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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
- B. Atenolol
- C. Lidocaine
- D. Adenosine
Correct Answer: A
Rationale: Diltiazem is used for rate control in atrial fibrillation by slowing AV node conduction, making it appropriate for rapid-rate atrial fibrillation. Atenolol, lidocaine, and adenosine are not primarily used for this purpose.
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The nurse is monitoring for adverse effects in a patient who is receiving an amiodarone 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
Correct Answer: B,D,F,G
Rationale: Amiodarone can cause constipation, QT prolongation, hypotension, and blue-gray skin discoloration due to its complex pharmacology. Tachycardia, chest pain, and headache are not typical adverse effects.
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
- B. Verapamil
- C. Amiodarone
- D. Adenosine
Correct Answer: C
Rationale: Amiodarone is the drug of choice for ventricular dysrhythmias per Advanced Cardiac Life Support guidelines due to its effectiveness in stabilizing ventricular rhythms. Diltiazem, verapamil, and adenosine are used for other dysrhythmias.
A 62-year-old man is to receive lidocaine as treatment for a symptomatic dysrhythmia. Upon assessment, the nurse notes that he has a history of alcoholism and has late-stage liver failure. The nurse will expect which adjustments to his drug therapy?
- A. The dosage will be reduced by 50%.
- B. A diuretic will be added to the lidocaine.
- C. The lidocaine will be changed to an oral dosage form.
- D. An increased dosage of lidocaine will be prescribed so as to obtain adequate blood levels.
Correct Answer: A
Rationale: Lidocaine is metabolized by the liver, so in liver failure, a 50% dosage reduction is often necessary to prevent toxicity. Lidocaine is not given orally, diuretics are not added, and increasing the dose is unsafe.
The nurse is reviewing the classes of antidysrhythmic drugs. Amiodarone is classified on the Vaughan Williams classification as a class III drug, which means it works by which mechanism of action?
- A. Blocking slow calcium channels
- B. Prolonging action potential duration
- C. Blocking sodium channels and affecting phase 0
- D. Decreasing spontaneous depolarization and affecting phase 4
Correct Answer: B
Rationale: Amiodarone, a Vaughan Williams class III drug, prolongs the action potential duration by delaying repolarization in phase 3, thus extending the refractory period. The other options describe mechanisms of other antidysrhythmic classes.
A patient is taking quinidine for the treatment of dysrhythmias. The nurse will monitor for which adverse effect of this drug?
- A. Diarrhea
- B. Tachycardia
- C. Tinnitus
- D. Dry mouth
Correct Answer: C
Rationale: Quinidine, a class Ia antidysrhythmic, can cause cinchonism, characterized by tinnitus, hearing loss, and gastrointestinal upset. Diarrhea, tachycardia, and dry mouth are not primary adverse effects.