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Class I Antidysrhythmic Drugs – Sodium Channel
Blockers (Quinidine, Lidocaine, Flecainide) | NCLEX-
Style Questions with Answers & Rationales | A-Graded
Pharmacology Exam Guide
The patient with which medical condition will most likely benefit from lidocaine administered
intravenously? ✔✔✔answer✔✔✔Acute ventricular tachycardia
Lidocaine administered intravenously is indicated for patients with ventricular dysrhythmias, such as acute ventricular tachycardia. The nurse will monitor for which therapeutic effect while administering quinidine?
✔✔✔answer✔✔✔Decreased heart rate
Quinidine, a Class IA antidysrhythmic drug, slows the conduction rate and prolongs repolarization, which decreases heart rate such as in atrial fibrillation with rapid ventricular response. Decreasing heart rate is a therapeutic effect. However, the nurse will need to monitor for heart rate less than 60 beats/minute, indicating bradycardia, which is a side effect of quinidine. Which time frame after administration of flecainide would the nurse expect the onset of
action to occur? ✔✔✔answer✔✔✔3 hours
Flecainide's onset is 3 hours. Before administering quinidine, the nurse would assess the patient for which
contraindication? ✔✔✔answer✔✔✔Complete heart block
Complete heart block is a contraindication for administration of quinidine. A nurse is preparing quinidine to administer to a patient with ventricular dysrhythmia. Which dose of quinidine would cause the nurse to notify the health care provider before
administering? ✔✔✔answer✔✔✔100 mg every 4 hours
The usual dose for quinidine is 324 to 648 mg every 8 to 12 hours. This dose is too low, and the nurse would be expected to notify and discuss with the health care provider before administering the drug. A patient with a ventricular dysrhythmia is to receive lidocaine. The health care provider prescribes a lidocaine bolus at 250 mg, which may be repeated in 5 minutes. This is to be followed by a maintenance lidocaine drip at 2 mg/minute for 24 hours. For which part of the
prescription will the nurse require clarification? ✔✔✔answer✔✔✔
Before the administration of quinidine, the nurse will review the patient's medication list for which other drugs that can prolong the QT interval?
✔✔✔answer✔✔✔Fluoxetine
Ciprofloxacin Flecainide Ondansetron A patient with ventricular tachycardia and a pulse is to receive lidocaine. Before administering lidocaine the nurse will assess for which contraindications to lidocaine?
✔✔✔answer✔✔✔First-degree atrioventricular block
Second-degree Mobitz I atrioventricular block Wolff-Parkinson-White (WPW) syndrome While administering lidocaine, the nurse will monitor for which adverse drug effect?
✔✔✔answer✔✔✔Seizure
Seizure is an adverse drug effect of lidocaine.
- What is the primary action of Class I antidysrhythmic drugs?
- Which statement by a patient taking flecainide requires immediate follow-up? A. “Sometimes my vision gets blurry.” B. “I’ve had mild nausea after meals.” C. “I feel short of breath walking up stairs.” D. “My appetite hasn’t been the same.”
✔✔✔answer✔✔✔: C
Rationale: Flecainide can cause new or worsening heart failure. Dyspnea should be reported and assessed promptly.
- Which class of antidysrhythmic drugs is most likely to cause prolonged QRS complex on ECG? A. Class I B. Class II C. Class III D. Class IV
✔✔✔answer✔✔✔: A
Rationale: Class I drugs slow depolarization and intraventricular conduction, leading to a widened QRS complex.
- A nurse administers IV procainamide. Which of the following should be closely monitored during infusion? A. Pupillary reaction and reflexes B. Bowel sounds and GI motility C. ECG and blood pressure D. Urine output and color
✔✔✔answer✔✔✔: C
Rationale: Procainamide can cause hypotension and prolonged QT intervals, so continuous ECG and BP monitoring are essential.
- What is the most appropriate nursing action before administering oral flecainide? A. Hold if the heart rate is above 100 bpm B. Check potassium and magnesium levels C. Withhold all other cardiac meds D. Give with grapefruit juice
✔✔✔answer✔✔✔: B
Rationale: Electrolyte imbalances increase the risk of arrhythmias when taking flecainide. Monitor and correct as needed.
- Which patient condition is a contraindication for use of Class Ic drugs like propafenone? A. Atrial fibrillation B. Supraventricular tachycardia C. Heart failure or structural heart disease D. Frequent premature atrial contractions
✔✔✔answer✔✔✔: C
Rationale: Class Ic drugs (flecainide, propafenone) are contraindicated in structural heart disease due to proarrhythmic risks.
- A nurse is teaching about lidocaine. Which statement by the patient reflects understanding? A. “This drug slows my heart rate permanently.” B. “It may cause drowsiness or tingling if too much is given.” C. “It will cure my arrhythmia completely.” D. “I need to take this drug every morning before food.”
✔✔✔answer✔✔✔: B
Rationale: Lidocaine, especially IV, can cause neurologic symptoms (e.g., drowsiness, tingling, confusion) if toxic levels develop. A nurse administering flecainide to a patient with sustained ventricular tachycardia will monitor the patient for which adverse drug effect?
✔✔✔answer✔✔✔Angioedema
Angioedema is an adverse drug effect of flecainide. Other adverse drug effects include worsening of arrhythmia, heart failure, seizures, and pulmonary toxicity. A patient who is prescribed quinidine, a Class I antidysrhythmic drug, tells the nurse that "long, hot baths are enjoyable at the end of a long work day." Which teaching will the nurse
provide to the patient regarding long, hot baths? ✔✔✔answer✔✔✔
