Chapter 15: Antidysrhythmic Drugs Nursing School Test Banks

Workman: Understanding Pharmacology

Chapter 15: Antidysrhythmic Drugs

Test Bank

MULTIPLE CHOICE

1. 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?
a. SA node
b. AV node
c. Bundle of His
d. Purkinje fibers
ANS: A
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.

PTS: 0 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 269 TOP: Nursing Process Step: N/A MSC: Client Needs Category: N/A

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

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Safe and Effective Care Environment

3. 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?
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.
ANS: D
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.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

4. A patients heart monitor shows ventricular fibrillation. What is the nurses best first action?
a. Check the patient.
b. Call a code.
c. Begin CPR
d. Defibrillate the patient.
ANS: A
Always check the patient first because a loose lead or brushing the teeth can cause a pattern that looks like ventricular fibrillation. If ventricular fibrillation is the patients actual rhythm, then call a code and begin CPR. Defibrillate the patient as soon as possible once the crash cart arrives in the patients room.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Safe and Effective Care Environment

5. 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?
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?
ANS: B
Over-the-counter cold and cough drugs containing pseudoephedrine (e.g., Sudafed) can cause a rapid heart rate (tachycardia).

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Health Promotion and Maintenance

6. A patient is prescribed digoxin. The patients apical heart rate is 58 beats per minute. What is the nurses best action?
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.
ANS: D
Digoxin can cause a decrease in heart rate. The nurse must assess the apical heart rate for a full minute before giving this drug. If the heart rate is less than 60 beats per minute, hold the drug and notify the prescriber.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Safe and Effective Care Environment

7. 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?
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.
ANS: C
A dry mouth is an expected response to atropine, which inhibits oral secretions. The nurse should also offer the patient the opportunity to brush the teeth and rinse the mouth; however, the first action is to relieve the patients concerns about this side effect.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Psychosocial Integrity

8. 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?
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
ANS: B
Although all of these values are abnormal, only the potassium level is dangerously out of the normal range (it is low, indicating hypokalemia; normal is 3.5 to 5 mEq/L). Abnormal potassium levels change the effectiveness of digoxin. In the case of hypokalemia, the sensitivity of the cardiac muscle membrane is increased to the effects of digoxin. This means that the risk for toxicity is greatly increased. The prescriber will probably order a digoxin level and lower the dosage of the drug.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Physiological Integrity

9. Nausea, vomiting, and an irregular heart rate develop in a patient who takes oral digoxin every morning. What is the nurses best action?
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.
ANS: D
Signs of digoxin overdose (toxicity) include nausea, vomiting, loss of appetite, diarrhea, and vision problems. Other signs include heart rate or rhythm changes, palpitations, and fainting. When these signs and symptoms occur, hold the dose, notify the prescriber, and check the patients serum digoxin level. This drug has a very narrow therapeutic range (0.8 to 2 ng/mL).

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Evaluation
MSC: Client Needs Category: Safe and Effective Care Environment

10. 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?
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.
ANS: D
Quinidine is a class Ia antidysrhythmic drug that can slow the conduction of electrical impulses through the heart and lengthen the interval between the QRS complex and the T wave. This increases the patients risk for development of an abnormal life-threatening ventricular rhythm called torsades de pointes, which can rapidly lead to ventricular fibrillation.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Physiological Integrity

11. Which statement by a patient who has been prescribed quinidine (Quinaglute) indicates to the nurse the need for additional teaching?
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.
ANS: A
Taking St. Johns wort at the same time as quinidine can cause decreased serum levels of the drug and decrease the intended effects of the drug. Teach patients to avoid this combination.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

12. 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?
a. 10
b. 25
c. 50
d. 100
ANS: B
For 100 mL to infuse in 1 hour, divide 100 by 60 (minutes) to equal 1.66 mL per minute. At a drop factor of 15 gtt/mL, multiply 1.66 by 15, = 24.9 gtt/minute; round up to 25.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Safe and Effective Care Environment

13. 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?
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.
ANS: C
Lidocaine can only be given by IV or by airway inhalation (ET tube). When given orally, the liver destroys most of the drug, making it ineffective.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

14. 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?
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.
ANS: D
With older adults, signs of confusion may indicate lidocaine toxicity. Older adults are more sensitive to the effects and side effects of this drug. Notify the prescriber immediately; the drug must be stopped and the patient started on another antidysrhythmic drug to prevent life-threatening dysrhythmias such as ventricular tachycardia. Once the drug is discontinued and metabolized, these symptoms will resolve.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Psychosocial Integrity

15. A patient who has been prescribed propafenone (Rythmol) asks the nurse how the drug works. What is the nurses best response?
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.
ANS: A
Propafenone (Rythmol) is a class Ic oral antidysrhythmic drug that works by slowing the conduction of electrical impulses in the heart. The results of these drugs include decreased episodes of ventricular and supraventricular dysrhythmias.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance

16. A patient is to receive propafenone (Rythmol). What important question does the nurse ask the patient before giving the first dose?
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?
ANS: C
When a patient is prescribed propafenone, the nurse should always check whether the patient has a history of bronchospasm. This drug blocks beta-adrenergic activity and can cause bronchospasm.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Safe and Effective Care Environment

17. Which laboratory result for a patient receiving sotalol (Betapace) does the nurse immediately report to the prescriber?
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
ANS: D
Sotalol is a beta blocker. When a beta blocker is prescribed for a patient with kidney damage, a lower dose of the drug should be ordered. A creatinine level of 2.4 mg/dL indicates kidney damage. Whereas all of these laboratory results are abnormal and should be reported to the prescriber, the creatinine level is the most important.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Evaluation MSC: Client Needs Category: Physiological Integrity

18. 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?
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.
ANS: D
Acebutolol is a beta blocker. Signs of drug overdose for these drugs include very slow heart rate, severe dizziness or fainting, difficult breathing, bluish-colored fingernails or palms, and seizures. The nurse should hold the drug and immediately notify the prescriber.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Physiological Integrity

19. A patient who has a history of depression is prescribed propranolol (Inderal). Which precaution is most important for the nurse to teach the patient?
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.
ANS: B
Depression is a side effect associated with taking beta blockers such as propranolol. The depression may be new onset, or a patient with a history of depression may find that it gets worse while taking these drugs. The patient should be instructed to report increased depression symptoms to the prescriber. The patient should not suddenly stop taking the drug. Although beta blockers often do affect sexual ability, this is not related to depression.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Psychosocial Integrity

20. 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?
a. Assess the patients feet daily.
b. Monitor for infection.
c. Administer oral diabetic drugs.
d. Regularly check the patients blood glucose.
ANS: D
Beta blockers can increase or decrease blood glucose levels. They can also mask the signs of hypoglycemia such as rapid heart rate, making it difficult to recognize and treat. Whereas all of these actions are important, the most important action related to a diabetic patient receiving a beta blocker is to regularly check the patients blood glucose.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 284 TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Safe and Effective Care Environment

21. A patient who is prescribed sotalol (Betapace) develops the following assessment findings. For which finding does the nurse immediately notify the prescriber?
a. Heart rate of 60 beats per minute
b. Difficulty sleeping
c. Cold hands and feet
d. Chest discomfort
ANS: D
All of these assessment findings can be side effects of sotalol, a beta blocker. However, if a patient develops chest pain it should be reported to the prescriber immediately because this symptom may indicate heart disease and require additional diagnostic testing. In addition, safe activity levels should be discussed with the patient.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Assessment MSC: Client Needs Category: Physiological Integrity

22. 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?
a. 2
b. 4
c. 6
d. 8
ANS: B
Want 1600 mg/X tablets; Have 400 mg/1 tablet. 1600/400 = 4 tablets.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Safe and Effective Care Environment

23. A patient prescribed amiodarone (Cordarone) tells the nurse that his scrotum is swollen and painful. What is the nurses best action?
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.
ANS: D
A male patient may experience pain or swelling in the scrotum while taking amiodarone. This should be reported to the prescriber immediately so that the drug dosage can be decreased.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Physiological Integrity

24. 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?
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.
ANS: A
When a calcium channel blocker such as diltiazem is prescribed for an older patient, or a patient with hepatic (liver) or renal (kidney) impairment, lower than normal initial doses are prescribed. The nurse should hold the drug and contact the prescriber about the dosage that has been prescribed for this patient.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Safe and Effective Care Environment

25. 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?
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.
ANS: D
Skin lesions, itching, achy joints, and fever are signs of Stevens-Johnson syndrome, an adverse effect of class IV antidysrhythmic drugs (calcium channel blockers). These symptoms should be reported immediately to the prescriber and the drug should be held because this syndrome has the potential to be fatal.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Physiological Integrity

26. Why does the nurse give adenosine (Adenocard) to a patient rapidly by intravenous (IV) push?
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.
ANS: B
Adenosine is an IV drug used to treat supraventricular tachycardia. It should be given as a rapid IV bolus injection (1 to 2 seconds). When given slowly, adenosine is eliminated from the body before it can get to the heart and act to slow down the rhythm.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 289 TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Physiological Integrity

27. 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?
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.
ANS: A
Adenosine slows electrical impulse conduction through the AV node. It is always given rapidly by IV push (1 to 2 seconds). After the drug is given, there is usually a very brief period of asystole (when the heart stops beating) before the heart resumes a normal rhythm. Because of this, emergency equipment must be available at the patients bedside before the drug is given.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Safe and Effective Care Environment

28. A patient who received an intravenous (IV) dose of magnesium sulfate has developed diarrhea. What is the nurses best response?
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.
ANS: A
The only common side effect of IV magnesium sulfate is diarrhea. Additional actions would include assisting the patient to the bathroom and providing skin care to prevent breakdown.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Physiological Integrity

MULTIPLE RESPONSE

1. 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)
ANS: A, C, D
Use the acronym NAVEL to remember which drugs may be given by endotracheal tube: narcan, atropine, Valium, epinephrine, and lidocaine.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 273 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Safe and Effective Care Environment

2. 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
ANS: A, C
Signs of IV patency include blood return and easy flushing of the line. Signs of infection include swelling, redness, warmth, fever, and pain.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 287 TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Safe and Effective Care Environment

3. 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
ANS: B, D
Baked potato, yogurt, and bananas are good sources for potassium. Box 14-4 in Chapter 14 lists additional food sources for magnesium.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)
REF: p. 292 TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Health Promotion and Maintenance

ESSAY

1. 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

ANS:
2 gtt
Want 0.008 mg/X mL, Have 0.050 mg/1 mL; 0.008/0.050 = 0.16 1 mL = 0.16 mL, at 15 gtt/mL = 0.16 15 = 2.4 gtt, rounded down to 2 gtt.

PTS: 1 DIF: Cognitive Level: Applying (Application) or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Safe and Effective Care Environment

Leave a Reply