Nokea
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.
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A nurse is reviewing a journal article about class IA antiarrhythmics. The article describes a drug that decreases depolarization and prolongs the refractory period. The nurse is most likely reading an article about which drug?
- A. Quinidine
- B. Lidocaine
- C. Disopyramide
- D. Flecainide
Correct Answer: C
Rationale: Disopyramide (Norpace) decreases depolarization of myocardial fibers, prolongs the refractory period, and increases the action potential duration of cardiac cells. Lidocaine (Xylocaine) decreases diastolic depolarization, decreases automaticity of ventricular cells, and raises the threshold of the ventricular myocardium. Quinidine depresses myocardial excitability or the ability of the myocardium to respond to an electrical stimulus. Flecainide (Tambocor) depresses fast sodium channels, decreases the height and rate of rise of action potentials, and slows conduction of all areas of the heart.
A client receiving antiarrhythmic therapy develops a new arrhythmia due to the administration of the drug. The nurse documents this as which of the following?
- A. Cinchonism
- B. Refractory period
- C. Proarrhythmic effect
- D. Action potential
Correct Answer: C
Rationale: The development of a new arrhythmia due to drug administration is referred to as a proarrhythmic effect. Cinchonism refers to quinidine toxicity. Refractory period refers to the quiet period between the transmission of nerve impulses along a nerve fiber. Action potential refers to the electrical impulse that passes from cell to cell in the myocardium of the heart and stimulates the fibers to shorten, causing heart muscles to contract.
The nurse identifies a nursing diagnosis of Nausea secondary to the effects of antiarrhythmic therapy. Which of the following would the nurse include in the client's plan of care? Select all that apply.
- A. Administering the drug with food
- B. Having the client lie flat for 2 hours after eating
- C. Scanning the client's bladder for distention
- D. Offering small, frequent meals
- E. Encouraging gradual position changes
Correct Answer: A,D
Rationale: To combat nausea, the nurse would administer the drug with food and offer the client small, frequent meals. The nurse would encourage the client to keep his head at least 4 inches higher than his feet when resting or reclining. Scanning for bladder distention would be appropriate if the client experienced urinary retention. Encouraging gradual position changes would be appropriate for the client at risk for injury from dizziness or lightheadedness.
A client with cardiac arrhythmia is prescribed verapamil. The nurse would instruct the client about which of the following as a possible adverse reaction?
- A. Diarrhea
- B. Hyperactivity
- C. Peripheral edema
- D. Hypertension
Correct Answer: C
Rationale: The nurse should inform the client that peripheral edema could be an adverse reaction to verapamil therapy. Diarrhea, hyperactivity, and hypertension are not adverse reactions associated with verapamil therapy. Other adverse reactions associated with verapamil are constipation, mental depression, and hypotension.
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.