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A client with a history of atrial fibrillation has undergone cardioversion. What drug would the nurse anticipate administering for long-term stabilization of this client?
A) disopyramide
B) moricizine
C) procainamide
D) quinidine (generic)
D) quinidine (generic)
Quinidine is often the drug of choice for long-term stabilization of atrial fibrillation after the rhythm is converted by electrocardioversion. Quinidine is a class I antiarrhythmic and stabilizes the cell membrane by binding to sodium channels, depressing phase 0 of the action potential, and changing the duration of the action potential. Disopyramide, moricizine, and procainamide are all used in the treatment of life-threatening ventricular arrhythmias.
The nurse is providing education to clients on antiarrhythmic drug classes. What class of antiarrhythmics drug will the nurse indicates blocks potassium channels, prolonging phase 3 of the action potential and slowing the rate and conduction of the heart?
A) I
B) II
C) III
D) IV
C) III
The class III antiarrhythmics block potassium, prolonging phase 3 of the action potential, which prolongs repolarization and slows the rate and conduction of the heart. Class I drugs block the sodium channels in the cell membrane during an action potential. Class II drugs are beta-adrenergic blockers that block beta-receptors, causing a depression of phase 4 of the action potential. Class IV drugs block calcium channels in the cell membrane leading to a depression of depolarization and a prolongation of phases I and II of repolarization, which slows automaticity.
The nurse is providing drug teaching about quinidine in preparation for a client’s discharge. What dietary guidelines should the nurse provide to the client?
A) “Avoid citrus juices and dairy products.”
B) “If possible, drink two to three quarts of fluids per day.”
C) “Avoid any processed food that contains added sodium.”
D) “In general, avoid food that has been fermented, pickled, or aged.”
A) “Avoid citrus juices and dairy products.”
Feedback: Quinidine requires a slightly acidic urine (normal state) for excretion. Clients receiving quinidine should avoid foods that alkalinize the urine (e.g., citrus juices, vegetables, antacids, milk products), which could lead to increased quinidine levels and toxicity. Grapefruit juice has been shown to interfere with the metabolism of quinidine, leading to increased serum levels and toxic effects. Adequate fluid intake is necessary, but most clients do not need to drink two to three quarts of fluid per day. Controlling sodium intake is important for clients with cardiac disease, but this does not require abstinence from all processed foods. Foods that are fermented, pickled, or aged tend to be high in tyramines, but this is not problematic.
The nurse is caring for a client who reports insomnia since starting a prescribed antiarrhythmic agent. What antiarrhythmic agent would the nurse expect this client is taking?
A) disopyramide
B) amiodarone
C) procainamide
D) propranolol
D) propranolol
Class II antiarrhythmics can cause insomnia. The adverse effects associated with class II antiarrhythmics are related to the effects of blocking beta-receptors in the sympathetic nervous system. CNS effects include dizziness, insomnia, unusual dreams, and fatigue. Disopyramide and procainamide are class I agents and do not cause insomnia. Amiodarone is a class III drug and is not associated with insomnia.
A client with a history of atrial fibrillation has been successfully cardioverted and prescribed dofetilide. The nurse closely monitors the client’s cardiac status. What other factor should the nurse monitor during treatment?
A) creatinine clearance
B) red blood cell indices
C) respiratory status
D) white cell differential
A) creatinine clearance
When giving dofetilide to a client with renal dysfunction, the dosage must be calculated according to the client’s creatinine level to ensure the therapeutic effect while limiting toxicity. Consequently, the nurse should monitor the client’s renal function. Red cell and white cell levels are not typically affected nor is the client’s respiratory status.
A nurse is caring for a client who has been prescribed disopyramide. Before administering disopyramide, what is the nurse’s priority action to maintain safety? A) Offer the client something to drink.
B) Determine if the client needs to void.
C) Lower the bed and raise the side rails.
D) Place the call button within reach.
C) Lower the bed and raise the side rails.
Feedback: When administering disopyramide, the nurse should make sure that all side rails are up. The central nervous system effects of the drug can include dizziness, drowsiness, fatigue, twitching, mouth numbness, slurred speech, vision changes, and tremors that can progress to convulsions. The other three options are appropriate and placing the call button within reach can also be considered a safety measure; however, nothing has a higher priority than lowering the bed and raising the bed’s side rails.
The nurse is caring for a client who has been prescribed an antiarrhythmic agent. What nursing assessment should the nurse prioritize?
A) mental status
B) breath sounds and respiratory rate
C) apical heart rate and blood pressure
D) activity level and exercise tolerance
C) apical heart rate and blood pressure
The nurse should continually monitor cardiac rate and rhythm when administering an antiarrhythmic agent to detect potentially serious adverse effects and to evaluate drug effectiveness. Activity level, respiratory status, and cognition are all relevant assessments, but cardiac assessment is a key priority.
The nurse is caring for a client who is receiving propranolol. The nurse will monitor the client for which potential adverse effects? Select all that apply.
A) seizures
B) rash
C) atrioventricular (AV) block
D) bronchospasm
E) bizarre dreams
C) atrioventricular (AV) block
D) bronchospasm
E) bizarre dreams
Feedback: The adverse effects associated with class II antiarrhythmics are related to the effects of blocking beta-receptors in the sympathetic nervous system. Central nervous system effects include dizziness, insomnia, unusual dreams, and fatigue. Cardiovascular symptoms can include hypotension, bradycardia, AV block, arrhythmias, and alterations in peripheral perfusion. Respiratory effects can include bronchospasm and dyspnea. GI problems frequently include nausea, vomiting, anorexia, constipation, and diarrhea. Other effects to anticipate include a loss of libido, decreased exercise tolerance, and alterations in blood glucose levels. Seizures and rash are not usually associated with the adverse effects of propranolol.
The nurse teaches a client receiving propranolol at home for management of a ventricular dysrhythmia to monitor what parameter?
A) daily fluid intake
B) daily blood pressure
C) weekly weight
D) weekly pulse
B) daily blood pressure
Feedback: Hypotension can occur with propranolol, which is a beta-blocker, so clients should check their blood pressure and pulse every day. Propranolol does not require that fluid intake be measured. Propranolol also will not require daily weight taking, but it may be necessary with a diagnosis of propranolol.
A client in the emergency department is unresponsive, and the monitor indicates ventricular tachycardia. Emergency resuscitation has begun. What is the nurse’s best action with regard to medication administration?
A) Administer digoxin as prescribed.
B) Prepare for the administration of lidocaine.
C) Prepare for administration of quinidine.
D) Administer acebutolol as prescribed.
B) Prepare for the administration of lidocaine.
Lidocaine is the drug of choice for ventricular tachycardia. Digoxin, quinidine, and acebutolol are not among the medication options for treating ventricular tachycardia.
The nurse administers a bolus of lidocaine to a client with a life-threatening ventricular arrhythmia and follows it with a continuous infusion at what rate? A) 0.25 to 0.75 mg/min
B) 1 to 4 mg/min
C) 6 to 8 mg/min
D) 10 to 20 mg/min
B) 1 to 4 mg/min
Lidocaine may be delivered at 1 to 4 mg/min after a bolus. Therefore, the other options are incorrect.
For what condition would the nurse expect to administer lidocaine intravenously to a client?
A) decrease in arterial oxygen saturation (SaO2)
B) precipitous increase in blood pressure
C) multiple premature ventricular contractions (PVCs)
D) increase in intracranial pressure (ICP)
C) multiple premature ventricular contractions (PVCs)
Lidocaine drips are indicated for the treatment of life-threatening ventricular arrhythmias such as long or frequent runs of PVCs. Lidocaine would not be indicated for the treatment of hypoxia, hypertension, or increased ICP.
The nurse is caring for a client who takes an antiarrhythmic agent and is reporting a complete lack of appetite. Which cardiac antiarrhythmic agent would the nurse suspect the client is taking?
A) diltiazem
B) propranolol
C) lidocaine
D) amiodarone
B) propranolol
Propranolol frequently causes gastrointestinal (GI) problems such as nausea, vomiting, anorexia, constipation, and diarrhea. Diltiazem could cause nausea and vomiting but would not cause anorexia. Lidocaine can lead to changes in taste, nausea, and vomiting but does not cause anorexia. Amiodarone has adverse effects including nausea, vomiting, GI distress, weakness, dizziness, hypotension, heart failure, arrhythmia, a potentially fatal liver toxicity, and ocular abnormalities but does not cause anorexia.
The nurse is responding to a code for an unresponsive client. The advanced cardiac life support (ACLS) protocol has been implemented. The nurse should prepare for administration of what medication?
A) sotalol
B) quinidine
C) amiodarone
D) dronedarone
C) amiodarone
Amiodarone is the antiarrhythmic of choice in the advanced cardiac life support protocol. Quinidine and dronedarone are more commonly used for longer-term maintenance. Sotalol is not the drug of choice.
The nurse is reviewing the medication regimen of a newly admitted client. The client currently takes dofetilide 250 mcg PO twice a day. This client’s health history likely includes what diagnosis?
A) atrial fibrillation
B) hypertensive crisis
C) ischemic heart disease
D) ventricular tachycardia
A) atrial fibrillation
Dofetilide is indicated for conversion of atrial fibrillation or flutter to normal sinus rhythm and for maintenance of normal sinus rhythm after conversion for adults. It is not used for long-term treatment after ventricular tachycardia, hypertensive crisis, or ischemic heart disease.
What client factor would result in the nurse administering a reduced dosage of disopyramide?
A) dehydration
B) hypertension
C) renal impairment
D) chronic diarrhea
) renal impairment
Caution should be used with renal or hepatic dysfunction, which could interfere with the biotransformation and excretion of these drugs. Caution is not indicated with the findings of dehydration, hypertension, or chronic diarrhea.
The nurse is administering an intravenous dose of amiodarone to a client in distress. What action should the nurse prioritize?
A) Perform medication reconciliation.
B) Establish cardiac monitoring and maintain it until full recovery.
C) Provide reassurance and support to the client.
D) Document resuscitation efforts in detail.
B) Establish cardiac monitoring and maintain it until full recovery.
Cardiac monitoring is imperative for determining therapeutic effect and monitoring the client’s status. Reassurance is likely a low priority, due to the client’s reduced levels of consciousness. Documentation is important, but cardiac monitoring is an even higher priority. Medication reconciliation is not performed during an emergency situation.
The nurse reviews a client’s medical history. What condition in the history does the nurse recognize as contraindicating class II antiarrhythmic medication administration for this client?
A) asthma
B) colitis
C) migraine headache
D) antidiarrheals
A) asthma
Class II antiarrhythmic medications are contraindicated in clients with asthma because they could worsen the condition due to blockage of beta-receptors. They are not contraindicated in clients with colitis, migraine headache, or diarrhea.
The nurse is caring for a client who has a history of atrial fibrillation (AF) and whose condition has recently worsened. The client is awaiting cardioversion. In addition to cardiac monitoring, what assessment should the nurse prioritize?
A) Carefully monitor the client’s fluid balance.
B) Review the client’s electrolyte levels.
C) Monitor the client for signs of a pulmonary embolism.
D) Assess the client for a myocardial infarction.
C) Monitor the client for signs of a pulmonary embolism.
In clients with AF, there is a substantial risk that clots or emboli will be pumped into the ventricles and then into the lungs (from the right auricle), which could lead to pulmonary emboli, or to the brain or periphery (from the left auricle), which could cause a stroke or occlusion of peripheral vessels. Fluid balance and electrolytes are relevant, but secondary, concerns. AF does not directly affect coronary circulation.
The nurse assesses a client’s cardiac rhythm and notes several premature ventricular contractions (PVCs). The nurse knows that stimulation of the ventricles from what location causes PVCs?
A) ectopic focus in the ventricles
B) atrioventricular node
C) Purkinje fibers
D) bundle of His
A) ectopic focus in the ventricles
Premature ventricular contractions are stimulations of the cells caused by an ectopic focus in the ventricles causing an early contraction. The source of these ectopic foci could be anywhere within the ventricles, but the end result is reduced cardiac output due to reduced force of contraction.
A nurse is caring for a client with an arrhythmia. What is the priority goal for this client?
A) Maintain nutritional intake.
B) Maintain fluid intake.
C) Maintain cardiac output.
D) Maintain urine output.
C) Maintain cardiac output.
Disruptions in the normal rhythm of the heart can interfere with myocardial contractions and affect the cardiac output, the amount of blood pumped with each beat. Arrhythmias that seriously disrupt cardiac output can be fatal. Therefore, the primary goal of treating a cardiac arrhythmia is to maintain adequate cardiac output to support life. The other goals may be important to individual client care, but sustaining life takes priority.
A pediatric client is diagnosed with Wolff–Parkinson–White syndrome. The nurse provides the parents with information regarding which option as the most likely method of treatment?
A) ablation
B) emergency treatment with procainamide
C) long-term management with propranolol
D) close monitoring until the client outgrows the symptoms
A) ablation
In Wolff–Parkinson–White (WPW) syndrome, an extra signaling pathway between the heart’s upper and lower chambers causes a fast heartbeat (tachycardia). The symptoms tend to increase progressively with age. WPW has been successfully treated with ablation techniques to destroy the arrhythmia-producing cells. Propranolol and procainamide have been successfully used to treat supraventricular arrhythmias, with propranolol being the drugs of choice for long-term management.
The nurse suspects drug toxicity in the client who has been receiving lidocaine by infusion to control a ventricular arrhythmia. What assessment should the nurse perform to determine the accuracy of the suspicion of toxicity?
A) neurological assessment
B) serum lidocaine level
C) renal function studies
D) hepatic function studies
B) serum lidocaine level
If lidocaine is used for ventricular arrhythmias related to cardiac surgery or digoxin toxicity, serum levels should be monitored regularly to determine the appropriate dose and to avoid the potential for serious proarrhythmias and other adverse effects. Neurological assessment may indicate adverse effects but would not confirm lidocaine toxicity. Renal and hepatic function would not confirm lidocaine toxicity.
The nurse performs an electrocardiogram (ECG) and finds the older adult client is in atrial fibrillation (AF). The date of onset is unknown but could be as long as 3 months earlier when the client was last assessed. What drug will the nurse expect to be prescribed?
A) anticoagulant
B) digoxin
C) quinidine
D) angiotensin-converting enzyme (ACE) inhibitor
A) anticoagulant
If the onset of AF is not known and it is suspected that the atria may have been fibrillating for longer than 1 week, the client is better off staying in AF without drug therapy or electrocardioversion. Prophylactic oral anticoagulants are given to decrease the risk of clot formation and emboli being pumped into the system. Conversion in this case could result in potentially life-threatening embolization of the lungs, brain, or other tissues. Administration of other antiarrhythmics or ACE inhibitors would not be indicated.
A nurse is caring for a client in symptomatic paroxysmal tachycardia. What class of antiarrhythmics will the nurse administer to markedly depress phase 0 with extreme slowing of conduction?
A) class Ib
B) class Ic
C) class II
D) class III
B) class Ic
Class Ic drugs markedly depress phase 0, with a resultant extreme slowing of conduction, but have little effect on the duration of the action potential. As a result, they are indicated for the treatment of paroxysmal tachycardia. Class Ib drugs depress phase 0 somewhat and actually shorten the duration of the action potential. The class II antiarrhythmics are beta-adrenergic blockers that block beta-receptors, causing a depression of phase 4 of the action potential. The class III antiarrhythmics block potassium channels and slow the outward movement of potassium during phase 3 of the action potential, thus prolonging it.
What class of antiarrhythmic agents does the nurse administer to a client to slow the outward movement of potassium during phase 3 of the action potential?
A) class Ib
B) class Ic
C) class II
D) class III
D) class III
The class III antiarrhythmics block potassium channels and slow the outward movement of potassium during phase 3 of the action potential, prolonging it. Class Ib drugs depress phase 0 somewhat and actually shorten the duration of the action potential. Class Ic drugs markedly depress phase 0, with a resultant extreme slowing of conduction but have little effect on the duration of the action potential. The class II antiarrhythmics are beta-adrenergic blockers that block beta-receptors, causing a depression of phase 4 of the action potential.
What class of antiarrhythmic agents does the nurse administer to a client to depress generation of the action potentials and delaying phases 1 and 2 of repolarization?
A) class Ib
B) class II
C) class III
D) class IV
D) class IV
Feedback: The class IV antiarrhythmics block the movement of calcium ions across the cell membrane, depressing the generation of action potentials and delaying phases 1 and 2 of repolarization, which slows automaticity and conduction. Class Ib drugs depress phase 0 somewhat and actually shorten the duration of the action potential. The class II antiarrhythmics are beta-adrenergic blockers that block beta-receptors, causing a depression of phase 4 of the action potential. The class III antiarrhythmics block potassium channels and slow the outward movement of potassium during phase 3 of the action potential, thus prolonging it.
he nurse is teaching a class for clients and is educating on dronedarone. What statement, if made by the nurse, is accurate? Select all that apply.
A) “Dronedarone is available only in an oral form.”
B) “Dronedarone is contraindicated for clients with permanent atrial fibrillation.”
C) “Dronedarone has been found to be safe for use during pregnancy.”
D) “Prolonged QT interval is a common adverse effect of dronedarone.”
E) “Common adverse effects of dronedarone include headache and insomnia.”
A) “Dronedarone is available only in an oral form.”
B) “Dronedarone is contraindicated for clients with permanent atrial fibrillation.”
D) “Prolonged QT interval is a common adverse effect of dronedarone.”
Dronedarone is administered only in oral form and is contraindicated for clients with permanent AF. The most common adverse effects seen with dronedarone are heart failure, prolonged QT interval, nausea, diarrhea, and rash. It should never be used during pregnancy because it has been associated with fetal abnormalities.
The nurse is caring for a female client who has been prescribed a class II antiarrhythmic. The client informs the nurse, “I do breastfeed my 6-month-old baby.” What is the nurse’s best action?
A) Contact the primary health care provider to question this use of the drug.
B) Assess the client and administer the drug as prescribed.
C) Inform the client it would be best for her to stop breastfeeding.
D) Withhold the drug and document in the client’s medical record.
B) Assess the client and administer the drug as prescribed.
Class I, III, and IV agents should not be used during lactation; if they are needed, another method of feeding the baby should be used. This leaves only class II drugs for consideration if the client is breastfeeding. There is no obvious reason to contact the care primary health care provider or withhold the drug, which the nurse cannot independently do.
The nurse is caring for a 67-year-old client who is new to the community. The client’s history indicates long-term antiarrhythmic medication therapy. What nursing intervention will be added to the plan of care to best assure appropriate evaluation of the client’s expected outcomes?
A) Discuss with the client any possible barriers to medication therapy adherence that exists.
B) Provide for cardiac rhythm assessment at each scheduled follow-up visit.
C) Assess the client’s understanding of the cardiac condition and medication therapy regime.
D) Provide information regarding safety precautions in the event that central nervous system (CNS) effects occur.
B) Provide for cardiac rhythm assessment at each scheduled follow-up visit.
This client’s outcomes are focused on the stabilization of cardiac rhythm and output. Arranging for periodic monitoring of cardiac rhythm for a client receiving long- term therapy is necessary to evaluate effects of the medication on the client’s cardiac status. While the remaining options are all appropriate, only the cardiac rhythm assessment focuses on the evaluation of stated expected outcomes.
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