Nokea
The nurse notes in the patient's medication orders that the patient will be taking ibutilide. Based on this finding, the nurse interprets that the patient has which disorder?
- A. Ventricular ectopy
- B. Atrial fibrillation
- C. Supraventricular tachycardia
- D. Bradycardia
Correct Answer: B
Rationale: Ibutilide, a class III antidysrhythmic, is used to convert atrial fibrillation or flutter to normal sinus rhythm. It is not indicated for ventricular ectopy, supraventricular tachycardia, or bradycardia.
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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 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.
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.
When starting a patient on antidysrhythmic therapy, the nurse will remember that which problem is a potential adverse effect of any antidysrhythmic drug?
- A. Deficiency of fat-soluble vitamins
- B. Hyperkalemia
- C. Heart failure
- D. Dysrhythmias
Correct Answer: D
Rationale: Antidysrhythmic drugs can cause new dysrhythmias (prodysrhythmic effect) due to their effects on cardiac electrophysiology. Fat-soluble vitamin deficiency, hyperkalemia, and heart failure are not universal adverse effects.
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.