Chapter 23 Drugs Used to Treat Dysrhythmias

Chapter 23  Drugs Used to Treat Dysrhythmias

Complete Chapter Questions And Answers
 

Sample Questions

MULTIPLE CHOICE

1. What is the action of amiodarone (Cordarone), a class III agent used to treat cardiac dysrhythmias?
a.
It acts as a myocardial depressant by inhibiting sodium ion movement.
b.
It prolongs the duration of the electrical stimulation on cells and the refractory time between electrical impulses.
c.
It acts as a beta-adrenergic agent.
d.
It slows the rate of electrical conduction and prolongs the time between contractions.

ANS: D
Class I antidysrhythmic drugs act as a myocardial depressant by inhibiting sodium ion movement. Class II antidysrhythmic drugs act as beta-adrenergic agents. Class III agents slow the rate of electrical conduction and prolong the time between contractions. Class IV antidysrhythmic drugs prolong the duration of the electrical stimulation on cells and the refractory time between electrical impulses.

DIF: Cognitive Level: Comprehension REF: Page 365 | Page 372
OBJ: 2 TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Clinical Judgment

2. How many milligrams of lidocaine will the nurse administer via intravenous (IV) bolus to a 30-year-old patient with ventricular tachycardia who weighs 75 kg after a myocardial infarction?
a.
10
b.
25
c.
50
d.
75

ANS: D
The initial lidocaine bolus is 1 to 1.5 mg/kg, decreased by half in older adults, patients with hepatic disease, and patients with heart failure. Doses of 10, 25, and 50 mg are too low for a patient of this weight.

DIF: Cognitive Level: Application REF: Page 369 OBJ: 3
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Clinical Judgment

3. A patient is taking amiodarone (Cordarone) for hypertrophic cardiomyopathy and begins to complain of dizziness. What will the nurse instruct the patient to do?
a.
Discontinue the medication immediately.
b.
Decrease the medication dosage for 1 week, and then resume the original order.
c.
Change positions slowly.
d.
Increase the dosage per health care provider directions.

ANS: C
Many adverse effects are dose related and resolve with reducing the dosage or discontinuing therapy. Patients should be taught to rise slowly from a supine or sitting position and sit or lie down if feeling faint. Medication should be discontinued only for serious adverse effects and with the consent of the health care provider. Changes in dose should be done only with the consent of the health care provider. Increasing the dose will likely increase the symptoms.

DIF: Cognitive Level: Application REF: Page 372 OBJ: 4
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Safe, Effective Care Environment
NOT: CONCEPT(S): Clinical Judgment; Patient Education; Safety

4. A patient who is started on phenytoin (Dilantin), who is also taking amiodarone (Cordarone), should be assessed for what possible effect?
a.
Central nervous system depression and sedation
b.
Decrease in effectiveness of phenytoin
c.
Respiratory depression
d.
Increase in serum phenytoin levels

ANS: D
Elevation of phenytoin serum levels (200% to 300%) is observed over several weeks. The dosage of phenytoin must be gradually reduced based on patient response. The combination of phenytoin and amiodarone does not produce sedation and depression, decrease the effectiveness of either drug, or produce respiratory depression.

DIF: Cognitive Level: Knowledge REF: Page 374 OBJ: 4
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Clinical Judgment; Safety

5. Which lidocaine preparation is appropriate for the treatment of cardiac dysrhythmias?
a.
0.1% lidocaine with preservative
b.
2% lidocaine for topical use
c.
Lidocaine patch
d.
Injectable lidocaine without preservative

ANS: D
Lidocaine for IV use is different from lidocaine used as a local anesthetic. The label for lidocaine for IV use should read “lidocaine for dysrhythmias” or “lidocaine without preservatives.” The 0.1% lidocaine, 2% lidocaine for topical use, and lidocaine patch are for topical anesthetic use.

DIF: Cognitive Level: Application REF: Page 369 OBJ: 2
TOP: Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Clinical Judgment