Nokea
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.
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Which of the following should be included in the nurse's ongoing assessment of a client receiving flecainide (Tambocor)? Select all that apply.
- A. Response to therapy
- B. Signs of heart failure
- C. Development of new cardiac arrhythmias
- D. Worsening of arrhythmia being treated
- E. Monitoring of serum flecainide levels
Correct Answer: A,B,C,D,E
Rationale: The nurse should closely monitor the client for a response to drug therapy, signs of heart failure, the development of new arrhythmias, worsening of the arrhythmia being treated, and serum flecainide levels.
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.
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.
Which of the following is important for the nurse to remember when administering quinidine (Quinaglute) orally? Select all that apply.
- A. Quinidine can be administered with food to decrease GI upset.
- B. Quinidine can cause auditory adverse reactions.
- C. Quinidine can be crushed or chewed.
- D. Normal quinidine levels are between 7 and 10 mcg/mL.
- E. Quinidine levels must be monitored during therapy.
Correct Answer: A,B,E
Rationale: Quinidine can be administered with food to decrease GI upset and can cause ringing in the ears and hearing loss. Levels should be monitored during therapy to reduce the risk of quinidine toxicity. Quinidine should not be crushed or chewed, and normal quinidine levels are less than 6 mcg/mL.
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.