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A client on antiarrhythmic drug therapy complains of nausea, vomiting, abdominal pain, diarrhea, and a ringing sensation in the ears. Which of the following drugs should the nurse consider as the possible cause?
- A. Lidocaine
- B. Quinidine
- C. Flecainide
- D. Procainamide
Correct Answer: B
Rationale: The nurse should consider the drug quinidine as the cause for these adverse reactions. Quinidine toxicity is called cinchonism. Some of its symptoms include ringing in the ears (tinnitus), hearing loss, headache, nausea, vomiting, abdominal pain, dizziness, vertigo, and lightheadedness. Lidocaine, flecainide, and procainamide do not cause tinnitus or hearing loss.
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A nurse is reading a journal article about propranolol. Which of the following would the nurse expect to find discussed? Select all that apply.
- A. Is a class III antiarrhythmic
- B. Acts by blocking beta-adrenergic receptors of the heart and kidney
- C. Reduces the release of renin
- D. Increases excitability of the heart
- E. Has membrane-stabilizing effects
Correct Answer: B,C,E
Rationale: Propranolol (Inderal) is a class II antiarrhythmic that acts by blocking beta-adrenergic receptors of the heart and kidney, reducing the influence of the sympathetic nervous system on these areas, decreasing the excitability of the heart and the release of renin. Propranolol also has membrane-stabilizing effects.
When discussing class IB antiarrhythmics, which of the following would the nurse identify as an effect? Select all that apply.
- A. Shortening of the action potential duration
- B. Depression of cardiac conduction
- C. Prolongation of the action potential
- D. Slowing of repolarization
- E. Increase in cardiac conduction
Correct Answer: A,B
Rationale: Class IB antiarrhythmics shorten the action potential and selectively depress cardiac conduction.
A nurse is caring for a client receiving an oral antiarrhythmic drug. Which apical pulse rate would lead the nurse to withhold the drug and notify the health care provider immediately?
- A. 58 beats/min
- B. 68 beats/min
- C. 78 beats/min
- D. 88 beats/min
Correct Answer: A
Rationale: The nurse should withhold the drug and report to the primary health care provider whenever the client's pulse rate falls below 60 beats/min or rises to more than 120 beats/min. Pulse rates of 68 beats/min, 78 beats/min, and 88 beats/min fall within the normal range.
When describing arrhythmias to a group of nursing students, the instructor explains that arrhythmias may be triggered by which of the following? Select all that apply.
- A. Emotional stress
- B. Heart disease
- C. Electrolyte imbalance
- D. Diabetes
- E. Hypoxia
Correct Answer: A,B,C,E
Rationale: Arrhythmias may occur as a result of heart disease, a disorder that affects cardiovascular function, emotional stress, hypoxia, and electrolyte imbalances. Diabetes is not a direct trigger for arrhythmias but may contribute indirectly through cardiovascular complications.
After teaching a group of nursing students about antiarrhythmics, the instructor determines that the teaching was successful when the students identify which of the following as a class IA antiarrhythmic? Select all that apply.
- A. Quinidine (Quinaglute)
- B. Lidocaine (Xylocaine)
- C. Propafenone (Rythmol)
- D. Disopyramide (Norpace)
- E. Flecainide (Tambocor)
Correct Answer: A,D
Rationale: Class IA antiarrhythmics include disopyramide and quinidine. Lidocaine is a class IB drug. Propafenone and flecainide are class IC drugs.