Chapter 49 - Antihymtics

Question 1

1. Which two classes of antidysrhythmic drugs have nearly identical cardiac effects?
   a.
   Beta blockers and calcium channel blockers
   b.
   Beta blockers and potassium channel blockers
   c.
   Calcium channel blockers and sodium channel blockers
   d.
   Sodium channel blockers and potassium channel blockers

Answer 1

A

Question 2

2. A patient with atrial fibrillation is taking verapamil [Calan]. The patient has read about the drug on the Internet and wants to know why a drug that affects the rate of ventricular contraction is used to treat an abnormal atrial contraction. What will the nurse tell the patient?
   a.
   “Drugs that treat ventricular dysrhythmias help to restore normal sinus rhythm.”
   b.
   “Atrial dysrhythmias can have life-threatening effects on ventricular function.”
   c.
   “Treating ventricular dysrhythmias helps prevent the likelihood of stroke.”
   d.
   “When ventricular contraction slows, atrial contraction

Answer 2

B

Question 3

2. A patient with atrial fibrillation is taking verapamil [Calan]. The patient has read about the drug on the Internet and wants to know why a drug that affects the rate of ventricular contraction is used to treat an abnormal atrial contraction. What will the nurse tell the patient?
   a.
   “Drugs that treat ventricular dysrhythmias help to restore normal sinus rhythm.”
   b.
   “Atrial dysrhythmias can have life-threatening effects on ventricular function.”
   c.
   “Treating ventricular dysrhythmias helps prevent the likelihood of stroke.”
   d.
   “When ventricular contraction slows, atrial contraction

Answer 3

B

Question 4

. A nurse is teaching a patient who is about to undergo direct-current (DC) cardioversion to treat atrial flutter. The patient has been taking verapamil and warfarin for 6 months. Which statement by the patient indicates understanding of the teaching?
a.
“I may need long-term therapy with another cardiac medication after the procedure.”
b.
“I should stop taking warfarin a few days before the procedure.”
c.
“I will need to take a beta blocker after the procedure to prevent recurrence of atrial flutter.”
d.
“I will not have to take antidysrhythmia medications after the procedure.”

Answer 4

A

Question 5

4. A nurse is teaching a group of nursing students about antidysrhythmic medications. Which statement by a student indicates understanding of the teaching?
   a.
   “Antidysrhythmic drugs can cause new dysrhythmias or worsen existing ones.”
   b.
   “Adverse effects of these drugs are mainly noncardiac in nature.”
   c.
   “For most antidysrhythmic drugs, there is evidence of reduced mortality.”
   d.
   “Use of these drugs may be necessary even if the benefits are unknown.”

Answer 5

A

Question 6

5. A patient is taking digoxin [Lanoxin] and quinidine to treat sustained ventricular tachycardia. Before giving medications, the nurse reviews the patient’s electrocardiogram (ECG) and notes a QRS complex that has widened by 50% from the baseline ECG. What will the nurse do?
   a.
   Administer the medications as ordered, because this indicates improvement.
   b.
   Contact the provider to discuss reducing the digoxin dose.
   c.
   Contact the provider to request an increase in the quinidine dose.
   d.
   Withhold the quinidine and contact the provider to report the ECG finding.

Answer 6

D

Question 7

6. A nurse provides teaching for a patient who will begin taking procainamide [Procanbid] for long-term suppression of a dysrhythmia. Which statement by the patient indicates a need for further teaching?
   a.
   “I need to take this drug at evenly spaced intervals around the clock.”
   b.
   “I may have increased bruising, but this is a temporary side effect.”
   c.
   “I should report pain and swelling in my joints when taking this drug.”
   d.
   “I will need to have blood tests at regular intervals while taking this drug.”

Answer 7

B

Question 8

7.	A nurse is caring for a patient in the intensive care unit who is receiving intravenous lidocaine. The patient is drowsy and confused and reports numbness of the fingers and toes. Which standing order will the nurse initiate at this time?
a.
Administer diazepam.
b.
Reduce the rate of infusion.
c.
Discontinue the infusion.
d.
Prepare for mechanical ventilation.

Answer 8

B

Question 9

8. A patient with diabetes develops ventricular tachycardia and is in the hospital for evaluation of this condition. The nurse reviews the history and learns that the patient takes mexiletine [Mexitil] for pain caused by peripheral neuropathy. What should the nurse do?
   a.
   Discuss common side effects associated with taking mexiletine with cardiac agents.
   b.
   Understand that this drug will help with both peripheral neuropathy and dysrhythmias.
   c.
   Notify the provider to request that another drug be used for peripheral neuropathy pain.
   d.
   Request an order for renal function and hepatic function tests.

Answer 9

C

Question 10

9.	A prescriber has ordered propranolol [Inderal] for a patient with recurrent ventricular tachycardia. The nurse preparing to administer this drug will be concerned about what in the patient’s history?
a.
Asthma
b.
Exercise-induced tachyarrhythmias
c.
Hypertension
d.
Paroxysmal atrial tachycardia associated with emotion

Answer 10

A

Question 11

0. A nurse is providing teaching to a patient who is admitted to the hospital for initiation of treatment with amiodarone [Cordarone] for atrial fibrillation that has been refractory to other medications. Which statement by the patient indicates a need for further teaching?
   a.
   “I may have itching, malaise, and jaundice, but these symptoms will subside.”
   b.
   “I need to use sunblock to help keep my skin from turning bluish gray.”
   c.
   “I should not drink grapefruit juice while taking this medication.”
   d.
   “I should report shortness of breath and cough and stop taking the drug immediately.”

Answer 11

A

Question 12

11.	A patient is in the intensive care unit after a myocardial infarction. The nurse notes that the QT interval on this patient’s electrocardiogram has been elongating. The nurse is concerned that which cardiac dysrhythmia may occur?
a.
AV block
b.
Bradycardia
c.
Supraventricular tachycardia
d.
Torsades de pointes

Answer 12

D

Question 13

12.	A prescriber is considering prescribing the amiodarone derivative dronedarone [Multaq] for a patient with atrial flutter. The nurse should be concerned about which of the following?
a.
History of asthma
b.
History of hypothyroidism
c.
PR interval of 260 msec
d.
QT interval of 520 msec

Answer 13

D

Question 14

13.	A prescriber orders verapamil [Covera-HS] for a patient who is taking digoxin [Lanoxin] and warfarin. The nurse will expect the prescriber to \_\_\_\_ the dose of \_\_\_\_.
a.
lower; digoxin
b.
increase; digoxin
c.
lower; warfarin
d.
increase; warfarin

Answer 14

A

Question 15

14. A nurse is discussing adenosine with a nursing student. Which statement by the student indicates a need for further teaching?
    a.
    “Adenosine acts by suppressing action potentials in the SA and AV nodes.”
    b.
    “Adenosine can be used to prevent paroxysmal supraventricular tachycardia and Wolff-Parkinson-White syndrome.”
    c.
    “Adenosine has a half-life that lasts only a few seconds and must be given intravenously.”
    d.
    “Adenosine is not effective for treating atrial fibrillation, atrial flutter, or ventricular dysrhythmias.”

Answer 15

B

Question 16

15.	A nursing student asks a nurse how digoxin causes dysrhythmias. The nurse correctly states that digoxin:
a.
reduces automaticity in the AV node.
b.
increases automaticity in the Purkinje fibers.
c.
increases automaticity in the SA node.
d.
speeds up AV conduction.

Answer 16

B

Question 17

16.	The nurse is teaching a class on dysrhythmias and associated therapy. The nurse asks the class, “Which cardiac dysrhythmia would result in the lowest cardiac output, and what treatment would be effective?” The class best demonstrates understanding by responding that \_\_\_\_ results in the lowest cardiac output, and treatment includes \_\_\_\_.
a.
atrial flutter; lidocaine
b.
tachycardia; atropine
c.
first-degree heart block; verapamil [Calan]
d.
ventricular fibrillation; defibrillation

Answer 17

D

Question 18

17. The nurse educator is providing patient education about the Cardiac Arrhythmia Suppression Trial (CAST). The nurse correctly explains that the trial demonstrated what effect from the pharmacologic suppression of dysrhythmias?
    a.
    It reduced mortality by 50% but increased morbidity.
    b.
    It significantly reduced the risk of a second myocardial infarction (MI).
    c.
    It doubled the risk of a second MI.
    d.
    It should be used in all patients who have had an MI, regardless of rhythm.

Answer 18

C

Question 19

18. The nurse is teaching a group of nursing students about dofetilide [Tikosyn] to treat dysrhythmias. Which statement by a student indicates understanding of the teaching?
    a.
    “Dofetilide is a first-line medication to treat atrial flutter or atrial fibrillation.”
    b.
    “Dofetilide carries a lower risk of causing torsades de pointes than other drugs.”
    c.
    “Dofetilide is used for patients with severe symptoms of atrial dysrhythmias.”
    d.
    “Dofetilide may be safely used as outpatient therapy to treat atrial fibrillation.”

Answer 19

C

Question 20

1.	A patient is taking digoxin [Lanoxin] and develops a dysrhythmia. The nurse reports this finding to the prescriber, who will most likely order what? (Select all that apply.)
a.
Amiodarone
b.
Diltiazem
c.
Phenytoin [Dilantin]
d.
Quinidine
e.
Serum electrolytes

Answer 20

C. E.

Question 21

2.	A patient will be taking amiodarone [Cordarone]. Which baseline tests are necessary before this medication is started? (Select all that apply.)
a.
Chest radiograph and pulmonary function tests
b.
Complete blood count with differential
c.
Ophthalmologic examination
d.
Renal function tests
e.
Thyroid function tests

Answer 21

A. C. E.