Nokea
Administration with which of the following would increase serum concentrations of disopyramide? Select all that apply.
- A. Amiodarone
- B. Quinidine
- C. Rifampin
- D. Cimetidine
- E. Erythromycin
Correct Answer: B,E
Rationale: Increased serum disopyramide levels occur when quinidine or erythromycin is given with disopyramide. Amiodarone and cimetidine increase serum flecainide levels. Rifampin decreases serum disopyramide levels.
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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.
Before administering any antiarrhythmic, the nurse would assess which of the following? Select all that apply.
- A. Skin color
- B. Blood glucose
- C. Input and output
- D. Orientation
- E. Level of consciousness
Correct Answer: A,D,E
Rationale: The preadministration assessment of the client's general condition should include observations such as skin color, orientation, level of consciousness, and the client's general status. Blood glucose and input/output are not directly relevant unless specified.
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.
When evaluating a client who is receiving antiarrhythmic therapy, which of the following would the nurse interpret as an expected outcome? Select all that apply.
- A. No evidence of injury is seen.
- B. No evidence of infection is seen.
- C. Client is free of nausea.
- D. Client urinates adequately.
- E. Oral mucous membranes are intact and moist
Correct Answer: A,B,C,D,E
Rationale: Absence of injury, infection, and nausea, adequate renal function, and intact, moist oral mucous membranes are expected outcomes for antiarrhythmic therapy.
When educating a group of nursing students on the mechanism of action of various antiarrhythmic drugs, the nurse identifies which of the following drugs as inhibiting the beta-adrenergic receptors of the heart and kidney?
- A. Propafenone
- B. Amiodarone
- C. Disopyramide
- D. Acebutolol
Correct Answer: D
Rationale: The nurse should inform the nursing students that acebutolol acts by inhibiting the beta-adrenergic receptors of the heart and kidney. Propafenone and amiodarone appear to act directly on the cardiac cell membrane, and not on the beta-adrenergic receptors of the heart and kidney. Disopyramide acts by decreasing the depolarization of the myocardial fibers, and not the beta-adrenergic receptors of the heart and kidney.