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NCLEX-Style Questions on Antidysrhythmic Drugs
– A-Graded Pharmacology Exam with Rationales &
Clinical Relevance for Nursing Students
Which of the following interventions should the nurse anticipate for a 62-year-old patient with late-stage liver failure and a history of alcoholism, who is prescribed lidocaine for premature ventricular dysrhythmia? a) Reduction of the lidocaine dosage by half b) Addition of a diuretic to the lidocaine therapy c) Conversion of lidocaine to an oral form d) Increase in the lidocaine dosage to achieve adequate blood levels Answer: a) Reduction of the lidocaine dosage by half Lidocaine is primarily metabolized in the liver. In patients with liver impairment, such as those with late-stage liver failure, metabolism of lidocaine is reduced, leading to increased drug levels and potential toxicity. Therefore, reducing the dosage in such patients is necessary to prevent toxicity while still achieving therapeutic effects. Lidocaine is typically used for the treatment of ventricular dysrhythmias, such as ventricular tachycardia or serious premature ventricular contractions. Lidocaine is particularly effective in treating dysrhythmias that occur after a myocardial infarction (heart attack). What is the drug of choice for a patient in the intensive care unit with an acute myocardial infarction who is experiencing severe ventricular dysrhythmias? A. Diltiazem (Cardizem) B. Verapamil (Calan) C. Amiodarone (Cordarone) D. Adenosine (Adenocard) C. Amiodarone (Cordarone) Rationale: Amiodarone is a potent antiarrhythmic agent that is particularly effective in treating ventricular arrhythmias, which can be life-threatening following an AMI. It works by prolonging the myocardial cell action potential duration and refractory period, thereby stabilizing the cardiac rhythm. iNCORRECT A. Diltiazem (Cardizem) is a calcium channel blocker primarily used for rate control in atrial fibrillation and in the treatment of angina and hypertension, but it's not the first-line treatment for ventricular arrhythmias post-AMI.
B. Verapamil (Calan) is another calcium channel blocker with similar indications to Diltiazem, used for controlling heart rate and managing hypertension and angina, but not typically for acute ventricular arrhythmias. D. Adenosine (Adenocard) is primarily used for the treatment of supraventricular tachycardia (SVT). It's not effective for ventricular arrhythmias and is not indicated in the management of post-AMI arrhythmias. When administering adenosine (Adenocard) to a patient experiencing an acute episode of paroxysmal supraventricular tachycardia (SVT), what is important to remember? A. The onset of action occurs in 5 minutes. B. The medication must be given as a slow intravenous (IV) push. C. Asystole may occur for a few seconds after administration. D. The medication has a long half-life, and therefore duration of action is very long. C. Asystole may occur for a few seconds after administration. Rationale: Adenosine, used to treat SVT, can cause a brief period of asystole due to its action on the atrioventricular node. This effect is temporary but crucial for resetting the heart's rhythm. Incorrect Options: A: Adenosine acts within seconds, not 5 minutes. B: Adenosine requires rapid IV push due to its short half-life, not a slow push. D: Adenosine has a very short half-life, resulting in a brief duration of action. 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 Rationale:Convulsions are possible if lidocaine reaches toxic levels. The other options are not adverse effects of lidocaine. 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."
D. Class I The Vaughan Williams classification is the most commonly used system to classify antidysrhythmic drugs. There are four major classes of antidysrhythmic drugs: I, II, III, and IV. Sodium channel blockers are classified as class I drugs. The nurse is caring for a patient prescribed amiodarone (Cordarone). The nurse knows the MOST serious adverse effect of this medication can occur in which body system? A. Immune B. Nervous C. Gastrointestinal D. Respiratory D. Respiratory Pulmonary toxicity is the most serious potential adverse effect of amiodarone. For patients prescribed amiodarone (Cordarone), the nurse should monitor for which potential adverse effects of this drug? (Select all that apply.) A. Hypothyroidism B. Visual halos C. Photosensitivity D. Blue gray skin discoloration E.Overgrowth of gum tissue F. Diarrhea A. Hypothyroidism B. Visual halos C. Photosensitivity D. Blue gray skin discoloration Potential adverse effects from amiodarone include visual halos, photosensitivity, photophobia, dry eyes, bluish skin discoloration, hyperthyroidism, hypothyroidism, constipation, and decreased libido. A patient is receiving lidocaine (Xylocaine) by continuous intravenous (IV) infusion. The nurse understands this medication is prescribed for what condition? A. Ventricular dysrhythmias B. Sinus bradycardia C. Atrial fibrillation D. First-degree heart block A. Ventricular dysrhythmias Lidocaine is a sodium channel blocker drug used specifically to treat ventricular dysrhythmias. The nurse is reviewing the protocol for administration of IV adenosine (Adenocard). What is the MOST important nursing intervention to remember when giving this medication?
A.Monitor the infusion site for hematoma. B. Assess for burning sensation at the IV site. C. Flush the IV catheter with normal saline. D. Administer it as a fast IV push. D. Administer it as a fast IV push. Adenosine must be given as rapidly as possible because it has an extremely short half-life of less than 10 seconds. For this reason, it is administered only IV and only as a fast IV push. The nurse understands adenosine (Adenocard) is used to treat which condition? A. Atrial fibrillation B. Second-degree atrioventricular block C. Paroxysmal supraventricular tachycardia (PSVT) D. Atrial flutter C. Paroxysmal supraventricular tachycardia (PSVT) The only therapeutic indication of use for adenosine is the treatment of PSVT. Before administering a dose of an antidysrhythmic drug to a patient, what is the priority nursing assessment? A. Measure urine output and specific gravity. B. Check apical pulse and blood pressure. C. Evaluate peripheral pulses and level of consciousness. D. Obtain temperature and pulse oximetry on room air. B. Check apical pulse and blood pressure. Antidysrhythmic drugs can cause both hypotension and bradycardia; therefore, it is important to assess blood pressure and apical pulse before administration. Which drug class is used to treat both hypertension and antidysrhythmias? A. Direct-acting vasodilators B. Alpha-adrenergic-blocking C. Sodium channel blockers D. Calcium channel blockers D. Calcium channel blockers Calcium channel blockers are effective in treating both hypertension and dysrhythmias secondary to their negative inotropic and chronotropic effects.
a. Diltiazem (Cardizem) b. Verapamil (Calan) c. Amiodarone (Cordarone) d. Adenosine (Adenocard) ANS: C Amiodarone (Cordarone) is the drug of choice for ventricular dysrhythmias according to the Advanced Cardiac Life Support guidelines. The other drugs are not used for acute ventricular dysrhythmias. 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 ANS: D Convulsions are possible if lidocaine reaches toxic levels. The other options are not adverse effects of lidocaine. 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) ANS: A 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 ANS: B 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. The nurse is preparing to administer a bolus dose of verapamil (Calan) as follows: "Give 5-mg bolus of verapamil, IV push, over 2 minutes. May repeat in 30 minutes if needed." The medication is available in a 2.5-mg/mL strength solution. Identify how many milliliters will the nurse draw into the syringe for this dose. _______ ANS: 2 mL
When assessing a patient who has been taking amiodarone for 6 months, the nurse monitors for which potential adverse effect? a. Hyperglycemia b. Dysphagia c. Photophobia d. Urticaria c P. 409
- The nurse is assessing a patient who has been taking quinidine and asks about adverse effects. An adverse effect associated with the use of this drug includes: a. Muscle pain b. Tinnitus c. Chest pain d. Excessive thirst b P. 409
- A patient calls the family practice office to report that he has seen his pills in his stools when he has a bowel movement. How will the nurse respond? a. "The pills are not being digested properly. You need to take them on an empty stomach." b. "The pills are not being digested properly. You need to take them with food." c. "What you are seeing is the wax matrix that contained the medication, but the drug has been absorbed." d. "This indicates that you are not tolerating this medication and will need to switch to a different form." c P. 409
- The nurse is administering lidocaine and considers which condition, if present in the patient, a caution for the use of this drug? a. Tachycardia b. Hypertension c. Ventricular dysrhythmias d. Renal dysfunction d P. 409
- When the nurse is teaching a patient about taking an antidysrhythmic drug, which statements
B. The medication must be given as a slow intravenous (IV) push. C. Asystole may occur for a few seconds after administration. D. The medication has a long half-life, and therefore duration of action is very long. C. Asystole may occur for a few seconds after administration. Rationale: Adenosine, used to treat SVT, can cause a brief period of asystole due to its action on the atrioventricular node. This effect is temporary but crucial for resetting the heart's rhythm. Incorrect Options: A: Adenosine acts within seconds, not 5 minutes. B: Adenosine requires rapid IV push due to its short half-life, not a slow push. D: Adenosine has a very short half-life, resulting in a brief duration of action. 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 Rationale:Convulsions are possible if lidocaine reaches toxic levels. The other options are not adverse effects of lidocaine. 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." Rationale: 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.
The nurse is monitoring for adverse effects in a patient who is receiving an amiodarone (Cordarone) infusion. Which are adverse effects for amiodarone? (Select all that apply.) A. Tachycardia B. Constipation C. Chest pain D. QT prolongation E. Headache F. Hypotension G. Blue-gray coloring of the skin on the face, arms, and neck Answer: b) Constipation d) QT prolongation f) Hypotension g) Blue-gray coloring of the skin on the face, arms, and neck Amiodarone, an antiarrhythmic medication, has several potential adverse effects. These include hypotension, particularly with IV administration; QT prolongation, which can increase the risk of torsade de pointes; a distinctive blue-gray discoloration of the skin, especially on areas exposed to the sun; and gastrointestinal effects such as constipation. Tachycardia, chest pain, and headache are not commonly associated with amiodarone therapy. To prevent the occurrence of cinchonism in a patient prescribed quinidine (Quindex), which instruction is MOST important for the nurse to provide for this patient? A. Increase dietary intake of potassium. B. Avoid drinking grapefruit juice. C. Advise the patient to wear sunscreen every day. D. Remind the patient to change positions slowly. B. Avoid drinking grapefruit juice. Grapefruit juice can inhibit the metabolism of quinidine, which increases the risk of cinchonism. Sodium channel blockers are considered which class of antidysrhythmic drugs? A. Class III B. Class II C. Class IV D. Class I D. Class I The Vaughan Williams classification is the most commonly used system to classify antidysrhythmic drugs. There are four major classes of antidysrhythmic drugs: I, II, III, and IV. Sodium channel blockers are classified as class I drugs. The nurse is caring for a patient prescribed amiodarone (Cordarone). The nurse knows the MOST serious adverse effect of this medication can occur in which body system? A. Immune B. Nervous
The nurse understands adenosine (Adenocard) is used to treat which condition? A. Atrial fibrillation B. Second-degree atrioventricular block C. Paroxysmal supraventricular tachycardia (PSVT) D. Atrial flutter C. Paroxysmal supraventricular tachycardia (PSVT) The only therapeutic indication of use for adenosine is the treatment of PSVT. Before administering a dose of an antidysrhythmic drug to a patient, what is the priority nursing assessment? A. Measure urine output and specific gravity. B. Check apical pulse and blood pressure. C. Evaluate peripheral pulses and level of consciousness. D. Obtain temperature and pulse oximetry on room air. B. Check apical pulse and blood pressure. Antidysrhythmic drugs can cause both hypotension and bradycardia; therefore, it is important to assess blood pressure and apical pulse before administration. Which drug class is used to treat both hypertension and antidysrhythmias? A. Direct-acting vasodilators B. Alpha-adrenergic-blocking C. Sodium channel blockers D. Calcium channel blockers D. Calcium channel blockers Calcium channel blockers are effective in treating both hypertension and dysrhythmias secondary to their negative inotropic and chronotropic effects. Calcium channel blockers have which pharmacodynamic effect? A. Positive chronotropic B. Shortened refractory period C. Positive inotropic
D. Coronary vasodilation D. Coronary vasodilation Calcium channel blockers cause coronary vasodilation, a negative inotropic effect, a negative chronotropic effect, and a negative dromotropic effect. A patient who has heart failure receives digoxin (Lanoxin) and an angiotension-converting enzyme (ACE) inhibitor. The patient will begin taking spironolactone (Aldactone). The patient asks why the new drug is necessary. The nurse will tell the patient that spironolactone will be given for which reason? a. To enhance potassium excretion b. To increase cardiac contractility c. To minimize fluid losses d. To provide cardioprotective effects d. To provide cardioprotective effects ANS: D Spironolactone is a potassium-sparing diuretic that blocks production of aldosterone, causing improved heart rate variability and decreased myocardial fibrosis. It is given in congestive heart failure for its cardioprotective effects. Spironolactone does not directly alter cardiac contractility but may slightly decrease contractility if fluid volume is decreased. It is a mild diuretic but is not given in this instance to minimize fluid losses. 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. ANS: B Quinidine, a cinchona alkaloid, may cause the symptoms of cinchonism, including tinnitus, loss of hearing, slight blurring of vision, and gastrointestinal upset. The medication will need to be continued even after symptoms subside, or the symptoms may return. Tablets or capsules that are visible in the stool are actually the wax matrices that contained the drug; the medication is extracted while in the intestines. Photosensitivity occurs with class III drugs, not with quinidine (class Ia). A patient is in the intensive care unit because of an acute myocardial infarction. He is experiencing severe ventricular dysrhythmias. The nurse will prepare to give which drug of choice for this dysrhythmia? a. Diltiazem (Cardizem) b. Verapamil (Calan) c. Amiodarone (Cordarone) d. Adenosine (Adenocard) ANS: C Amiodarone (Cordarone) is the drug of choice for ventricular dysrhythmias according to the Advanced Cardiac Life Support guidelines. The other drugs are not used for acute ventricular dysrhythmias.
P. 409
- The nurse is assessing a patient who has been taking quinidine and asks about adverse effects. An adverse effect associated with the use of this drug includes: a. Muscle pain b. Tinnitus c. Chest pain d. Excessive thirst b P. 409
- A patient calls the family practice office to report that he has seen his pills in his stools when he has a bowel movement. How will the nurse respond? a. "The pills are not being digested properly. You need to take them on an empty stomach." b. "The pills are not being digested properly. You need to take them with food." c. "What you are seeing is the wax matrix that contained the medication, but the drug has been absorbed." d. "This indicates that you are not tolerating this medication and will need to switch to a different form." c P. 409
- The nurse is administering lidocaine and considers which condition, if present in the patient, a caution for the use of this drug? a. Tachycardia b. Hypertension c. Ventricular dysrhythmias d. Renal dysfunction d P. 409
- When the nurse is teaching a patient about taking an antidysrhythmic drug, which statements by the nurse are correct? (Select all that apply.) a. "Take the medication with an antacid if stomach upset occurs." b. "Do not chew sustained-release capsules." c. "If weight gains of 5 pounds within 1 week occurs, notify your physician at the next office visit." d. "If you experience severe adverse effects, stop the drug and notify your physician." e. "You may take the medication with food if stomach upset occurs." b, e
The nurse is caring for a pediatric patient with a prescription for 0.2 mg/kg bolus of verapamil (Calan). What is the correct dose for a pediatric patient with a weight of 34 lb? 3.1 mg The pediatric patient's weight of 34 lb is converted to kilograms by dividing 34 by 2.2, which equals 15.45 kg. When 15.45 kg is multiplied by 0.2 mg/kg, the result is 3.09 mg, which rounds to 3.1 mg. A patient is receiving lidocaine (Xylocaine) by continuous intravenous (IV) infusion. The nurse understands this medication is prescribed for what condition? a. Ventricular dysrhythmias b. Sinus bradycardia c. Atrial fibrillation d. First-degree heart block a Ventricular dysrhythmias Lidocaine is a sodium channel blocker drug used specifically to treat ventricular dysrhythmias. Evolve
- Sodium channel blockers are considered which class of antidysrhythmic drugs? a. Class III b. Class II c. Class IV d. Class I d Class I The Vaughan Williams classification is the most commonly used system to classify antidysrhythmic drugs. There are four major classes of antidysrhythmic drugs: I, II, III, and IV. Sodium channel blockers are classified as class I drugs. Evolve
- The patient is prescribed ibutilide (Corvert), a class III antiarrhythmic drug. The nurse understands this drug has been prescribed for which reason? a. Conversion of recent-onset atrial fibrillation and flutter b. Treatment of PSVT c. Conversion of life-threatening ventricular dysrhythmias d. Treatment of dysrhythmias in patients with acute renal failure a Conversion of recent-onset atrial fibrillation and flutter
Calcium channel blockers cause coronary vasodilation, a negative inotropic effect, a negative chronotropic effect, and a negative dromotropic effect. Evolve
- The nurse is caring for a patient prescribed amiodarone (Cordarone). The nurse knows the MOST serious adverse effect of this medication can occur in which body system? a. Immune b. Nervous c. Gastrointestinal d. Respiratory d Respiratory Pulmonary toxicity is the most serious potential adverse effect of amiodarone. Evolve
- For patients prescribed amiodarone (Cordarone), the nurse should monitor for which potential adverse effects of this drug? (Select all that apply.) a. Hypothyroidism b. Visual halos c. Photosensitivity d. Blue gray skin discoloration e. Overgrowth of gum tissue f. Diarrhea a,b,c,d Hypothyroidism, Visual halos, Photosensitivity, Blue gray skinndiscoloration Potential adverse effects from amiodarone include visual halos, photosensitivity, photophobia, dry eyes, bluish skin discoloration, hyperthyroidism, hypothyroidism, co A patient is receiving lidocaine (Xylocaine) by continuous intravenous (IV) infusion. The nurse understands this medication is prescribed for what condition? a. Atrial fibrillation b. Sinus bradycardia c. First-degree heart block d. Ventricular dysrhythmias D The patient is prescribed ibutilide (Corvert), a class III antiarrhythmic drug. The nurse understands this drug has been prescribed for which reason? a. Conversion of life-threatening ventricular dysrhythmias b. Conversion of recent-onset atrial fibrillation and flutter
c. Treatment of dysrhythmias in patients with acute renal failure d. Treatment of PSVT B Which drug class is used to treat both hypertension and antidysrhythmias? a. Sodium channel blockers b. Calcium channel blockers c. Direct-acting vasodilators d. Alpha-adrenergic-blocking B Calcium channel blockers have which pharmacodynamic effect? a. Positive inotropic b. Positive chronotropic c. Coronary vasodilation d. Shortened refractory period C The nurse is caring for a patient prescribed amiodarone (Cordarone). The nurse knows the MOST serious adverse effect of this medication can occur in which body system? a. Nervous b. Immune c. Respiratory d. Gastrointestinal C For patients prescribed amiodarone (Cordarone), the nurse should monitor for which potential adverse effects of this drug? (Select all that apply.) a. Diarrhea b. Visual halos c. Hypothyroidism d. Photosensitivity e. Overgrowth of gum tissue f. Blue gray skin discoloration B,C,D,F Which of the following interventions should the nurse anticipate for a 62-year-old patient with late-stage liver failure and a history of alcoholism, who is prescribed lidocaine for premature ventricular dysrhythmia? a) Reduction of the lidocaine dosage by half b) Addition of a diuretic to the lidocaine therapy c) Conversion of lidocaine to an oral form d) Increase in the lidocaine dosage to achieve adequate blood levels Answer: a) Reduction of the lidocaine dosage by half Lidocaine is primarily metabolized in the liver. In patients with liver impairment, such as those with late-stage liver failure, metabolism of lidocaine is reduced, leading to increased drug levels and potential toxicity. Therefore, reducing the dosage in such patients is necessary to prevent toxicity while still achieving therapeutic effects.
