Question 1

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?

Accepted Answer

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." B

Question 2

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?

Accepted Answer

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." A

Question 3

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?

Accepted Answer

A)   History of asthma
B)   History of hypothyroidism
C)   PR interval of 260 msec
D)   QT interval of 520 msec D

Question 4

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?

Accepted Answer

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.

Question 5

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?

Accepted Answer

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 is also slowed."

Question 6

A nurse is discussing adenosine with a nursing student. Which statement by the student indicates a need for further teaching?

Accepted Answer

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."

Question 7

A patient will be taking amiodarone [Cordarone]. Which baseline tests are necessary before this medication is started?

Accepted Answer

A)   Chest radiograph and pulmonary function tests
B)   Complete blood count with differential
C)   Ophthalmologic examination
D)   Renal function tests
E)   Thyroid function tests

Question 8

A patient is taking digoxin [Lanoxin] and develops a dysrhythmia. The nurse reports this finding to the prescriber, who will most likely order what?

Accepted Answer

A)   Amiodarone
B)   Diltiazem
C)   Phenytoin [Dilantin]
D)   Quinidine
E)   Serum electrolytes

Question 9

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?

Accepted Answer

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.

Question 10

A nurse is teaching a group of nursing students about antidysrhythmic medications. Which statement by a student indicates understanding of the teaching?

Accepted Answer

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."

Question 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?

Accepted Answer

A)   AV block
B)   Bradycardia
C)   Supraventricular tachycardia
D)   Torsades de pointes

Question 12

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 ____.

Accepted Answer

A)   atrial flutter; lidocaine
B)   tachycardia; atropine
C)   first-degree heart block; verapamil [Calan]
D)   ventricular fibrillation; defibrillation

Question 13

Which two classes of antidysrhythmic drugs have nearly identical cardiac effects?

Accepted Answer

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

Question 14

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?

Accepted Answer

A)   Asthma
B)   Exercise-induced tachyarrhythmias
C)   Hypertension
D)   Paroxysmal atrial tachycardia associated with emotion

Question 15

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?

Accepted Answer

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 antidysrhythmic medications after the procedure."

Question 16

A nursing student asks a nurse how digoxin causes dysrhythmias. The nurse correctly states that digoxin:

Accepted Answer

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.

Question 17

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?

Accepted Answer

A)   Administer diazepam.
B)   Reduce the rate of infusion.
C)   Discontinue the infusion.
D)   Prepare for mechanical ventilation.

Question 18

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?

Accepted Answer

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.

Question 19

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 ____.

Accepted Answer

A)   lower; digoxin
B)   increase; digoxin
C)   lower; warfarin
D)   increase; warfarin

Question 20

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?

Accepted Answer

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."

Exam 49: Antidysrhythmic Drugs