Pharm CARDIO DYSRHYTHMIA ONLY

What is the newest goal of the dysrhythmias drug therapy?

To treat/relieve symptoms

What must the nurse make sure to monitor in terms of anti-dysrhythmia medications?

EKG, HR, and BP

Which of the following medications have a black box warning for increasing the risk of causing dysrhythmias

Quanidine

A 68-year-old client with atrial fibrillation is prescribed quinidine. The client is also taking digoxin for heart rate control. Which nursing action is MOST important before administering the first dose?

Check the digoxin level and assess for signs of toxicity

A 45-year-old client in the ICU is receiving lidocaine IV at 2 mg/min for severe PVCs. The client suddenly reports feeling lightheaded and confused. Vital signs: BP 95/60, HR 118, RR 22. What is the nurse's PRIORITY action?

Stop the infusion and notify the provider immediately; assess for CNS toxicity

A client starting propafenone therapy in the hospital setting reports severe shortness of breath and chest tightness. The EKG shows sustained ventricular tachycardia. What is the BEST nursing interpretation?

This is a pro-dysrhythmic effect and a medical emergency requiring immediate provider notification

A client receiving IV propranolol asks the nurse, "Why do I have to take my pulse before each dose at home?" What is the BEST nursing response that reflects understanding of the drug's action?

"We're checking that your heart rate hasn't dropped too low, because propranolol slows the heart, and we hold it if HR is below 60"

A 55-year-old client with diabetes and atrial flutter is on propranolol. During a clinic visit, the client says, "I haven't noticed my usual warning signs when my blood sugar drops." What is the nurse's PRIORITY response?

Educate the client that propranolol masks hypoglycemia symptoms and teach alternative monitoring methods; reinforce checking blood glucose regularly

A client is admitted to start amiodarone therapy for recurrent ventricular dysrhythmias. The nurse is obtaining baseline assessments. Which baseline test is MOST critical?

Chest X-ray, eye examination, ECG, thyroid function tests, and potassium/magnesium levels

A client on amiodarone therapy reports a new dry cough and mild dyspnea that developed over 2 weeks. What is the nurse's PRIORITY action?

Notify the provider immediately; these are signs of pulmonary toxicity requiring assessment

A client on amiodarone asks the nurse why the provider said to take the medication with food. What is the BEST response?

"Food will help prevent nausea and minimize GI upset"

A client with a history of chronic kidney disease (Stage 4) and atrial flutter is prescribed diltiazem. What is the nurse's PRIORITY action?

Verify renal function status with the provider before administration; impaired renal function is a contraindication

A 62-year-old client on verapamil reports ankle swelling and dizziness when standing up. Which nursing action is MOST appropriate?

Teach about orthostatic hypotension and edema as known side effects; instruct to change positions slowly and report persistent symptoms

A client in the ER has rapid supraventricular tachycardia. Adenosine 6 mg IV is ordered. Which statement about adenosine administration is MOST accurate based on its pharmacokinetics?

"Administer as a rapid IV bolus through a line close to the heart, followed immediately by saline flush, because the half-life is only 1.5-10 seconds"

A client receiving an adenosine bolus suddenly reports chest discomfort and dizziness. The monitor shows brief asystole. What is the nurse's BEST response?

These are expected transient effects of adenosine; monitor closely and reassure the client"

A client on digoxin therapy for atrial fibrillation reports anorexia, nausea, and seeing a yellowish halo around lights. Heart rate is 48 bpm. What is the nurse's PRIORITY action?

Hold the dose, notify the provider immediately, and check digoxin level; these are classic signs of digoxin toxicity

A client on digoxin therapy is found to have a potassium level of 2.8 mEq/L (normal 3.5-5.0). What is the nurse's BEST response?

Notify the provider and educate client about high potassium diet; hypokalemia increases risk for digoxin toxicity

A 70-year-old client presents with symptomatic bradycardia (HR 42, BP 88/56, dizzy). Atropine IV is ordered. Which statement reflects a correct understanding of atropine's mechanism?

Atropine increases heart rate by blocking parasympathetic (vagal) stimulation

A client with a history of recent myocardial infarction presents with symptomatic bradycardia. The provider orders atropine. What is the nurse's PRIORITY response?

Question the order and clarify with the provider; use cautiously in patients with heart disease as it may increase myocardial oxygen demand

A student nurse asks, "Why doesn't atropine raise blood pressure like other cardiac drugs?" What is the BEST response?

Atropine has little to no effect on blood pressure, unlike sympathomimetics

A client in the clinic with paroxysmal supraventricular tachycardia (PSVT) asks, "Are there ways to stop this without medication?" What are the BEST responses the nurse can teach?

Valsalva maneuver and carotid massage are non-pharmacological methods to try first

A client in the ED develops ventricular tachycardia with a pulse. Which non-pharmacological intervention is MOST appropriate?

Immediate defibrillation

A client with chronic atrial fibrillation asks about devices that might help control the rhythm. The nurse mentions several non-pharmacological management options. Which are CORRECT based on your notes?

Pacemakers, defibrillators, and radiofrequency ablation of ectopic foci

A client in septic shock has a blood pressure of 78/45, HR 128, RR 28, and decreased urine output. What is the PRIMARY goal of shock treatment?

Raise BP to maintain perfusion to vital organs such as brain, kidneys, heart

A client in hypovolemic shock from severe hemorrhage is brought to the ED. The nurse is implementing shock treatment. Which interventions should be prioritized FIRST, according to your notes?

Identify and treat the cause; place patient in recumbent position; give blood transfusion, fluids, electrolytes

A client in shock has received 2 liters of normal saline, but BP remains 82/50. What is the BEST next step?

Administer adrenergic agents per protocol AFTER adequate fluid volume replacement"

A nursing student is studying shock types. Which classification CORRECTLY matches the mechanism

Hypovolemic = hemorrhage/severe dehydration; Cardiogenic = MI/cardiac arrhythmia; Distributive = septic/anaphylactic

A client presents with the following: BP 105/68 (slightly low), HR 105, anxious, pale skin, cool/moist skin, RR 24 with increased depth. The client is NOT yet comatose or in severe distress. Which shock stage is this?

Early shock

A nurse is managing a patient receiving norepinephrine via central line. Which clinical manifestations or complications must the nurse actively monitor for?

Extravasation of IV sites, decreased perfusion to organs, Limb ischemia

A nurse cares for a patient with symptomatic bradycardia. Which medication is the only drug indicated to treat bradycardia?

Atropine

Which end-stage clinical assessment findings are commona cross all forms of shock?

Hypotension, Tachycardia, Tachypnea, Cold, pale skin

A patient is receiving diltiazem for a dysrhythmia. Which adverse effect should the nurse specifically monitor for in the lower extremities?

Edema

A patient with diabetes mellitus is prescribed propranolol. Which potential masking effect should the nurse educate this patient about?

Masking signs of hypoglycemia

A nurse prepares to administer intravenous adenosine to a patient. Which administration technique is mandatory for this medication?

IV bolus closest to the heart followed by an immediate saline flush

A nurse is preparing to administer intravenous propranolol. What is the maximum recommended rate of administration for this drug?

No faster than 1 mg/min

A nurse is caring for a patient taking verapamil for a dysrhythmia. Which instruction is essential to prevent injury related to blood pressure changes?

Change positions slowly

A patient is initiated on oral propafenone therapy. Which instruction should the nurse provide to the patient regarding administration?

Take the medication with food

A nurse is administering intravenous atropine. What hemodynamic effect does atropine have on blood pressure?

No effect on BP

A nurse is preparing a discharge teaching plan for a patient starting amiodarone. Which routine specialist evaluation must be scheduled as part of monitoring?

Eye exam

The nurse notes that conditions are identified as underlying causes of cardiogenic shock. Which conditions are they?

Lung embolism, Myocardian Infarction

The nurse identifies adverse effects associated with the administration of propranolol. Which are they?

Bronchospasms, Sexual dysfunction

A nurse is preparing to administer intravenous lidocaine for a ventricular dysrhythmia. Which principle must guide the administration of this medication?

Administer only by injection without epinephrine

Which of the following medications must the nurse understand that therapy must begin in the hospital?

propafenone and Amiodarone

A nurse is administering intravenous lidocaine to a patient with a severe ventricular dysrhythmia. Which clinical manifestation indicates a severe adverse effect of this medication?

Altered level of consciousness

Before administering a scheduled dose of digoxin, what action must the nurse perform?

Monitor the apical heart rate for 1 full minute

A patient is prescribed quinidine. Which black box warning associated with this medication must the nurse consider when monitoring the patient?

Increased risk of causing dysrhythmias

A nurse is reviewing the laboratory report of a patient taking digoxin for a dysrhythmia. Which serum drug level falls within the therapeutic non-protein index (NPI) range?

1.2 ng/mL

What is the approximate half-life of adenosine that dictates its rapid method of administration?

1.5 to 10 seconds

A patient is admitted in severe hypotensive shock. Under which condition should norepinephrine infusion be initiated?

After fluid volume replacement

A patient receiving oral quinidine therapy asks the nurse for a dietary beverage choice. Which dietary item must the nurse instruct the patient to avoid?

Grapefruit

A patient is prescribed amiodarone. Which condition is an explicit contraindication to receiving this medication?

Thyroid dysfunction