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Class IV Antidysrhythmic Drugs – NCLEX-Style
Questions on Calcium Channel Blockers (Verapamil
& Diltiazem) with Answers and Rationales | A-
Graded Pharmacology Exam Prep
Chapter 25 – Antidysrhythmic Drugs | NCLEX-Style Pharmacology Questions with Answers & Rationales | A-Graded Nursing Exam Resource Which effect on the electrocardiogram (ECG) will the nurse expect to see in a patient who is receiving
a Class IV antidysrhythmic drug? ✔✔✔answer✔✔✔Prolonged PR interval
Class IV antidysrhythmic drugs prolong PR intervals, which delays the atrioventricular conduction, thereby decreasing the heart rate. Which statement is an accurate description of the mechanism of action for verapamil?
✔✔✔answer✔✔✔Blocks the slow influx of calcium ions into slow calcium channels
Calcium channel blockers block the slow influx of calcium ions into the slow calcium channels. Which cardiovascular condition is treated with nondihydropyridine calcium channel blockers?
✔✔✔answer✔✔✔Supraventricular tachycardia
Calcium channel blockers are indicated for supraventricular tachycardia, atrial dysrhythmias, hypertension, and angina. Which route of administration for verapamil is appropriate for maintenance therapy?
✔✔✔answer✔✔✔Oral verapamil is administered for maintenance therapy. Oral
verapamil is usually administered along with digoxin. Mr. Allen, a 73-year-old patient with a history of mitral valve regurgitation, is admitted to the hospital with chest pain. His ECG shows atrial fibrillation at a rate of 140 beats/min. He is initially treated with verapamil 5 mg IV push for two doses before he converts to sinus rhythm with a rate of 86 beats/min. To prevent further dysrhythmias, Mr. Allen is prescribed verapamil 80 mg PO TID. The nurse's assessment indicates Mr. Allen has no more chest pain. His lungs are clear, and his abdomen is soft.
He has 1+ edema to his ankles and feet bilaterally. Mr. Allen's vital signs are as follows: BP 124/66, HR 56, R 20, and T 97.8°F. Which of Mr. Allen's vital sign findings will indicate to the nurse to hold the verapamil?
✔✔✔answer✔✔✔Pulse of 56 beats/min
Mr. Allen, a 73-year-old patient with a history of mitral valve regurgitation, is admitted to the hospital with chest pain. His ECG shows atrial fibrillation at a rate of 140 beats/min. He is initially treated with verapamil 5 mg IV push for two doses before he converts to sinus rhythm with a rate of 86 beats/min. To prevent further dysrhythmias, Mr. Allen is prescribed verapamil 80 mg PO TID. The nurse's assessment indicates Mr. Allen has no more chest pain. His lungs are clear, and his abdomen is soft. He has 1+ edema to his ankles and feet bilaterally. Mr. Allen's vital signs are as follows: BP 124/66, HR 56, R 20, and T 97.8°F. The nurse notes Mr. Allen, who is taking verapamil, has edema to his ankles and feet. Which medical
condition would the nurse suspect as the cause? ✔✔✔answer✔✔✔Heart failure
Class IV antidysrhythmic drugs, such as verapamil, could cause heart failure. Swelling of the ankles and feet could be an early indicator of heart failure. Which statement is accurate regarding the interaction between verapamil and grapefruit juice?
✔✔✔answer✔✔✔Grapefruit juice can inhibit the metabolism of verapamil.
Grapefruit juice can inhibit the metabolism of verapamil, raising serum drug levels with potential toxicity. A patient is noted to be experiencing a cardiac dysrhythmia. Which parameter would the nurse use to
administer a bolus dose of diltiazem? ✔✔✔answer✔✔✔Intravenously slowly over 2
minutes Diltiazem intravenous should be administered slowly over 2 minutes while monitoring the cardiac rhythm for any changes in rate or rhythm. Which instruction would the nurse provide a patient about the proper administration of extended-
release diltiazem? ✔✔✔answer✔✔✔Swallow whole without crushing or chewing.
The nurse would hold the diltiazem until the prescription can be clarified with the health care provider. Giving diltiazem to a patient who is already taking digoxin and metoprolol could suppress the cardiac function and cause severe bradycardia, decrease atrioventricular conduction, and decrease cardiac contractility. Beta blockers and diltiazem should be administered several hours apart to minimize the risk of cardiosuppression. A patient who is being discharged on diltiazem tells the nurse that cooking with herbs and taking supplements has improved the patient's physical stamina. Which response by the nurse is
appropriate? ✔✔✔answer✔✔✔"Certain supplements can alter the therapeutic effects of
diltiazem." Great! You're focusing on Class IV Antidysrhythmic Drugs, which are Calcium Channel Blockers (CCBs) like verapamil and diltiazem, primarily used to manage supraventricular dysrhythmias.
- Class IV antidysrhythmic drugs exert their primary effect by: A. Blocking sodium channels in the ventricles B. Enhancing potassium outflow to speed repolarization C. Inhibiting calcium influx in the SA and AV nodes D. Stimulating the vagus nerve to slow heart rate
✔✔✔answer✔✔✔: C
Rationale: Class IV drugs (verapamil, diltiazem) block calcium channels, particularly affecting SA and AV nodal conduction, which slows heart rate and reduces conduction velocity.
- Which cardiac dysrhythmia is most commonly treated with Class IV calcium channel blockers? A. Ventricular fibrillation B. Supraventricular tachycardia (SVT) C. Torsades de Pointes D. Premature ventricular contractions (PVCs)
✔✔✔answer✔✔✔: B
Rationale: Class IV CCBs are effective for SVTs because they slow AV nodal conduction.
- A nurse is preparing to administer IV diltiazem. What is the most important assessment prior to administration? A. Respiratory rate B. Blood glucose level C. Blood pressure and heart rate D. Potassium and calcium levels
✔✔✔answer✔✔✔: C
Rationale: Diltiazem can cause hypotension and bradycardia. Always assess vital signs before administering.
- Which of the following is a common side effect of verapamil therapy? A. Hyperkalemia B. Constipation C. Polyuria D. Metallic taste
✔✔✔answer✔✔✔: B
Rationale: Constipation is a frequent side effect of verapamil. Patients should be encouraged to increase fiber intake.
- The nurse is teaching a patient about verapamil. Which statement by the patient indicates a need for further education? A. “I’ll monitor my heart rate every day.” B. “I can drink grapefruit juice with this medication.” C. “I may feel dizzy when standing up too quickly.” D. “This medication might make me constipated.”
✔✔✔answer✔✔✔: B
Rationale: Grapefruit juice can inhibit metabolism of verapamil and increase risk of toxicity. Patients should avoid it.
- A patient receiving IV diltiazem develops a heart rate of 48 bpm and a BP of 86/54. What is the nurse’s first action? A. Document the findings and continue monitoring B. Increase the infusion rate of diltiazem C. Stop the infusion and notify the provider D. Administer potassium chloride
✔✔✔answer✔✔✔: C
Rationale: The patient is bradycardic and hypotensive, which are signs of CCB toxicity. The nurse should stop the drug and alert the provider.
- What is the mechanism of action for Class IV antidysrhythmic drugs in arrhythmia control? A. They suppress automaticity in Purkinje fibers B. They stabilize cardiac membranes via sodium inhibition C. They delay depolarization in the AV node D. They prolong PR interval by slowing AV conduction
Reduction of myocardial contractility A patient with atrial fibrillation is being discharged on verapamil. Which symptoms will the nurse
instruct the patient to report to the health care provider? ✔✔✔answer✔✔✔Weight gain
Dyspnea Swelling to feet and ankles
