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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.
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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.
When describing arrhythmias to a group of nursing students, the instructor explains that arrhythmias may be triggered by which of the following? Select all that apply.
- A. Emotional stress
- B. Heart disease
- C. Electrolyte imbalance
- D. Diabetes
- E. Hypoxia
Correct Answer: A,B,C,E
Rationale: Arrhythmias may occur as a result of heart disease, a disorder that affects cardiovascular function, emotional stress, hypoxia, and electrolyte imbalances. Diabetes is not a direct trigger for arrhythmias but may contribute indirectly through cardiovascular complications.
A nurse is preparing to administer an antiarrhythmic and identifies the drug as a class III potassium channel blocker. Which drug would the nurse be most likely to administer?
- A. Amiodarone
- B. Flecainide
- C. Mexiletine
- D. Propafenone
Correct Answer: A
Rationale: Amiodarone is a class III potassium channel blocker. Flecainide, mexiletine, and propafenone are class I sodium channel blockers.
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.
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.