Southwestern College - NURSING 100

Chapter 18: Drug Therapy for Dysrhythmias

Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition

MULTIPLE CHOICE

BASIC CONCEPTS

1)What does the term “asystole” mean?

1. 1. Absence of electrical activity in the heart
   2. The ability of the heart to fire an impulse on its own
   3. Full heart contraction that occurs earlier than it should
   4. The normal rhythm of the heart as measured by an electrocardiogram

2. Which part of the heart normally controls the heart rate?
   1. Atrioventricular (AV) node
   2. His-Purkinje system
   3. Sinoatrial (SA) node
   4. Left ventricle

3. Which person is likely to have the lowest resting heart rate?
   1. Newborn infant
   2. Exercising child
   3. Young adult athlete
   4. Older adult female

4. Why must most cardiac dysrhythmias be treated?
   1. They increase preload.
   2. They decrease preload.

1. 3. They increase cardiac output.
   4. They decrease cardiac output.

5. What cardiac dysrhythmia can be helped or corrected by the drug atropine?
   1. Tachycardia
   2. Bradycardia
   3. Premature atrial contractions
   4. Premature ventricular contractions

6. Which condition is a common side effect of atropine?
   1. Urinary retention
   2. Loss of appetite
   3. Weight gain
   4. Difficulty sleeping

7. What step must be taken before giving digoxin (Lanoxin)?
   1. Measure the size of both ankles.
   2. Take the apical pulse for a full minute.
   3. Make sure the patient has not eaten for at least an hour.
   4. Take the blood pressure in both the right arm and the left arm.

8. In which class of antidysrhythmic drugs do beta blockers belong?
   1. Class I
   2. Class II
   3. Class III
   4. Class IV

9. Which patient problem can be made worse by beta blocker drugs?
   1. Depression
   2. Glaucoma
   3. Indigestion
   4. Heat intolerance

10. By what route is the potassium channel blocker ibutilide (Corvert) usually given?
    1. Oral tablet
    2. Sublingual tablet
    3. Subcutaneously
    4. Intravenously

11. What is the most common side effect of adenosine (Adenocard)?
    1. Nightmares
    2. Constipation
    3. Facial flushing
    4. Leg and ankle swelling

12. What type of dysrhythmia or cardiac problem is usually treated with magnesium sulfate?
    1. Asystole
    2. Heart block
    3. Chest pain
    4. Torsades de pointes

ADVANCED CONCEPTS

13. A patient’s heart rate is regular at 68 beats/min. The electrocardiogram (ECG) tracing shows P waves before every QRS complex. What is the likely pacemaker of the heart?
    1. SA node
    2. AV node
    3. Bundle of His
    4. Purkinje fibers

14. A patient whose heart rate is 52 beats/min reports feeling dizzy and light-headed. What is your best first action?
    1. Start an IV line.
    2. Ask if the patient has experienced this before.
    3. Notify the prescriber immediately.
    4. Check the patient’s blood pressure.

15. A patient on a telemetry monitor reports feeling like the heart is skipping beats, and asks you what could be causing this. What is your best response?
    1. “Have you been exercising recently?”
    2. “Do you notice any other symptoms when your heart skips beats?”
    3. “You will have to tell your prescriber about this and ask him or her what is the cause.”

1. 4. “Let me first listen to your heart, measure your blood pressure, and check your heart monitor.”

16. A patient with an upper respiratory infection reports feeling like the heart is pounding. After finding out that the patient does not having chest pain or difficulty breathing, what is the most important question you must ask the patient?
    1. “How long have you had upper respiratory infection symptoms?”
    2. “Are you using any over-the-counter cold or cough drugs?”
    3. “Is this the first time you have felt like this?”
    4. “What exercise have you done today?”

17. A patient is prescribed digoxin. The patient’s apical heart rate is 58 beats/min. What is your best action?
    1. Give the drug as ordered.
    2. Document the finding because this is an expected effect of the drug.
    3. Recheck the heart rate and blood pressure after 30 minutes.
    4. Hold the drug and notify the prescriber.

18. A patient given atropine (atropine sulfate) intravenously as a one-time dose for bradycardia now reports a very dry mouth. What is your best response?
    1. Notify the prescriber immediately.
    2. Document the report as the only action.
    3. Reassure the patient that this is a normal drug response.
    4. Offer the patient the opportunity to brush his or her teeth and rinse the mouth.

19. 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 should you notify the prescriber immediately?
    1. Sodium (Na) 132 mEq/L
    2. Potassium (K) 2.1 mEq/L
    3. Blood urea nitrogen (BUN) 9 mg/dL
    4. International normalized ratio (INR) 1.5

20. Nausea, vomiting, and an irregular heart rate develop in a patient who takes oral digoxin every morning. What is your best action?
    1. Give prescribed promethazine (Phenergan) as needed.
    2. Check the patient’s cardiac monitor strip.
    3. Assess the apical pulse for a full minute.
    4. Check laboratory results for a digoxin level.

21. A patient who is prescribed oral quinidine (Quinaglute) for a tachydysrhythmia is on a cardiac monitor, which shows lengthening PR intervals. What is your best action?
    1. Perform a 12-lead electrocardiogram (ECG).
    2. Send a serum potassium level to the laboratory.
    3. Document this as an expected action of the drug.
    4. Notify the prescriber immediately.

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

1. 1. “I use over-the-counter St. John’s wort to help with my memory.”
   2. “I am careful not to eat too much food that is high in alkaline ash.”
   3. “I check my heart rate and blood pressure at least once a day.”
   4. “I take a multivitamin and calcium supplement daily.”

23. 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 your best action?
    1. Reorient the patient to person, place, and time.
    2. Ask the patient’s family about alcohol use or abuse.
    3. Check the patient’s chart for a history of dementia.
    4. Slow the infusion and notify the prescriber immediately.

24. A patient who is prescribed propafenone (Rythmol) asks how the drug works. What is your best response?
    1. “It slows the conduction of electrical impulses in your heart.”
    2. “It increases your heart rate and the blood flow to your tissues.”
    3. “It prevents your heart muscle from sensing electrical impulses.”
    4. “It keeps the conduction of electrical impulses completely normal.”

25. A patient is to receive propafenone (Rythmol). What important question should you ask the patient before giving the first dose?
    1. “Do you have any hearing problems?”
    2. “Are you having difficulty reading?”
    3. “Have you ever had a problem with asthma?”
    4. “What other problems are being treated by your prescriber?”

26. A patient who has been prescribed acebutolol (Sectral) develops a heart rate of 48 beats/min, dizziness, difficulty breathing, and bluish fingernails. What is your best first action?
    1. Instruct the patient to take several slow deep breaths.
    2. Place the patient in high Fowler’s position.
    3. Hold the drug and notify the prescriber.
    4. Apply oxygen by mask or nasal cannula.

27. A patient who has a history of depression is prescribed propranolol (Inderal). Which precaution is most important for you to teach the patient?
    1. “You should expect a decrease in depression symptoms while you are taking propranolol.”
    2. “While taking propranolol you may notice that your depression gets worse.”
    3. “Stop taking propranolol whenever you experience depression symptoms.”
    4. “Propranolol may cause difficulty with your ability to perform sexually.”

28. What is the most important action when caring for a patient with type 2 diabetes mellitus who is prescribed a beta blocker?
    1. Assess the patient’s feet daily.
    2. Monitor for infection.
    3. Administer oral diabetic drugs.
    4. Regularly check the patient’s blood glucose.

29. A patient who is prescribed sotalol (Betapace) develops the following problems. For which finding should you immediately notify the prescriber?
    1. Heart rate of 60 beats/min
    2. Difficulty sleeping
    3. Cold hands and feet
    4. Chest discomfort

30. A patient is prescribed an oral loading dose of amiodarone (Cordarone) 1600 mg. Amiodarone is available in 400 mg tablets. How many tablets should you give?
    1. 2
    2. 4
    3. 6
    4. 8

31. A patient prescribed amiodarone (Cordarone) tells you that his scrotum is swollen and painful. What is your best action?
    1. Instruct the patient that this side effect is reversible and will go away over several months.
    2. Document this expected side effect as the only action.
    3. Support the patient’s scrotum on a pillow.
    4. Hold the drug and notify the prescriber.

32. An older patient with a history of liver impairment is prescribed diltiazem (Cardizem) SR 120 mg twice a day for supraventricular tachycardia. What is your best action before giving the first dose?
    1. Hold the drug and contact the prescriber.
    2. Administer the drug as ordered.
    3. Give 60 mg four times a day.
    4. Give an XR capsule of 240 mg once a day.

33. A patient who has been prescribed verapamil (Calan) develops skin lesions, itching, achy joints, and a temperature of 101^o F. What is your best action?
    1. Administer an as-needed dose of diphenhydramine (Benadryl).
    2. Contact the prescriber and request an order for acetaminophen 650 mg.
    3. Draw a set of blood cultures to detect any infection.
    4. Hold the drug and notify the prescriber.

34. Why is adenosine (Adenocard) given to a patient rapidly by intravenous (IV) push?
    1. If given slowly, the heart rate will dramatically increase.
    2. When given slowly, the drug is eliminated before it can act on the heart.
    3. Slow administration can lead to tissue irritation and IV infiltration.
    4. The drug is given rapidly so that within a minute, second or third doses may be given if needed.

35. A patient is prescribed intravenous (IV) adenosine (Adenocard) for treatment of supraventricular tachycardia. Which safety precaution is most important to perform before this drug is administered?
    1. Bring the crash cart and defibrillator to the patient’s bedside.
    2. Make sure that all four bed side rails are in the upright position.
    3. Place the patient’s bed in the lowest position.
    4. Continuously monitor blood pressure.

36. A patient who received an intravenous (IV) dose of magnesium sulfate has developed diarrhea. What is your best response?
    1. Reassure the patient that diarrhea is a common side effect of magnesium sulfate.
    2. Order a bedside commode so that the patient does not have to walk to the bathroom.
    3. Hold the drug and notify the prescriber.
    4. Document the finding as the only action.

37. What should you teach any patient prescribed an antidysrhythmic drug to do every day?
    1. Keep accurate intake and output records.
    2. Drink half of a glass of water with each drug.
    3. Check heart rate and blood pressure.
    4. Participate in an aerobic exercise program.

38. What dose of atropine is prescribed to be administered via endotracheal tube?
    1. The same dose as normal
    2. Twice the normal dose
    3. Three times the normal dose
    4. Four times the normal dose

39. The prescriber orders atropine 0.3 mg IV push for an adult patient with symptomatic bradycardia. What is your best action?
    1. Contact the prescriber and question the order.
    2. Give the drug exactly as prescribed.
    3. Administer a prepared amp of 1 mg atropine in 5 mL NS.
    4. Give half an amp of prepared atropine 1 mg in 5 mL NS.

40. What advice would you give a patient prescribed tocainide (Tonocard) to avoid an adverse effect of this drug?
    1. “Be sure to avoid foods that are high in alkaline ash such as citrus fruits.”
    2. “Wear protective clothing and a strong sunscreen when you go outdoors.”
    3. “Avoid large crowds and people with flu or cold symptoms.”
    4. “Report any pulmonary symptoms (e.g., cough) to your prescriber right away.”

41. For signs and symptom of which endocrine problem must you monitor when a patient is prescribed amiodarone (Cordarone)?
    1. Hypoaldosteronism
    2. Hyperaldosteronism
    3. Hypothyroidism
    4. Hyperthyroidism

42. How should you prepare to administer adenosine (Adenocard) to a patient with persistent supraventricular tachycardia (SVT)?
    1. Sublingual spray
    2. Rapid IV bolus
    3. Continuous slow infusion
    4. Continuous transdermal patch

43. A patient who received an oral dose of procainamide immediate release an hour ago at 9:00

a.m. is now prescribed to receive an oral dose of disopyramide. When is the earliest you should give the disopyramide?

1. Immediately
2. 12:00 noon

c.   3:00 p.m.

d.   9:00 p.m.

MULTIPLE RESPONSE ADVANCED CONCEPTS

1. Which antidysrhythmic drugs may be given by the endotracheal tube route? (select all that apply)
   1. Atropine (Atropine Sulfate)
   2. Digoxin (Lanoxin)
   3. Epinephrine (Adrenalin)
   4. Lidocaine (Xylocaine)
   5. Procainamide (Pronestyl)

2. Which foods should you teach patients are good sources of magnesium? (select all that apply)
   1. Baked potato
   2. Bran cereal
   3. Yogurt
   4. Whole-grain rice
   5. Bananas

COMPLETION

ADVANCED CONCEPTS

1. A patient is prescribed sotalol (Betapace) 320 mg orally once a day. Sotalol comes in 80 mg tablets. How many tablets would you give for each daily dose?