Cardiovascular and Renal

Question 1

A patient has been prescribed lidocaine (Xylocaine). What does the nurse understand as the reason for this medication order?

Answer 1

Ventricular arrhythmias:

Lidocaine is a sodium channel–blocking drug used specifically to treat ventricular arrhythmias.

Question 2

The nurse is reviewing emergency protocols and administration of adenosine (Adenocard). What is a vitally important task to remember when administering adenosine?

Answer 2

Give it as a rapid intravenous push.
Adenosine must be given as rapidly as possible, followed by a 50-mL normal saline flush in order to get all of the medication into the circulation quickly since the half-life of adenosine is less than 10 seconds.

Question 3

To prevent the occurrence of cinchonism in a patient prescribed quinidine, what does the nurse emphasize as important?

Answer 3

Avoid drinking grapefruit juice.

Grapefruit juice can also inhibit the metabolism of quinidine, which increases the risk of cinchonism.

Question 4

Adenosine is used to treat which condition?

Answer 4

Paroxysmal supraventricular tachycardia (PSVT):

The only therapeutic indication of use for adenosine is the treatment of PSVT.

Question 5

Sodium channel blockers are considered which class of antidyshythmic drugs?

Answer 5

Class I

Question 6

The patient has been prescribed ibutilide (Corvert), a class III antiarrhythmic drug. The nurse is aware that this drug has been prescribed for which reason?

Answer 6

Conversion of recent-onset atrial fibrillation and flutter:

Ibutilide is specifically indicated only for treatment of recent-onset atrial fibrillation and flutter.

Question 7

Before administering a dose of an antidysrhythmic drug to an assigned patient, which assessments would be of highest priority?

Answer 7

Apical pulse and blood pressure:
Antiarrhythmic drugs can cause both hypotension and bradycardia; therefore it is important to assess blood pressure and apical pulse before administration. Peripheral pulses are not as reliable as the apical pulse assessment.

Question 8

Which class of drugs is used to treat both hypertension and dysrhythmias?

Answer 8

Calcium channel blockers:
Calcium channel blockers are effective in treating both hypertension and dysrhythmias secondary to their negative inotropic and chronotropic effects.

Question 9

Calcium channel blockers have which pharmacodynamic effect?

Answer 9

Coronary vasodilation:
Calcium channel blockers cause 
coronary vasodilation, 
a negative inotropic effect, 
a negative chronotropic effect, and 
a negative dromotropic effect.

Question 10

The most severe adverse effects of amiodarone are evidenced in which body system?

Answer 10

Pulmonary:
Patients taking amiodarone must have baseline and serial pulmonary function tests in order to monitor for potential pulmonary toxicity.

Question 11

For which potential adverse effects would the nurse monitor patients prescribed amiodarone? (Select all that apply.)

Answer 11

Bluish skin discoloration
Hypothyroidism
Photosensitivity

Question 12

any deviation from the normal rhythm of the heart

Answer 12

dysrhythmia

Question 13

“no rhythm” implies asystole or no heartbeat at al

Answer 13

arrhythmia

Question 14

when antidysrhythmic drugs cause dysrhythmias

Answer 14

prodysrhythmic

Question 15

SA node

Answer 15

the natural pacemaker of the heart because it spontaneously depolarizes the most frequently; have a slower upstroke velocity

Question 16

resting membrane potential (RMP)

Answer 16

an important determinant of the rate of its impulse conduction to other cells

Question 17

Common Dysrhythmias

Answer 17

Supraventricular dysrhythmias;
Ventricular dysrhythmias;
Dysrhythmias

Question 18

Supraventricular dysrhythmias

Answer 18

originate above the ventricles in the SA or AV node or atrial myocardium.

Question 19

Ventricular dysrhythmias

Answer 19

originate below the AV node in the His-Purkinje system or ventricular myocardium

Question 20

Dysrhythmias

Answer 20

originate outside the conduction system (i.e., in atrial or ventricular cells) are called ectopic and their points of origin are called ectopic foci

Question 21

Conduction blocks

Answer 21

dysrhythmias that involve disruption of impulse conduction between the atria and ventricles through the AV node, directly affecting ventricular function
may originate in the His-Purkinje system

Question 22

Class I

Answer 22

Membrane-stabilizing drugs (e.g., class Ia, quinidine; class Ib, lidocaine; class Ic, flecainide); these drugs exert their actions on the sodium (fast) channels

Question 23

Class II

Answer 23

Beta-adrenergic blockers that depress phase 4 depolarization (e.g., atenolol);
commonly used as antihypertensives, working by blocking sympathetic nervous system stimulation to the heart and, as a result, the transmission of impulses in the heart’s conduction system. These drugs mostly affect slower-conducting cardiac tissues

Question 24

Class III

Answer 24

Drugs that prolong repolarization in phase 3 (e.g., amiodarone and dofetilide); these drugs affect fast tissue and are most commonly used to manage dysrhythmias that are difficult to treat

Question 25

Class IV

Answer 25

Calcium channel blockers that depress phase 4 depolarization (e.g., verapamil); these drugs work specifically by inhibiting the calcium channels, which reduces the influx of calcium ions during action potentials. Diltiazem and verapamil are the calcium channel blockers most commonly used to treat cardiac dysrhythmias

Question 26

Adverse effects common to most antidysrhythmics

Answer 26

hypersensitivity reactions, nausea, vomiting, and diarrhea. Other common effects include dizziness, headache, and blurred vision

Question 27

toxic effects of the antidysrhythmics

Answer 27

heart, circulation, and central nervous system (CNS)

Question 28

interactions

Answer 28

result in dysrhythmias, hypotension or hypertension, respiratory distress, or excessive therapeutic or toxic drug effects

Question 29

signs and symptoms to assess for decreased cardiac functioning (as a result of dysrhythmia and decrease in cardiac output)

Answer 29

apical-radial pulse deficits, jugular vein distension, edema, prolonged capillary refill (longer than 5 seconds), decreased urinary output, activity intolerance, chest pain or pressure, dyspnea, and fatigue

Question 30

administering antidysrhythmic

Answer 30

Review any baseline ECGs; vital signs with attention to blood pressure, postural blood pressure, heart sounds, and heart rate, rhythm, and quality; Document any changes in level of alertness, increase in anxiety levels, syncope, or dizziness

Question 31

lidocaine

Answer 31

assess the cardiovascular system, with attention to heart rate and blood pressure.

Question 32

Amiodarone

Answer 32

assess respiratory, thyroid, hepatic, dermatologic, and/or hypertensive conditions due to possible drug-related pulmonary toxicity, exacerbation of thyroid disorders, abnormal liver function tests, and rash; gastrointestinal upset, may be prevented or decreased by taking the drug with food or a snack; Photosensitivity and photophobia

Question 33

notify the prescriber

Answer 33

prolongation of the QT interval by more than 50%; pulse rate is lower than 60 beats/min

Question 34

Beta blockers

Answer 34

diltiazem, and verapamil may all be used to manage abnormal rhythms and are to be given only after checking and documenting pulse rates and blood pressures; withhold if pulse rate is 60 beats/min or lower or 100 beats/min or higher and/or the systolic blood pressure is 90 mm Hg or lower.

Question 35

Dofetilide

Answer 35

monitor for any changes in the ECG; report chest pain, nausea, or diarrhea, to the prescriber immediately

Question 36

Adverse effects for the class I antidysrhythmics

Answer 36

procainamide:
hypotension, rash, diarrhea, systemic lupus erythematosus, SLE–like syndrome;
quinidine:
ECG changes, bitter taste, anorexia, blurred vision, and tinnitus; and
phenytoin:
gingival hyperplasia and decrease in blood pressure and pulse rate

Question 37

Adverse effects for class II beta blockers

Answer 37

may cause bradycardia, AV block, heart failure, bronchospasm, and changes in blood glucose levels

Question 38

Adverse effects for class III

Answer 38

Amiodarone:
may lead to pulmonary toxicity, thyroid disorders, decrease in blood pressure and pulse rate, photosensitivity, and abnormal liver function

Question 39

Adverse effects for class IV Calcium channel blockers

Answer 39

are associated with heart block, hypotension, constipation, dizziness, and dyspnea

Question 40

therapeutic responses to antidysrhythmics

Answer 40

decrease in blood pressure in hypertensive patients,
a decrease in edema, and
restoration of a regular pulse rate