Chapter 24: Drugs Used to Treat Dysrhythmias My Nursing Test Banks

Chapter 24: Drugs Used to Treat Dysrhythmias

Test Bank

MULTIPLE CHOICE

1. What is the action of amiodarone (Cordarone), a class III agent used to treat cardiac dysrhythmias?

a.

It acts as a myocardial depressant by inhibiting sodium ion movement.

b.

It prolongs the duration of the electrical stimulation on cells and the refractory time between electrical impulses.

c.

It acts as a beta adrenergic agent.

d.

It slows the rate of electrical conduction and prolongs the time between contractions.

ANS: D

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.

DIF: Cognitive Level: Comprehension REF: p. 396 OBJ: 3

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

2. 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?

a.

10

b.

25

c.

50

d.

75

ANS: D

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.

DIF: Cognitive Level: Application REF: p. 393 OBJ: 4

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

3. A patient is taking amiodarone (Cordarone) for hypertrophic cardiomyopathy and begins to complain of dizziness. What will the nurse instruct the patient to do?

a.

Discontinue the medication immediately.

b.

Decrease the medication dosage for 1 week, and then resume the original order.

c.

Change positions slowly.

d.

Increase the dosage per health care provider directions.

ANS: C

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.

DIF: Cognitive Level: Application REF: pp. 396-397 OBJ: 5

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Safe, Effective Care Environment

4. A patient who is started on phenytoin (Dilantin), who is also taking amiodarone (Cordarone), should be assessed for what possible effect?

a.

Central nervous system depression and sedation

b.

Decrease in effectiveness of phenytoin

c.

Respiratory depression

d.

Increase in serum phenytoin levels

ANS: D

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.

DIF: Cognitive Level: Knowledge REF: p. 398 OBJ: 6

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

5. Which lidocaine preparation is appropriate for the treatment of cardiac dysrhythmias?

a.

0.1% lidocaine with preservative

b.

2% lidocaine for topical use

c.

Lidocaine patch

d.

Injectable lidocaine without preservative

ANS: D

Lidocaine for IV use is different from lidocaine used as a local anesthetic. The label for lidocaine for IV use should read lidocaine for dysrhythmias or lidocaine without preservatives. The 0.1% lidocaine, 2% lidocaine for topical use, and lidocaine patch are for topical anesthetic use.

DIF: Cognitive Level: Application REF: p. 393 OBJ: 6

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

6. Patients who are on neuromuscular blocking agents and lidocaine must be closely observed for which complication?

a.

Hyperkalemia

b.

Respiratory depression

c.

Neurotoxicity

d.

Seizures

ANS: B

Lidocaine, when administered with neuromuscular blocking agents, may cause respiratory depression. Ventilator dependent patients may require additional time to be weaned when on these categories of medications. Hyperkalemia, neurotoxicity, and seizures are not adverse effects of therapy with these two drugs.

DIF: Cognitive Level: Comprehension REF: p. 394 OBJ: 6

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Safe, Effective Care Environment

7. Which statement is true regarding the antidysrhythmic agent adenosine (Adenocard)?

a.

It is synthesized from petroleum products.

b.

It is created through recombinant DNA.

c.

It is extracted from plants.

d.

It is a naturally occurring chemical in the body.

ANS: D

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.

DIF: Cognitive Level: Knowledge REF: p. 395 OBJ: 3

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

8. Amiodarone is contraindicated for patients with which condition?

a.

Pulmonary edema

b.

Severe sinus node dysfunction causing bradycardia

c.

Atrial fibrillation

d.

Premature ventricular contractions (PVCs)

ANS: B

Amiodarone is contraindicated for patients with severe sinus node dysfunction that causes sinus bradycardia, with second and third degree AV block, and when episodes of bradycardia have caused syncope (except in the presence of a pacemaker). Pulmonary edema is not a contraindication for amiodarone. Atrial fibrillation is an indication for the use of amiodarone. Premature ventricular contractions are not a contraindication for amiodarone, but the medication is not indicated for the treatment of PVCs.

DIF: Cognitive Level: Comprehension REF: p. 397 OBJ: 5

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

9. The patient recently prescribed quinidine is at highest risk for which common adverse effect?

a.

Chills

b.

Diarrhea

c.

Nausea

d.

Rash

ANS: B

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

DIF: Cognitive Level: Knowledge REF: p. 392 OBJ: 6

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

10. Which symptom will the nurse encourage the patient taking flecainide to report to the health care provider?

a.

Headache

b.

Dizziness

c.

Constipation

d.

Weight gain

ANS: D

Flecainide may induce or aggravate preexisting heart failure. Weight gain is a symptom of fluid retention; the patient should be instructed to contact the health care provider for further evaluation. Headache and constipation are not typical adverse effects. Dizziness is usually mild and tends to resolve with continued therapy.

DIF: Cognitive Level: Comprehension REF: p. 395 OBJ: 6

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

11. 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:

a.

hold anticoagulant medications.

b.

remove ECG leads.

c.

assess potassium level.

d.

ensure QTc interval is more than 440 to 500 msec.

ANS: C

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.

DIF: Cognitive Level: Application REF: p. 399 OBJ: 4

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

12. 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 and 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.

ANS: C

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.

DIF: Cognitive Level: Analysis REF: p. 389 OBJ: 5

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

MULTIPLE RESPONSE

13. 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

ANS: A, B, C, D, E

Baseline nursing assessment of patients with dysrhythmias includes ECG monitoring, medication and medical histories, oxygen saturation, observation for the six cardinal signs of cardiovascular disease, and neurologic assessment. Sleep pattern history is not a priority for this patient.

DIF: Cognitive Level: Application REF: p. 388 OBJ: 5

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

14. The nurse is preparing to administer adenosine to a patient with supraventricular tachycardia. Which consideration(s) should the nurse take into account before administration? (Select all that apply.)

a.

Constant ECG monitoring is necessary.

b.

Initial recommended dosage is 12 mg IV bolus.

c.

Rapid IV bolus administration is recommended.

d.

Saline flush following bolus is necessary.

e.

Long half life of adenosine may prolong adverse medication effects.

ANS: A, C, D

Continuous cardiac monitoring is required when administering any IV medications to treat dysrhythmias. Because of the short half life of adenosine, the IV bolus should be administered rapidly. The initial dosage of adenosine is rapid IV bolus of 6 mg followed by a saline flush. Adenosine has a short half life.

DIF: Cognitive Level: Application REF: p. 400 OBJ: 4

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

15. The nurse is preparing to mix a lidocaine infusion for a patient. Which consideration(s) should the nurse take into account before administration? (Select all that apply.)

a.

Lidocaine with preservatives should be used.

b.

Dextrose 5% is the solution to mix with lidocaine.

c.

Therapeutic blood levels should be 1 to 5 mg/L.

d.

The rate of administration is 1 to 4 mg/min.

e.

Monitor for changes in neurologic status.

ANS: B, C, D, E

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.

DIF: Cognitive Level: Application REF: p. 393 OBJ: 6

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

16. 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: (Select all that apply.)

a.

cardiac rhythm.

b.

blood pressure.

c.

oxygen saturation.

d.

blood glucose levels.

e.

liver function tests.

ANS: A, B, C

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.

DIF: Cognitive Level: Application REF: p. 391 OBJ: 4

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

Leave a Reply