Cardiac Rhythm

Question 1

Cardiac Dysrhythmias: causes

Answer 1

1) electrolyte disturbance
2) overstimulation of the heart

-found anywhere in heart (atria, ventricles, conduction system)

Question 2

Classes of Antidysrhythmic Drugs

Answer 2

1) class I = sodium channel blockers
2) class II = beta blockers
3) class III = potassium channel blockers
4) class IV = calcium channel blockers
5) other medications = adenosine; digoxin

Question 3

Antidysrhythmic Drugs: therapeutic uses

Answer 3

1) slow or prolong conduction
2) block beta-adrenergic receptor in heart
3) prolong action potential and refractory period
4) block calcium influx

Question 4

Class I Sodium Channel Blockers: medications

Answer 4

1) IA = procainamide (Pronestyl, Procanbid)–oral and IV
2) IB = lidocaine (Xylocaine)–IV
3) IC = propafenone (Rythmol)–oral

Question 5

Class I Sodium Channel Blockers: therapeutic uses

Answer 5

1) IA
- supraventricular tachycardia
- ventricular tachycardia
- atrial flutter
- atrial fibrillation
2) IB
- short-term use for ventricular dysrhythmias
3) IC
- severe ventricular tachycardia

Question 6

Class II Beta Blockers: medications

Answer 6

1) propranolol hydrochloride (Inderal)–oral, IV
2) sotalol HCl (Betapace)
3) esmolol hydrochloride (Brevibloc)
4) acebutolol hydrochloride (Sectral)

Question 7

Class II Beta Blockers: therapeutic uses

Answer 7

1) atrial fibrillation
2) atrial flutter
3) paroxysmal SVT
4) hypertension
5) angina

Question 8

Class III Potassium Channel Blockers: medications

Answer 8

1) amiodarone (Cordarone, Pacerone)–oral, IV
2) bretylium (Bretylol)
3) sotalol (betapace)
4) ibutilide (Corvert)
5) dofetilide (Tikosyn)

Question 9

Class III Potassium Channel Blockers: therapeutic action

Answer 9

1) conversion of atrial fibrillation
2) recurrent ventricular fibrillation
3) recurrent ventricular tachycardia

Question 10

Class IV Calcium Channel Blockers: medications

Answer 10

1) varapamil (Calan)–oral, IV

2) diltiazem (Cardizem)

Question 11

Class IV Calcium Channel Blockers: therapeutic uses

Answer 11

1) atrial fibrillation and flutter

2) SVT

Question 12

Other Medications: Adenosine

Answer 12

1) decrease electrical conduction through AV node
2) therapeutic uses:
- paroxysmal SVT
- Wolff-Parkinson-White syndrome

Question 13

Other medications: digoxin (Lanoxin)

Answer 13

1) decrease electrical conduction through AV node
2) increase myocardial contraction
3) therapeutic uses:
- HF
- atrial fibrillation and flutter
- paroxysmal SVT

Question 14

Class I: procainamide

adverse effects

Answer 14

1) painful, inflamed joints (lupus)
2) blood dyscrasias (neutropenia)
3) cardiotoxicity
4) hypotension

Question 15

Class I: procainamide

nursing interventions/client education

Answer 15

1) symptoms resolve with discontinuation of medication
2) NSAIDs can be used
3) monitor weekly CBC
4) monitor for signs of infections and bleeding
5) monitor procainamide levels
6) monitor vital signs and ECG
7) notify provider if dysrhythmias occur

Question 16

Class I: lidocaine

adverse effects

Answer 16

1) CNS effects
- drowsiness
- altered mental status
- seizures
2) respiratory arrest

Question 17

Class I: lidocaine

nursing interventions/client education

Answer 17

1) monitor for CNS effects
2) notify provider if they occur
3) administer phenytoin (Dilantin) to control seizure activity
4) monitor vital signs
5) obtain ECG
6) make sure resuscitation is available

Question 18

Class II: amiodarone

adverse effects

Answer 18

1) pulmonary toxicity
2) sinus bradycardia and AV block, which may lead to HF
3) visual disturbances (photophobia, blurred vision, may lead to blindness)
4) phlebitis w/ IV administration

Question 19

Class II: amiodarone

nursing interventions/client education

Answer 19

1) monitor for cough, dyspnea, chest pain
2) monitor BP, ECG
3) if AV block occurs, stop medication
4) report visual disturbances
5) use central venous catheter

Question 20

Class IV: verapamil

adverse effects

Answer 20

1) bradycardia
2) hypotension
3) heart failure

Question 21

Class IV: verapamil

nursing interventions/client education

Answer 21

1) monitor ECG, blood pressure
2) reverse with calcium chloride
3) H/O HF may need reduced dose

Question 22

Adenosine: adverse effects

Answer 22

1) sinus bradycardia (decreased conduction through AV node)
2) hypotension
3) dyspnea (bronchoconstriction)
4) flushing of face (vasodilation)

Question 23

Adenosine: nursing interventions

Answer 23

1) monitor ECG. Effects usually last 1 min or less

2) monitor for manifestations, and notify provider if occur

Question 24

Digoxin: adverse effects

Answer 24

1) bradycardia
2) hypotension
3) toxicity:
- nausea
- vomiting
- dysrhythmias

Question 25

Digoxin: nursing interventions

Answer 25

1) monitor apical HR. hold dose if < 60/min
2) monitor digoxin level (0.8-2.0 ng/mL)
3) monitor serum potassium level

Question 26

Procainamide, Lidocaine:

nursing administration

Answer 26

1) take meds as prescribed
2) do not crush or chew preparations
3) IV administration (loading dose) maintenance
4) adjust rate to cardiac response
5) leave on longer than 24 hr
6) do not use lidocaine w/ epinephrine (severe hypertension/dysrhthmias)

Question 27

Amiodarone: nursing administration

Answer 27

1) highly toxic. monitor closely for adverse effects
2) inform clients that adverse effects may continue for extended period of time after medication is discontinued
3) provide written information on potential toxicities

Question 28

Verapamil: nursing administration

Answer 28

1) change position slowly
2) lie flat until dizziness subsides
3) notify provider for peripheral edema or SOB

Question 29

Adenosine: nursing administration

Answer 29

1) half life very short
2) adverse reactions short and mild
3) administration by IV bolus, flushed w/ normal saline