Antidysrhythmic Drugs

Understanding Pharmacology Essentials for Medication Safety

Nursing
33
Questions
0
True/False
28
Choices
5
Essay
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Questions

Q1
Free

A patients heart rate is regular at 68 beats per minute. The electrocardiogram (ECG) tracing shows P waves before every QRS complex. What is the likely pacemaker of the heart?

Multiple Choice
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A) SA node
B) AV node
C) Bundle of His
D) Purkinje fibers
Answer:
A) SA node

Explanation:
The SA node initiates electrical impulses at a rate of 60 to 100 per minute. When the ECG shows P waves before every QRS complex with a rate between 60 and 100 per minute, the rhythm is a normal sinus rhythm which is initiated by the SA node.
Q2
Free

A patient whose heart rate is 52 beats per minute reports feeling dizzy and light-headed. What is the nurses best first action?

Multiple Choice
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A) Start an IV line.
B) Ask if the patient has experienced this before.
C) Notify the prescriber immediately.
D) Check the patients blood pressure.
Answer:
D) Check the patients blood pressure.

Explanation:
A slow heart rate (less than 50 beats per minute) results in a decrease in cardiac output, blood pressure, and perfusion to a patients vital organs. This leads to symptoms such as dizziness, light-headedness, syncope, and decreased peripheral pulses. While the nurse will want to notify the prescriber, the patients blood pressure should be checked first.
Q3
Free

A patient on a telemetry monitor reports feeling like the heart is skipping beats, and asks the nurse what could be causing this. What is the nurses best response?

Multiple Choice
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A) Have you been exercising recently?
B) Do you notice any other symptoms when your heart skips beats?
C) You will have to tell your prescriber about this and ask him or her what is the cause.
D) Let me first listen to your heart, measure your blood pressure, and check your heart monitor.
Answer:
D) Let me first listen to your heart, measure your blood pressure, and check your heart monitor.

Explanation:
To answer the patients question, the nurse needs to gather more information including heart rhythm, blood pressure, and ECG tracing. The nurse may also want to notify the prescriber about the patients sensation of skipped heart beats.
Q4

A patients heart monitor shows ventricular fibrillation. What is the nurses best first action?

Multiple Choice
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A) Check the patient.
B) Call a code.
C) Begin CPR
D) Defibrillate the patient.
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Q5

A patient with an upper respiratory infection reports feeling like the heart is pounding. After checking that the patient is not having chest pain or difficulty breathing, what is the most important question the nurse must ask the patient?

Multiple Choice
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A) How long have you had upper respiratory infection symptoms?
B) Are you using any over-the-counter cold or cough drugs?
C) Is this the first time you have felt like this?
D) What exercise have you done today?
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Q6

A patient is prescribed digoxin. The patients apical heart rate is 58 beats per minute. What is the nurses best action?

Multiple Choice
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A) Give the drug as ordered.
B) Document the finding because this is an expected effect of the drug.
C) Recheck the heart rate and blood pressure after 30 minutes.
D) Hold the drug and notify the prescriber.
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Q7

A patient given atropine (Atropine Sulfate) intravenously as a one-time dose for bradycardia now reports a very dry mouth. What is the nurses best response?

Multiple Choice
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A) Notify the prescriber immediately.
B) Document the report as the only action.
C) Reassure the patient that this is a normal drug response.
D) Offer the patient the opportunity to brush his or her teeth and rinse the mouth.
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Q8

A 70-year-old patient who has been taking digoxin (Lanoxin) for 4 years has all of the following laboratory blood tests. For which test value does the nurse notify the prescriber immediately?

Multiple Choice
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A) Sodium (Na) 132 mEq/L
B) Potassium (K) 2.1 mEq/L
C) Blood urea nitrogen (BUN) 9 mg/dL
D) International normalized ratio (INR) 1.5
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Q9

Nausea, vomiting, and an irregular heart rate develop in a patient who takes oral digoxin every morning. What is the nurses best action?

Multiple Choice
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A) Give prescribed diphenhydramine (Phenergan) as needed.
B) Check the patients cardiac monitor strip.
C) Assess the apical pulse for a full minute.
D) Check laboratory results for a digoxin level.
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Q10

A patient who is prescribed oral quinidine (Quinaglute) for a tachydysrhythmia is on a cardiac monitor, which shows lengthening PR intervals. What is the nurses best action?

Multiple Choice
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A) Perform a 12-lead electrocardiogram (ECG).
B) Send a serum potassium level to the laboratory.
C) Document this as an expected action of the drug.
D) Notify the prescriber immediately.
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Q11

Which statement by a patient who has been prescribed quinidine (Quinaglute) indicates to the nurse the need for additional teaching?

Multiple Choice
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A) I use over-the-counter St. Johns wort to help with my memory.
B) I am careful not to eat too much food that is high in alkaline ash.
C) I check my heart rate and blood pressure at least once a day.
D) I weigh myself every morning at the same time.
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Q12

A patient with unstable ventricular dysrhythmia is prescribed lidocaine 200 mg by intravenous (IV) piggyback in 100 mL of IV solution. With an IV infusion set that has a drop factor of 15 gtt/mL, how many drops per minute does the nurse set the IV rate to deliver the correct dose in the specified time?

Multiple Choice
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A) 10
B) 25
C) 50
D) 100
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Q13

A patient asks the nurse why an intravenous (IV) line must be used to receive the antidysrhythmic drug lidocaine (Xylocaine). What is the nurses best response?

Multiple Choice
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A) The drug companies have not developed an oral form of this drug.
B) This drug can also be given by endotracheal tube in the ICU.
C) The drug in oral form would be destroyed by the liver making it ineffective.
D) This drug does not work when given by any other route.
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Q14

An older adult patient with frequent premature ventricular contractions (PVCs) is receiving intravenous (IV) lidocaine (Xylocaine) by continuous infusion. The patient becomes confused and sees insects on the walls. What is the nurses best action?

Multiple Choice
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A) Reorient the patient to person, place, and time.
B) Ask the patients family about alcohol use or abuse.
C) Check the patients chart for a history of dementia.
D) Notify the prescriber immediately.
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Q15

A patient who has been prescribed propafenone (Rythmol) asks the nurse how the drug works. What is the nurses best response?

Multiple Choice
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A) It shows the conduction of electrical impulses in your heart.
B) It increases your heart rate and the blood flow to your tissues.
C) It prevents your heart muscle from sensing electrical impulses.
D) It keeps the conduction of electrical impulses completely normal.
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Q16

A patient is to receive propafenone (Rythmol). What important question does the nurse ask the patient before giving the first dose?

Multiple Choice
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A) Do you have any hearing problems?
B) Are you having difficulty reading?
C) Have you ever had a problem with bronchospasm?
D) What other problems are being treated by your prescriber?
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Q17

Which laboratory result for a patient receiving sotalol (Betapace) does the nurse immediately report to the prescriber?

Multiple Choice
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A) Blood urea nitrogen (BUN) 21 mg/dL
B) Potassium (K) 3.4 mEq/L
C) Sodium (Na) 147 mEq/L
D) Creatinine 2.4 mg/dL
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Q18

A patient who has been prescribed acebutolol (Sectral) develops a heart rate of 48 beats per minute, dizziness, difficulty breathing, and bluish fingernails. What is the nurses best action?

Multiple Choice
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A) Instruct the patient to take several slow deep breaths.
B) Document these findings as expected with this drug.
C) Place the patient in high Fowlers position.
D) Hold the drug and notify the prescriber.
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Q19

A patient who has a history of depression is prescribed propranolol (Inderal). Which precaution is most important for the nurse to teach the patient?

Multiple Choice
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A) You should expect a decrease in depression symptoms while you are taking propranolol.
B) While taking propranolol you may notice that your depression gets worse.
C) Stop taking propranolol whenever you experience depression symptoms.
D) Propranolol may cause difficulty with the ability to perform sexually.
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Q20

What is the most important action for the nurse when caring for a patient with type 2 diabetes mellitus who is prescribed a beta blocker?

Multiple Choice
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A) Assess the patients feet daily.
B) Monitor for infection.
C) Administer oral diabetic drugs.
D) Regularly check the patients blood glucose.
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Q21

A patient who is prescribed sotalol (Betapace) develops the following assessment findings. For which finding does the nurse immediately notify the prescriber?

Multiple Choice
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A) Heart rate of 60 beats per minute
B) Difficulty sleeping
C) Cold hands and feet
D) Chest discomfort
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Q22

A patient is prescribed an oral loading dose of amiodarone (Cordarone) 1600 mg. Amiodarone is available in 400-mg tablets. How many tablets does the nurse give?

Multiple Choice
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A) 2
B) 4
C) 6
D) 8
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Q23

A patient prescribed amiodarone (Cordarone) tells the nurse that his scrotum is swollen and painful. What is the nurses best action?

Multiple Choice
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A) Instruct the patient that this side effect is reversible and will go away over several months.
B) Document this expected side effect as the only action.
C) Support the patients scrotum on a pillow.
D) Hold the drug and notify the prescriber.
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Q24

An older patient with a history of liver impairment is prescribed diltiazem (Cardizem) SR 120 mg twice a day for supraventricular tachycardia. What is the nurses best action before giving the first dose?

Multiple Choice
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A) Hold the drug and contact the prescriber.
B) Administer the drug as ordered.
C) Give 60 mg four times a day.
D) Give an XR capsule of 240 mg.
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Q25

A patient who has been prescribed verapamil (Calan) develops skin lesions, itching, achy joints, and a temperature of 101 F. What is the nurses best action?

Multiple Choice
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A) Administer the as-needed dose of diphenhydramine (Benadryl).
B) Contact the prescriber and request an order for acetaminophen 650 mg.
C) Draw a set of blood cultures to detect any infection.
D) Hold the drug and notify the prescriber.
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Q26

Why does the nurse give adenosine (Adenocard) to a patient rapidly by intravenous (IV) push?

Multiple Choice
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A) If given slowly, the heart rate will dramatically increase.
B) When given slowly, the drug is eliminated before it can act on the heart.
C) Slow administration can lead to tissue irritation and IV infiltration.
D) The drug is given rapidly so that within a minute, second or third doses may be given if needed.
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Q27

A patient is prescribed intravenous (IV) adenosine (Adenocard) for treatment of supraventricular tachycardia. Which safety precaution is most important for the nurse to perform before this drug is administered?

Multiple Choice
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A) Bring the crash cart and defibrillator to the patients bedside.
B) Make sure that all four bed side rails are in the upright position.
C) Place the patients bed in the lowest position.
D) Continuously monitor blood pressure.
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Q28

A patient who received an intravenous (IV) dose of magnesium sulfate has developed diarrhea. What is the nurses best response?

Multiple Choice
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A) Reassure the patient that diarrhea is a common side effect of magnesium sulfate.
B) Order a bedside commode so that the patient does not have to walk to the bathroom.
C) Hold the drug and notify the prescriber.
D) Document the finding as the only action.
Answer:

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Q29

[Multiple Response] Which antidysrhythmic drugs may be given by the endotracheal tube route? (Select all that apply.)
a. atropine (Atropine Sulfate)
b. digoxin (Lanoxin)
c. epinephrine (Adrenalin)
d. lidocaine (Xylocaine)
e. procainamide (Pronestyl)

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Q30

[Multiple Response] Which are signs of IV line patency? (Select all that apply.)
a. Blood return
b. Swelling
c. Easy flush of line
d. Redness
e. Pain
f. Warmth

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Q31

[Multiple Response] Which foods does the nurse teach a patient are good sources of magnesium? (Select all that apply.)
a. Baked potato
b. Bran cereal
c. Yogurt
d. Whole grain rice
e. Bananas

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Q32

[Multiple Response] Which foods does the nurse teach a patient are good sources of magnesium? (Select all that apply.)
a. Baked potato
b. Bran cereal
c. Yogurt
d. Whole grain rice
e. Bananas

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Q33

A pediatric patient is prescribed 0.008 mg of digoxin (Lanoxin). The drug on hand is digoxin 0.05 mg/mL. How many drops (gtt) will the nurse administer? _____ gtt

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