Nokea
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.
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Quinidine is prescribed to a client with cardiac arrhythmia. When documenting the client's drug history, the nurse inquires about the concomitant use of any other drug. Which of the following drugs when given concomitantly may cause an increase in serum quinidine levels?
- A. Cimetidine
- B. Rifampin
- C. Hydantoins
- D. Nifedipine
Correct Answer: A
Rationale: Cimetidine, when given concurrently with quinidine, may cause an increase in serum quinidine levels. Hydantoins and nifedipine cause a decrease in serum quinidine levels. Rifampin does not interact with quinidine.
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.
A client is admitted to the cardiology unit of a health care facility for ventricular arrhythmia. In which of the following conditions can an antiarrhythmic drug be safely administered?
- A. Aortic stenosis
- B. Premature ventricular contraction
- C. Third-degree heart block
- D. Severe heart failure
Correct Answer: B
Rationale: The nurse can safely administer an antiarrhythmic drug if the client has premature ventricular contractions. Aortic stenosis, third-degree heart block, and severe congestive heart failure are contraindications for the use of antiarrhythmic drugs.
A nurse is reading a journal article about propranolol. Which of the following would the nurse expect to find discussed? Select all that apply.
- A. Is a class III antiarrhythmic
- B. Acts by blocking beta-adrenergic receptors of the heart and kidney
- C. Reduces the release of renin
- D. Increases excitability of the heart
- E. Has membrane-stabilizing effects
Correct Answer: B,C,E
Rationale: Propranolol (Inderal) is a class II antiarrhythmic that acts by blocking beta-adrenergic receptors of the heart and kidney, reducing the influence of the sympathetic nervous system on these areas, decreasing the excitability of the heart and the release of renin. Propranolol also has membrane-stabilizing effects.
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.