Nokea
The nurse should monitor a client receiving lidocaine (Xylocaine) IV closely for which of the following? Select all that apply.
- A. Heartburn
- B. Apprehension
- C. Hypotension
- D. Auditory changes
- E. Bradycardia
Correct Answer: B,C,E
Rationale: The nurse must observe the client closely for signs of apprehension, hypotension, and bradycardia. Auditory changes are seen with quinidine, not lidocaine. Heartburn is associated with mexiletine.
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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.
A nurse is caring for a client who is prescribed mexiletine for the treatment of a cardiac arrhythmia. Which adverse reaction would lead the nurse to identify a nursing diagnosis of Risk for Infection?
- A. Lightheadedness
- B. Dry mouth
- C. Agranulocytosis
- D. Nausea
Correct Answer: C
Rationale: A nursing diagnosis of Risk for Infection related to the adverse reaction of the drug may be made in the case of agranulocytosis. Lightheadedness would lead to a nursing diagnosis of Risk for Injury related to the adverse effect of the drug. Dry mouth leads to a nursing diagnosis of Impaired Oral Mucous Membranes related to the adverse effect of the drug. Nausea does not indicate the implementation of the nursing diagnosis of Risk for Infection.
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.
After administering an antiarrhythmic drug, the nurse would report which of the following electrocardiogram (ECG) changes to the physician? Select all that apply.
- A. Tachycardia
- B. Prolongation of PR interval
- C. Prolongation of QT interval
- D. Widening of the QRS complex
- E. Bradycardia
Correct Answer: A,B,C,D,E
Rationale: The nurse reports to the physician any abnormalities or significant interval changes of the ECG, including tachycardia, prolongation of the PR interval or QT interval, widening of the QRS complex, or bradycardia.
A client is diagnosed with an arrhythmia that involves irregular and rapid atrial contraction and an irregular and inefficient ventricular contraction. The nurse interprets this arrhythmia as which of the following?
- A. Atrial flutter
- B. Atrial fibrillation
- C. Ventricular tachycardia
- D. Ventricular fibrillation
Correct Answer: B
Rationale: Atrial fibrillation is characterized by irregular and rapid atrial contraction, resulting in a quivering of the atria and causing an irregular and inefficient ventricular contraction. Atrial flutter is the rapid contraction of the atria at a rate too rapid for the ventricle to pump efficiently. Ventricular tachycardia is a rapid heartbeat with a rate greater than 100 bpm. Ventricular fibrillation is rapid, disorganized contractions of the ventricles, resulting in the inability of the heart to pump any blood to the body.