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Chapter 25 – Antidysrhythmic Drugs |
NCLEX-Style Pharmacology Questions
with Answers & Rationales | A-Graded
Nursing Exam Resource (ALREADY
GRADED).
2 (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. The client is complaining of excess fatigue in this case, because exercise is an activity he "usually' completes without complaint, as inferred from the client's statement.) A client taking atenolol and amiodarone by mouth complains of not being able to complete his usual exercise routine. The client attributes this complaint to the medication, because the atenolol is a new medication. What is the nurse's best response? 1 "You should not be exercising at all while taking this medication." 2 "You should report your fatigue to your healthcare provider." 3 "Feeling tired is normal when you exercise a lot." 4 "As we age, exercising is a challenge; and fatigue is normal." 2 (The SA node is the pacemaker because it can spontaneously depolarize easier and faster than the other areas. ) The nurse knows that which structure in the heart is referred to as the "pacemaker"? 1 AV node 2 SA node 3 Pukinje fibers 4 Bundle of His 2 (Class III drugs, such as amiodarone, prolong repolarization in phase 3. Verapamil is a class IV calcium channel blocker that depresses phase 4 depolarization. Lidocaine is a class I membrane- stabilizing antidysrhythmic. Atenolol is a class II beta blocker that depresses phase 4 of depolarization.)
The nurse recognizes which drug as a Class III antidysrhythmic? 1 Verapamil 2 Amiodarone 3 Lidocaine 4 Atenolol 3 (Grapefruit juice can inhibit the metabolism of several antidysrhythmics such as amiodarone, disopyramide, and quinidine. The other food and drink options are not as necessary to restrict in the client's diet.) When preparing a teaching plan for client started on amiodarone, which food or drink should the nurse advise the client to avoid? 1 Gluten 2 Poultry 3 Grapefruit juice 4 Whole milk 3 (Assess first. Amiodarone can be absorbed in fat and manifest as a bluish discoloration. Before assuming the client is cyanotic, the nurse should fully assess the client. If the client's assessment findings are consistent with hypoxia, the next steps include oxygen application, notifying the HCP, and possible crash cart retrieval. ) A client visiting the clinic has been taking amiodarone for several months. The nurse observes a bluish discoloration in the client's skin. What is the nurse's first action? 1 Call for crash cart. 2 Apply non-rebreather oxygen mask. 3 Apply pulse oximeter. 4 Call the healthcare provider. 1 (The most serious adverse effect of this drug is pulmonary toxicity, which involves a clinical syndrome of progressive dyspnea and cough accompanied by damage to the alveoli.) The nurse is caring for patient who is being treated with amiodarone (Cordarone). The nurse notes that the patient is experiencing a hacking cough. The highest priority action on the part of the nurse is to 1 notify the physician regarding this symptom. 2
Increase the continuous intravenous fluid rate. 4 Place the client in Trendelenburg to improve venous return. 1 (Lidocaine vials should contain clear solution labeled as cardiac or not for cardiac use. The plain solution is used for cardiac conditions. Parenteral solutions of these drugs are usually stable only for 24 hours. Epinephrine is a potent vasoconstrictor that should never be used parenterally.) A 100 mg IV bolus of lidocaine is prescribed for client experiencing ventricular dysrhythmias. Which available lidocaine medication should the nurse use to prepare this bolus? 1 Lidocaine vial of clear solution 2 Lidocaine 1% vial of light yellow solution 3 Lidocaine with epinephrine vial of clear solution 4 Lidocaine pre-mixed in 50 mL normal saline prepared within past 48 hours 4 (Amiodarone has two very significant drug interactions, namely with digoxin and warfarin. Clients often refer to anticoagulants as "blood thinners." The nurse should verify which medication the client is taking, then notify the healthcare provider. When amiodarone is prescribed in clients taking warfarin, it is recommended to reduce the dose of warfarin by 50% at the start of warfarin 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 client may get faint at the site of needles, however the priority of care is to eliminate dysrhythmias. The nurse can provide emotional reassurance and compassionately administer the amiodarone to help reduce the client's fears. ) The health care provider has prescribed amiodarone for a client with ventricular dysrhythmias. The nurse verifies the client's medical history and should notify the healthcare provider when the client states 1 "I wear eyeglasses to read print up close." 2 "I break out in a rash when I take antibiotics." 3 "I get faint when I see needles." 4 "I take a blood thinner so I don't get clots." digoxin and warfarin What are the two very significant drugs which have interactions with Amiodarone? 2 (Bradycardia is an adverse effect of lidocaine (Xylocaine), which the nurse should monitor for in the patient. Anorexia is an adverse effect of quinidine (Quinidex), but is not associated with lidocaine. Bronchospasm is a potential side effect of beta blockers. Prodysrhythmic effects are observed in patients who are taking propafenone (Rythmol).)
A nurse is caring for a patient who is taking lidocaine (Xylocaine). Which adverse effect should the nurse monitor for in the patient? 1 Anorexia 2 Bradycardia 3 Bronchospasm 4 Prodysrhythmic effect
Lidocaine (Class 1 B) ✔✔✔answer✔✔✔used for VENTRICULAR DYSRHYTHMIAS ONLY
- if PT has liver disease, reduce dose by 50% (lido is metabolized by the liver)
- works by raisiing ventricular fibrillation threshold, which helps prevent the dysrhythmia
Loading dose adverse effect of Lidocaine ✔✔✔answer✔✔✔convulsions
Cordarone (amiodarone) (class lll) ✔✔✔answer✔✔✔prolongs action potential duration
during phase 3
- used for dysrhythmias difficult to treat
- used for life threatening V tach or V fib
- DRUG OF CHOICE for Ventricular dysrrhythmias
- Drug given after MI NCLEX-Style Questions: Chapter 25 – Antidysrhythmic Drugs
- A patient with atrial fibrillation is prescribed amiodarone. Which of the following assessments is most important for the nurse to monitor? A. Liver function tests B. Blood glucose C. Hemoglobin levels D. Urine ketones
✅ ✔✔✔answer✔✔✔: A
Rationale: Amiodarone can cause hepatotoxicity and requires regular monitoring of liver enzymes.
✅ ✔✔✔answer✔✔✔: B
Rationale: Long-term use of amiodarone is associated with pulmonary fibrosis, a serious and potentially fatal adverse effect.
- Which lab value should the nurse check before administering quinidine? A. Digoxin level B. Troponin C. Serum sodium D. Amylase
✅ ✔✔✔answer✔✔✔: A
Rationale: Quinidine can increase digoxin levels and risk of toxicity; digoxin levels should be monitored closely.
- A patient receiving propranolol for dysrhythmia reports feeling dizzy and lightheaded. What is the nurse's priority action? A. Instruct the patient to take the next dose with food B. Monitor the patient's blood pressure and heart rate C. Notify the healthcare provider to increase the dose D. Educate about side effects of blood thinners
✅ ✔✔✔answer✔✔✔: B
Rationale: Beta-blockers like propranolol can cause hypotension and bradycardia; vital signs should be assessed.
- A nurse is teaching a patient about verapamil. Which statement indicates a need for further teaching? A. “I will avoid grapefruit juice while taking this medication.” B. “I may experience constipation while on this drug.” C. “I can stop this medication once I feel better.” D. “This drug helps lower my blood pressure and control heart rate.”
✅ ✔✔✔answer✔✔✔: C
Rationale: Abruptly stopping verapamil can lead to rebound hypertension or worsened dysrhythmia; patients must take it as prescribed.
- Procainamide is being used for a ventricular dysrhythmia. Which adverse effect would be most concerning?
A. Constipation B. Rash C. Widened QRS complex on ECG D. Dry mouth
✅ ✔✔✔answer✔✔✔: C
Rationale: A widened QRS complex may indicate toxicity or excessive effect and requires prompt evaluation.
- Which teaching point is essential for a patient taking sotalol? A. “Take this medication with an antacid to reduce stomach upset.” B. “It is safe to take over-the- counter decongestants.” C. “Check your pulse daily and report a rate less than 60.” D. “You can drink alcohol freely while taking this medication.”
✅ ✔✔✔answer✔✔✔: C
Rationale: Sotalol is a beta-blocker that can cause bradycardia; patients should monitor heart rate and report abnormalities.
Diltiazem (Class IV) ✔✔✔answer✔✔✔temporary control of new onset patients with rapid
rate atrial fibrillation or flutter and PSVT.
- used for rapid onset of A fib
Adenosine (Adenocard) ✔✔✔answer✔✔✔-very short 1/2 life (10 sec)
- only adminstered as fast IV push
- may cause asystole for a few seconds
Antidysrhythmics adverse effects ✔✔✔answer✔✔✔ALL antidysrhythmics can cause
dysrhythmias! Hypersensitivity reactions Nausea Vomiting Diarrhea Dizziness Blurred vision Headache
"Use over the counter steroid cream if a red, swollen rash occurs." B (Lidocaine is a sodium channel-blocking drug used specifically to treat ventricular arrhythmias.) A patient has been prescribed lidocaine (Xylocaine). What does the nurse understand as the reason for this medication order? Bradycardia Ventricular arrhythmias Atrial arrhythmias Heart block A (Adenosine must be given as rapidly as possible, followed by a 50-mL normal saline flush in order to get all of the medication into the circulation quickly since the half-life of adenosine is less than 10 seconds.) The nurse is reviewing emergency protocols and administration of adenosine (Adenocard). What is a vitally important task to remember when administering adenosine? Give it as a rapid intravenous push. Give it at the highest port in the IV tubing. Offer it with food or milk. Prepare to set up for an intravenous drip infusion. C (Grapefruit juice can also inhibit the metabolism of quinidine, which increases the risk of cinchonism, or quinism, which is a pathological condition caused by an overdose of quinidine or its natural source, cinchona bark. Quinine is medically used to treat malaria..) To prevent the occurrence of cinchonism in a patient prescribed quinidine, what does the nurse emphasize as important? Wear sunscreen. Change positions slowly. Avoid drinking grapefruit juice. Increase dietary intake of potassium. C (The only therapeutic indication of use for adenosine is the treatment of PSVT.) Adenosine is used to treat which condition? Atrial fibrillation Atrial flutter Paroxysmal supraventricular tachycardia (PSVT) Second-degree atrioventricular block The nurse is reviewing the classes of antidysrhythmic drugs. Amiodarone (Cordarone) is classified on the Vaughan Williams classification as a class III drug, which means it works by which mechanism of action? a. Blocking slow calcium channels b. Prolonging action potential duration c. Blocking sodium channels and affecting phase 0 d. Decreasing spontaneous depolarization and affecting phase 4
b. Prolonging action potential duration Vaughan Williams class III drugs (amiodarone, dronedarone, sotalol, ibutilide, and dofetilide) increase the action potential duration by prolonging repolarization in phase 3. The other answers are incorrect. A patient is taking procainamide (Pronestyl) for a cardiac dysrhythmia. The nurse will monitor the patient for which possible adverse effect? a. Bradycardia b. Shortened QT interval c. Dyspnea d. Diarrhea d. Diarrhea Diarrhea is a potential adverse effect of procainamide therapy. Prolonged QT interval on the ECG is also possible. The other options are incorrect. Which nursing diagnosis is appropriate for a patient receiving antidysrhythmics? a. Risk for infection b. Deficient knowledge c. Deficient fluid volume d. Urinary retention b. Deficient knowledge Deficient knowledge related to lack of experience with medication therapy is a potential nursing diagnosis for a patient receiving antidysrhythmics. The other options are incorrect. A patient will be discharged on quinidine sulfate (Quinidex) extended-release tablets for the treatment of ventricular ectopy. The nurse will include which information in the teaching plan? a. The medication should be stopped once the cardiac symptoms subside. b. Signs of cinchonism, such as tinnitus, loss of hearing, or slight blurring of vision, may occur. c. It is important to use sunscreen products when outside because of increased photosensitivity. d. If any tablet or capsule is visible in the stool, contact the prescriber immediately. b. Signs of cinchonism, such as tinnitus, loss of hearing, or slight blurring of vision, may occur.
c. The lidocaine will be changed to an oral dosage form. d. An increased dosage of lidocaine will be prescribed so as to obtain adequate blood levels. a. The dosage will be reduced by 50%. Because lidocaine is metabolized primarily by the liver, a reduction of the dosage by 50% may be necessary in cases of liver failure or cirrhosis. Lidocaine does not come in oral form. A patient has been started on therapy of a continuous infusion of lidocaine after receiving a loading dose of the drug. The nurse will monitor the patient for which adverse effect? a. Drowsiness b. Nystagmus c. Dry mouth d. Convulsions d. Convulsions Convulsions are possible if lidocaine reaches toxic levels. The other options are not adverse effects of lidocaine. When starting a patient on antidysrhythmic therapy, the nurse will remember that which problem is a potential adverse effect of any antidysrhythmic drug? a. Deficiency of fat-soluble vitamins b. Hyperkalemia c. Heart failure d. Dysrhythmias d. Dysrhythmias Many antidysrhythmics are themselves capable of producing new dysrhythmias (the prodysrhythmic effect). The other options are not adverse effects of antidysrhythmic drugs. A patient is in the emergency department with a new onset of rapid-rate atrial fibrillation, and the nurse is preparing a continuous infusion. Which drug is most appropriate for this dysrhythmia? a. diltiazem (Cardizem) b. atenolol (Tenormin) c. lidocaine
d.adenosine (Adenocard) a. diltiazem (Cardizem) Diltiazem (Cardizem) is indicated for the temporary control of a rapid ventricular response in a patient with atrial fibrillation or flutter and paroxysmal supraventricular tachycardia. It is given by continuous infusion after a loading dose given by IV bolus. The other options are incorrect. The nurse notes in the patient's medication orders that the patient will be taking ibutilide (Corvert). Based on this finding, the nurse interprets that the patient has which disorder? a. Ventricular ectopy b. Atrial fibrillation c. Supraventricular tachycardia d. Bradycardia b. Atrial fibrillation Ibutilide (Corvert) is one of two class III antidysrhythmic drugs available for rapid conversion of these atrial fibrillations and atrial flutters into normal sinus rhythm. Which patient-teaching instructions are appropriate for a patient taking an antidysrhythmic drug? (Select all that apply.) a. "Do not chew or crush extended-release forms of medication." b. "Take the medication with food if gastrointestinal distress occurs." c. "If a dose is missed, the missed dose should be taken along with the next dose that is due to be taken." d. "Take the medications with an antacid if gastrointestinal distress occurs." e. "Limit or avoid the use of caffeine." f. "The presence of a capsule in the stool should be reported to the physician immediately." a. "Do not chew or crush extended-release forms of medication." b. "Take the medication with food if gastrointestinal distress occurs." e. "Limit or avoid the use of caffeine." Appropriate teaching instructions for a patient taking an antidysrhythmic drug include: do not chew or crush extended-release forms; if gastrointestinal distress occurs, take the drug with food; and limit or avoid the use of caffeine. Do not double medication doses or take medications with an antacid. The presence of a portion of a capsule or tablet in the stool is actually the wax matrix that carried the medication, which has been absorbed. The physician does not need to be notified.
