question 13

The client and nurse have set a goal that the client will demonstrate proper technique for self-administration of epoetin alfa (Epogen) before the client is discharged from the hospital. Which client actions would the nurse evaluate as indicating this goal is met?

A) The client shakes the vial prior to drawing up the medication.
B) The client warms the vial by holding it for a few minutes before drawing up the medication.
C) The client draws the appropriate amount of medication into the syringe.
D) The client saves the remaining medication in the vial for the next dose.
E) The client verbalizes a plan to keep the medication vials in a cabinet out of the reach of children.

Accepted Answer

The answer of The client and nurse have set a...

Question 14

A client and nurse have set this goal: &#34;The client will verbalize precautions required while taking medications to reverse neutropenia by date of discharge.&#34; Which client statements would the nurse evaluate as indicating this goal is not met?&#10;A) &#34;I should eat plenty of fresh fruits and vegetables while on this drug.&#34;&#10;B) &#34;I should expect my stools to be light in colour.&#34;&#10;C) &#34;I will avoid going to the shopping mall until my therapy is complete.&#34;&#10;D) &#34;I will call my health care provider's office if my temperature goes over 100.5&#176;F.&#34;&#10;E) &#34;If I develop a cough, I will call my health care provider's office.&#34;&#10;

Accepted Answer

The answer of A client and nurse have set this...

Deck 21: Pharmacotherapy of Dysrhythmias