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A-Graded Pharmacology Exam on
Antidysrhythmic Drugs with Detailed
Answers and Clinical Rotation Insights
– Comprehensive Study Guide for
Medical Students
Which is the most appropriate outcome for a patient who has been prescribed an antidysrhythmic medication? 1 Cardiac output increased 2 Palpated radial pulses and pedal pulses 3 Weight gain in 1 week of 5 pounds or more 4 Systolic blood pressure 90 mm Hg or above 1 Rationale: The most appropriate criteria when taking antidysrhythmic medications is that the patient's symptoms of dysrhythmia are decreased and/or alleviated and subsequent cardiac output increased. The patient's peripheral pulses should be equal, strong, and regular bilaterally, with warm, pink extremities. Weight gain of 5 pounds or more in 1 week is of concern, and the prescriber should be notified. Heart failure may be developing or worsening if the patient already has known heart failure. The systolic blood pressure should be 90 mm Hg. A patient has been prescribed amiodarone. Which topics should the nurse include when teaching the patient about this medication? Select all that apply. 1 High-fiber diet 2 Sunscreen use 3 Gastrointestinal upset 4 Decreased fluid intake 5 Photophobia and wearing sunglasses
Rationale: Amiodarone may lead to gastrointestinal upset, which may be prevented or decreased by taking the drug with food or a snack. Photosensitivity (sunburn and other exaggerated skin reactions to the sunlight) and photophobia (light sensitivity) are other concerns with this drug. With photosensitivity, protective clothing, hat, and sunscreen are needed. The nurse should emphasize protection of the eyes (eg, wearing of sunglasses and/or tinted contact lenses) to patients taking this medication. Consumption of a high-fiber diet and forcing of fluids (not decreasing) can minimize the constipation that is a common side effect of antidysrhythmic drugs. When beta blockers are used with an antidysrhythmic, any shortness of breath, weight gain, changes in baseline blood glucose levels, or excess fatigue must be reported to the prescriber immediately. Which statement by a patient demonstrates the need for further teaching regarding atrial fibrillation? 1 "This condition is always reversible." 2 "A possible complication is a stroke." 3 "Atrial fibrillation can be a permanent condition." 4 "Anticoagulation is necessary while I am in atrial fibrillation." 1 Rationale: Atrial fibrillation can be permanent, and anticoagulation with warfarin or newer anticoagulants is necessary to prevent a stroke. The condition is not always reversible. Which should the nurse teach a patient who is diagnosed with nonsustained ventricular tachycardia? 1 "This dysrhythmia decreases cardiac output significantly." 2 "Medication therapy usually works very well with this disorder." 3 "The risks of drug therapy outweigh the benefits for this disorder in most cases." 4 "You will need to have monthly 12-lead electrocardiograms to monitor this disorder." 3 Rationale: The Cardiac Arrhythmia Suppression Trial, in which use of class IC drugs (encainide and flecainide) to prevent dysrhythmias after myocardial infarction actually doubled the rate of mortality; this points to the fact that drugs can worsen existing dysrhythmias. Because of their prodysrhythmic actions, antidysrhythmic drugs should be used only when dysrhythmias are symptomatically significant and only when the potential benefits clearly outweigh the risks. Applying this guideline, it would be inappropriate to give antidysrhythmic drugs to a patient with nonsustained ventricular tachycardia, because this dysrhythmia does not significantly reduce cardiac output. When teaching a patient about amiodarone, the nurse should advise the patient to avoid which food or drink? 1 Gluten
3 Administer medication to help the patient rest. 4 Administer the cough syrup that has been ordered. 1 Rationale: The most serious adverse effect of amiodarone is pulmonary toxicity, which involves a clinical syndrome of progressive dyspnea and cough accompanied by damage to the alveoli. The nurse will also document the findings; however, this is not the priority. Administering the medication or a cough syrup will not address the pulmonary toxicity that may accompany amiodarone and may make it worse. Which drug administered by the nurse typically produces asystole before converting tachycardia to a sinus rhythm? 1 Atenolol 2 Diltiazem 3 Adenosine 4 Procainamide 3 Rationale: Adenosine is an unclassified antidysrhythmic that slows electrical conduction time through the atrioventricular node. It commonly causes asystole for a period of seconds before ideally converting to normal sinus rhythm. Repeat doses may be necessary to achieve desired results. Diltiazem is a class IV antidysrhythmic, or calcium channel blocker. Atenolol is a class II antidysrhythmic, or beta blocker. Procainamide is a class IA antidysrhythmic drug. None of the other options cause a brief period of asystole The nurse is caring for a patient who has been experiencing ventricular dysrhythmias without atrial involvement. The nurse would anticipate that the patient will be placed on which class drug? 1 Class II 2 Class IA 3 Class IB 4 Class IC 3 Rationale: The class IB drug lidocaine is given for ventricular dysrhythmias only. Class IA and II medications are approved for supraventricular and ventricular dysrhythmias. Class IC are approved for supraventricular dysrhythmias only. Class IC are approved for ___________ only. supraventricular dysrhythmias Class IA and II medications are approved for ____________________
supraventricular and ventricular dysrhythmias. The class IB drug lidocaine is given for_________ only. ventricular dysrhythmias The nurse is interpreting an electrocardiogram (ECG). Which component represents the depolarization of the ventricles? 1 T wave 2 P wave 3 ST segment 4 QRS complex 4 Rationale: An ECG has several components. The QRS complex is caused by depolarization of the ventricles, the P wave is caused by depolarization in the atria, and the T wave is caused by repolarization of the ventricles. The ST segment may be depressed in some clinical conditions. The nurse is interpreting an electrocardiogram (ECG). Which component represents the depolarization of the atria? 1 T wave 2 P wave 3 ST segment 4 QRS complex 2 Rationalee: An ECG has several components. The QRS complex is caused by depolarization of the ventricles, the P wave is caused by depolarization in the atria, and the T wave is caused by repolarization of the ventricles. The ST segment may be depressed in some clinical conditions. The nurse is interpreting an electrocardiogram (ECG). Which component represents the repolarization of the ventricles? 1 T wave 2 P wave 3 ST segment 4 QRS complex 1 Rationale: An ECG has several components. The QRS complex is caused by depolarization of the ventricles, the P wave is caused by depolarization in the atria, and the T wave is caused by repolarization of the ventricles. The ST segment may be depressed in some clinical conditions. Which are common causes of dysrhythmias? Select all that apply.
2 Purkinje system 3 Internodal pathways 4 Atrioventricular node 4 Rationale: Impulses originate in the sinoatrial node and then travel through the atrioventricular node to reach the ventricles. The impulse is delayed at the atrioventricular node to provide time for the ventricles to fill before they contract. The His-Purkinje system acts to rapidly conduct electrical excitation to fill the ventricles. The intermodal pathways allow the atria to contract in unison. A patient who is receiving antidysrhythmic drugs exhibits improved cardiac output, increased activity tolerance, blood pressure 120/76, and pulse 86 and has voided 400 mL of urine during the past 8-hour shift. What is the nurse's best action? 1 Notify the health care provider. 2 Increase the continuous intravenous fluid rate. 3 Document the findings in the patient's medical record. 4 Place the patient in Trendelenburg's position to improve venous return. 3 Rationale: In general, therapeutic effects for antidysrhythmic drugs include improved cardiac output; decreased chest discomfort; decreased fatigue; improved vital signs, skin color, and urinary output; and conversions of irregularities to normal rhythm. Given that these are all expected and positive findings, there is no need to increase the fluid rate, improve venous return, or notify the health care provider. A patient receiving amiodarone develops chest pain. Which is the nurse's priority action? 1 Call a code. 2 Check serum electrolytes. 3 Assess the patient's lungs. 4 Call the healthcare provider. 3 Rationale: The nurse should assess the patient's lungs and electrocardiogram (ECG) before calling the health care provider. Toxicity to amiodarone can occur in up to 20% of patients. Pulmonary toxicity and cardiotoxicity can occur. Blood levels of the drug and electrolyte levels will not assist in determining the cause of the chest pain. Calling a code is not necessary unless the patient stops breathing or is pulseless. Calling the health care provider will occur after obtaining assessment information. Which assessment finding in a patient with cardiac risk factors should be reported immediately if the patient is taking a nonselective beta blocker?
1 Chest pain 2 Weight loss 3 History of asthma 4 History of alcohol abuse 3 Rationale: Beta blockers must be used cautiously in patients with a history of asthma because the drugs induce bronchoconstriction and increased airway resistance, which may further cause dyspnea and wheezing. Weight loss is not a concern for patients with cardiac risk factors who are taking nonselective beta blockers; however, weight gain may indicate edema. Beta blockers are effective in the treatment of angina or chest pain. Although beta blockers can interact with alcohol and cause adverse effects, such as hypotension, a history of alcohol abuse is not a concern if the patient no longer engages in such behavior. Before the nurse administers verapamil, what is a priority nursing assessment? 1 Assess blood pressure. 2 Assess serum electrolytes. 3 Assess telemetry and heart rate. 4 Measure blood urea nitrogen and creatinine. 3 Rationale: Only two calcium channel blockers (CCBs)—verapamil and diltiazem—are able to block calcium channels in the heart. Accordingly, they are the only CCBs used to treat dysrhythmias. Blockade of cardiac calcium channels has three effects: slowing of sinoatrial nodal automaticity, delay of atrioventricular nodal conduction, and reduction of myocardial contractility. Blood pressure, electrolytes, and renal function also will be monitored; however, they are not the priority assessment by the nurse. The nurse should closely monitor a patient who takes verapamil for which side or adverse effects? Select all that apply. 1 Dizziness 2 Decreased blood pressure 3 Complaints of constipation 4 Equivocal atrial and ventricular rates 5 Heart block evident on cardiac monitor 1, 2, 3, 5 Rationale: Verapamil is a class IV antidysrhythmic drug, or calcium channel blocker. These drugs are associated
Rationale; Class IV antidysrhythmic drugs are calcium channel blockers (CCBs). Chest pain assessment, ventricular rate, cardiac monitoring, and blood pressure are all assessments that can be performed to evaluate the effectiveness of CCBs. CCBs are also prescribed to treat hypertension and angina. Verapamil and diltiazem are most commonly used for treating dysrhythmias, specifically those that arise above the ventricles, and for controlling the ventricular response to atrial fibrillation and flutter by slowing conduction of the atrioventricular node, which prevents the ventricles from beating as fast as the atria. Breath sounds and pupil responses are not affected by CCBs. The nurse is teaching a patient whose dysrhythmia is being treated with medication therapy. Which fact should the nurse include in the teaching plan? 1 "Drug therapy is only used for bradydysrhythmias." 2 "Medication therapy often does not work for dysrhythmias." 3 "Almost all drugs used to treat dysrhythmias can cause dysrhythmias." 4 "Medication is only taken during the time the dysrhythmia is occurring." 3 Rationale: The patient should understand that almost all drugs used to treat dysrhythmias can cause dysrhythmias. The nurse should teach the patient the effects of the drug as well as how to assess their pulse rate. These medications may be taken to prevent the dysrhythmia from recurring. Although these medications are effective to treat dysrhythimas, they have many side and adverse effects and are used for both bradydysrhythmias and tachydysrhythmias. Which patient may be prescribed beta blockers with the least concerns for complications? Correct 1
1. A patient with atrial fibrillation 2 A patient who has a history of asthma 3 A patient with type two diabetes mellitus 4 A patient with diabetes who is experiencing chest pain 1 Rationale; The patient with atrial fibrillation can be treated with beta blockers, which can be used to slow the heart rate. When patients with diabetes take beta blockers, the provider may need to make adjustments to their diabetes medications. Because beta blockers can cause bronchoconstriction, extreme caution must be taken when prescribed to patients with asthma, and benefits must be weighed against risks. The health care provider has prescribed amiodarone for a patient with ventricular dysrhythmias. Upon reviewing the patient's medical history, which statement by the patient would lead the
nurse to notify the health care provider? 1 "I get faint when I see needles." 2 "I wear eyeglasses to read print up close." 3 "I take a blood thinner so I don't get clots." 4 "I break out in a rash when I take antibiotics." 3 Rationale: Amiodarone has two very significant drug interactions, namely with digoxin and warfarin. Patients often refer to anticoagulants as "blood thinners." The nurse should verify which medication the patient is taking, then notify the health care provider. When amiodarone is prescribed for patients taking warfarin, the recommendation is to reduce the dose of warfarin by 50% at the start of amiodarone therapy. Amiodarone adverse effects include visual halos, photophobia, and dry eyes, but wearing eyeglasses is not a contraindication. Amiodarone is an antidysrhythmic, and there should be no cross sensitivities with antibiotics. The patient may get faint at the site of needles; however, the priority of care is to eliminate dysrhythmias. To help reduce the patient's fears, the nurse can provide emotional reassurance and compassionately administer the amiodarone. The nurse should monitor for which adverse effects in a patient who takes amiodarone? Select all that apply. 1 Dyspnea 2 Hypertension 3 Hyperthyroidism 4 Light sensitivity 5 Elevated liver enzymes 1, 3, 4, 5 Rationale: Amiodarone, a class III drug, may lead to pulmonary toxicity (evidenced by dyspnea and alveolar damage), thyroid disorders (hypothyroidism or hyperthyroidism), decrease in blood pressure (not hypertension) and pulse rate, photosensitivity, and abnormal liver function. Before administering amiodarone, what is the most important assessment for the nurse to complete?
**1. Heart rate
- Temperature
- Skin integrity
- Respiratory rate**
4 Decreased cardiac output 5 Capillary blood glucose 145 mg/dL 2, 3, 4, 5 Rationale: Class II beta blockers such as esmolol may cause heart failure (decreased cardiac output), bronchospasm, changes in blood glucose levels, bradycardia (not tachycardia), and atrioventricular (AV) block. Beta blockers also can be prescribed to treat blood pressure and angina. A patient visiting the clinic has been taking amiodarone for several months. The nurse observes a bluish discoloration in the patient's skin. Which action should the nurse perform first?
**1. Apply an oxygen mask.
- Call the health care provider.
- Call for crash cart to resuscitate the patient.
- Apply a pulse oximeter to check oxygen levels.** 4 Rationale: Assess first. Amiodarone can be absorbed in fat and manifest as a bluish discoloration. Before assuming the patient is cyanotic, the nurse should fully assess the patient. If the patient's assessment findings are consistent with hypoxia (eg, low oxygen levels obtained via pulse oximetry), the next steps include oxygen application, notifying the health care provider, and possible crash cart retrieval. In the case of amiodarone skin discoloration, the nurse will identify that the problem is not related to oxygen deficit. The nurse is caring for a patient who has been experiencing atrial fibrillation that has been resistant to drug therapy. The nurse would anticipate that the patient will now be placed on which class drug? 1 Class II 2 Class III 3 Class IC 4 Class IV 2 Rationale: The class III drugs (eg, amiodarone) are given for atrial fibrillation resistant to other drug therapy. Class II, IC, and IV are considered first-line treatments. he nurse should teach a patient with intractable atrial fibrillation about which characteristic of amiodarone? 1 This is a first-line drug. 2 This drug causes hypertension.
3 This drug has some severe toxicities. 4 This drug treats only ventricular dysrhythmias. 3 Rationale: Amiodarone (Cordarone) is a very effective drug approved for the treatment of life-threatening ventricular dysrhythmias; however, it is also effective for treatment of atrial fibrillation. This drug is associated with many toxicities, such as cardiotoxicity, thyroid toxicity, liver toxicity, and pulmonary toxicity. The medication is not a first-line drug. It is used to treat patients who have not responded to other medications and is known to cause hypotension. The nurse should be least concerned about toxic effects of medication in a patient treated with which medication? 1 Lidocaine 2 Adenosine 3 Amiodarone 4 Procainamide 2 Rationale: Adenosine has a half-life of an estimated 1.5 to 10 seconds; therefore, toxic effects are least likely with this drug and are self-limiting. Amiodarone may take several days to weeks to be completely excreted. An older adult is at higher risk for toxic effects of medications metabolized by the liver and kidneys. The half-life of lidocaine is only 8 minutes, but the risk of toxic effects on the central nervous system can be significant. The half-life of procainamide is 3 to 4 hours and has several side and adverse effects. Which statement indicates the nurse understands the action of calcium channel blockers?
**1. "These medications increase automaticity."
- "These medications increase repolarization."
- "These medications slow cardiac conduction."
- "These medications shorten the action potential."** 3 Rationale: The calcium channel blockers verapamil and diltiazem are used as antidysrhythmics to slow cardiac conduction. Calcium channel blockade has the same impact on cardiac action as does beta blockade. They reduce myocardial contractility, decrease automaticity in the sinoatrial node, and delay conduction through the atrioventricular node. Which conditions are indications for amiodarone? Select all that apply. 1 Hypertension
The drug of choice for terminating SVT is adenosine. Lidocaine is used for ventricular dysrhythmias , amiodarone is used for atrial and ventricular dysrhythmias, and phenytoin is used for digoxin- induced dysrhythmias. The nurse is caring for a patient receiving amiodarone. Which body system should the nurse assess for serious adverse effects of this medication? 1 Respiratory 2 Integumentary 3 Gastrointestinal 4 Musculoskeletal 1 Rationale: Pulmonary toxicity is the most serious potential adverse effect of amiodarone. It may manifest as pneumonitis or pulmonary fibrosis, with symptoms such as dyspnea, cough, and chest pain. Amiodarone may cause less serious adverse effects on the other body systems listed. The nurse is caring for a patient who is being treated with amiodarone. After 6 weeks on the medication, laboratory work is drawn on the patient and shows evidence of hypothyroidism developing. How should the nurse interpret this information? 1 This is indicative of a toxic dosage of the medication. 2 This is an expected adverse reaction to the medication. 3 This is indicative of an inadequate dosage of the medication. 4 The patient is developing an anaphylactic reaction to the medication. 2 Rationale: Hypothyroidism or hyperthyroidism may develop as a result of taking amiodarone as a result of its lipophilic nature and the use of iodine in its chemical structure. It does not indicate supratherapeutic or subtherapeutic dosage or levels of amiodarone. Anaphylactic reactions are evidenced by hives, wheezing, and hypotension. Which effect will beta blockers have on the conduction system in the heart? Select all that apply. 1 Increased cardiac output 2 Increased sympathetic stimulation 3 Reduced contractility in the atria and ventricles 4 Slowed conduction in the atrioventricular (AV) node 5 Reduction of automaticity in the sinoatrial (SA) node 3, 4, 5
Rationale: Beta blockers are classified as class II antidysryhthmic drugs. They decrease calcium entry during fast and slow potentials and depress phase 4 depolarization in slow potentials only. They decrease the automaticity of the SA node, slow conduction through the AV node, and decrease contractility in the atria and ventricles. These medications may decrease cardiac output and decrease sympathetic stimulation. The nurse is caring for a patient prescribed quinidine for a supraventricular dysrhythmia. Which is a common side effect of this drug? 1 Diarrhea 2 Leg cramps 3 Blurred vision 4 Urinary retention 1 Rationaele: Diarrhea and other gastrointestinal problems occur in approximately one-third of patients who take quinidine. This is the most common reason patients stop taking the drug. Quinidine does not cause leg cramps, blurred vision, or urinary retention. The nurse can safely administer verapamil to a patient with which vital signs? 1 Apical pulse 58 beats/min 2 Radial pulse 110 beats/min 3 Cardiac monitor rate 60 beats/min 4 Systolic blood pressure 110 mm Hg 4 Rationale: Verapamil may be administered to manage abnormal rhythms and is to be given only after checking and documenting pulse rates and blood pressure. Contact the prescriber and withhold the drug (if supported by facility policy and the prescriber's guidelines) if the pulse rate is 60 beats/min or lower or 100 beats/min or higher and/or the systolic blood pressure is 90 mm Hg or lower. Amiodarone is prescribed for a patient with atrial fibrillation. Which is the most important nursing intervention before administering this medication? 1 Explain that a dermatologic evaluation is needed. 2 Obtain baseline serum thyroid and liver-function studies. 3 Document that an ophthalmic examination was performed. 4 Maintain nothing by mouth (NPO) for transesophageal echocardiogram (TEE). 2 Rationale: Amiodarone may cause hypothyroidism or hyperthyroidism and may also injure the liver. Serum
3 "Stop the medication immediately." 4 Administer half a tablet every 6 hours 1 Rationale: The patient should notify the prescriber. Significant adverse effects of the drug quinidine include cardiac asystole and ventricular ectopic beats. Quinidine can cause cinchonism. Symptoms of mild cinchonism include tinnitus, loss of hearing, slight blurring of vision, and gastrointestinal upset. Contraindications to the use of the drug include hypersensitivity, thrombocytopenic purpura resulting from previous therapy, atrioventricular block, intraventricular conduction defects, and torsades de pointes. Quinidine is available in both oral and parenteral (injectable) forms and in three different salt forms. The oral preparations include sulfate and gluconate salts. Instruct the patient to report immediately to the prescriber any dizziness, shortness of breath, chest pain, and/or worsening of symptoms or occurrence of new symptoms. The patient must never stop taking or changing the dose of these medications without specific instructions to do so; an abrupt discontinuation of these drugs may lead to severe or life-threatening complications. Which statement by a patient demonstrates correct understanding of the nurse's teaching about quinidine? 1 "A side effect is increased appetite." 2 "I should always take this medicine on an empty stomach." 3 "I should call my provider immediately if my ears are ringing." 4 "Lightheadedness is expected. I should just change positions slowly." 3 Rationale: During treatment with quinidine (or with any of the antidysrhythmics), patients should immediately report to the prescriber any complaints of tinnitus, hypotension, lightheadedness, loss of appetite, or diarrhea. The nurse should advise patients that oral dosage forms of antidysrhythmics are generally better tolerated if taken with food and fluids to help minimize gastrointestinal upset, unless otherwise ordered. The nurse is caring for a patient with a ventricular dysrhythmia resulting from digoxin toxicity. Which medication does the nurse anticipate the health care provider will prescribe? 1 Quinidine 2 Phenytoin 3 Procainamide 4 Disopyramide 2 Rationale: Phenytoin will likely be prescribed for treatment of the ventricular dysrhythmia. Phenytoin is a Class IB antidysrhythmic drug specifically used to treat ventricular dysrhythmias associated with digoxin toxicity. Quinidine is a broad-spectrum treatment used for long-term suppression of ventricular and
supraventricular dysrhythmias. Procainamide has a similar action to quinidine, but toxicity makes it undesirable for long-term use. Disopyramide is used for ventricular dysrhythmias but not necessarily related to digoxin toxicity.
What are antidysrhythmic drugs used for? ✔✔ answer ✔✔They are used to treat abnormal
heart rhythms, which may not be cured and may require lifelong use.
What are the reasons for prescribing antidysrhythmic drugs? ✔✔ answer ✔✔1. Increase or
decrease heart rate 2. Convert a dysrhythmia to a normal rhythm 3. Control and prevent serious dysrhythmias.
How do antidysrhythmic drugs affect myocardial cells? ✔✔ answer ✔✔They may decrease
spontaneous contraction (automaticity), slow impulse transmission (conductivity), and prolong the refractory period.
What is the absolute refractory period in cardiac cells? ✔✔ answer ✔✔It is the time after
impulse generation during which no new impulse can be conducted.
What is the relative refractory period in cardiac cells? ✔✔ answer ✔✔It is the time when an
impulse can be conducted only if it is stronger than normal.
What should a nurse check before administering antidysrhythmic drugs? ✔✔ answer ✔✔1.
Complete list of patient's medications 2. Apical pulse for one minute 3. Blood pressure 4. Patient's rhythm if on a cardiac monitor 5. Baseline weight. What heart rate indicates a potential issue before administering antidysrhythmic drugs?
✔✔ answer ✔✔A heart rate less than 60 beats per minute or more than 100 beats per minute.
What blood pressure reading indicates a potential issue before administering antidysrhythmic
drugs? ✔✔ answer ✔✔A blood pressure less than 90/60 mm Hg.
What actions should a nurse take after administering antidysrhythmic drugs?
✔✔ answer ✔✔1. Recheck heart rate and blood pressure in 30 minutes 2. Monitor for changes
in heart rhythm 3. Take actions to prevent falls.
