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The nurse is preparing to administer a bolus dose of verapamil as follows: 'Give 5-mg bolus of verapamil, IV push, over 2 minutes. May repeat in 30 minutes if needed.' The medication is available in a 2.5-mg/mL strength solution. Identify how many milliliters will the nurse draw into the syringe for this dose.
Correct Answer: 2 mL
Rationale: To calculate: 2.5 mg/1 mL = 5 mg/x mL. Cross-multiply: (2.5 * x) = (1 * 5); 2.5x = 5; x = 5/2.5 = 2 mL.
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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.
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.
Which patient-teaching instructions are appropriate for a patient taking an antidysrhythmic drug? (Select all that apply.)
- A. Do not chew or crush extended-release forms of medication.
- B. Take the medication with food if gastrointestinal distress occurs.
- C. If a dose is missed, the missed dose should be taken along with the next dose that is due to be taken.
- D. Take the medications with an antacid if gastrointestinal distress occurs.
- E. Limit or avoid the use of caffeine.
- F. The presence of a capsule in the stool should be reported to the physician immediately.
Correct Answer: A,B,E
Rationale: Appropriate instructions include not chewing/crushing extended-release forms, taking with food for GI distress, and limiting caffeine due to its cardiac stimulant effects. Doubling doses, using antacids, or reporting wax matrices in stool (normal for some formulations) are incorrect.
A patient has been started on therapy of a continuous infusion of lidocaine after receiving a loading dose of the drug. The nurse will monitor the patient for which adverse effect?
- A. Drowsiness
- B. Nystagmus
- C. Dry mouth
- D. Convulsions
Correct Answer: D
Rationale: Lidocaine toxicity can cause convulsions due to central nervous system effects. Drowsiness, nystagmus, and dry mouth are not primary adverse effects of lidocaine.
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.