Unit6: Chapter 45 (Karch 7th Ed) - Antiarrhythmic Agents

Question 1

1. A patient with a history of atrial fibrillation has had a worsening of his or her condition. The nurse
   knows that the drug of choice for long-term stabilization of atrial fibrillation following
   electrocardioversion is what?
   A) Disopyramide (Norpace)
   B) Moricizine (Ethmozine)
   C) Procainamide (Pronestyl)
   D) Quinidine (generic)

Answer 1

Ans: D
Feedback:
Quinidine is often the drug of choice for long-term stabilization of atrial fibrillation after the rhythm is
converted by electrocardioversion. Quinidine is a class I antiarrhythmic and stabilizes the cell
membrane by binding to sodium channels, depressing phase 0 of the action potential, and changing the
duration of the action potential. Disopyramide, moricizine, and procainamide are all used in the
treatment of life-threatening ventricular arrhythmias

Question 2

2. What class of antiarrhythmics drug blocks potassium channels, prolonging phase 3 of the action
   potential and slowing the rate and conduction of the heart?
   A) I
   B) II
   C) III
   D) IV

Answer 2

Ans: C
Feedback:
The class III antiarrhythmics block potassium, prolonging phase 3 of the action potential, which
prolongs repolarization and slows the rate and conduction of the heart. Class I drugs block the sodium
channels in the cell membrane during an action potential. Class II drugs are beta-adrenergic blockers
that block beta-receptors, causing a depression of phase 4 of the action potential. Class IV drugs block
calcium channels in the cell membrane leading to a depression of depolarization and a prolongation of phases I and II of repolarization, which slows automaticity

Question 3

3. The nurse is caring for a pediatric patient who has been diagnosed with paroxysmal atrial tachycardia.
   The order reads digoxin 10 mcg/kg orally. The child weighs 44 pounds. How many mcg will the nurse
   administer?
   A) 50 mcg
   B) 100 mcg
   C) 150 mcg
   D) 200 mcg

Answer 3

Ans: D
Feedback:
The nurse will administer 200 mcg. (2.2 pounds: 1 kg = X: 20 kg, 20(10) = 200 mcg).

Question 4

4. The nurse is providing drug teaching about quinidine in preparation for the patient’s discharge. The
   nurse discusses drug food interactions and advises the patient to drink what?
   A) Apple juice
   B) Grapefruit juice
   C) Milk
   D) Orange juice

Answer 4

Ans: A
Feedback:
Apple juice would be the best choice. Quinidine requires a slightly acidic urine (normal state) for
excretion. Patients receiving quinidine should avoid foods that alkalinize the urine (e.g., citrus juices,
vegetables, antacids, milk products), which could lead to increased quinidine levels and toxicity.
Grapefruit juice has been shown to interfere with the metabolism of quinidine, leading to increased
serum levels and toxic effects; this combination should be avoided.

Question 5

5. A patient has had sotalol (Betapace) ordered for treatment of a ventricular arrhythmia. What will the
   nurse consider when administering the drug?
   A) Sotalol has a very short duration of action
   B) Food increases the bioavailability of the drug
   C) Absorption of sotalol is decreased by the presence of food
   D) The drug is best administered intramuscularly

Answer 5

Ans: C
Feedback:
This drug should not be taken with food because absorption is decreased. The drug should be given 1
hour before or 2 hours after a meal. Adenosine, not sotalol, has a very short duration of action and food
increases the bioavailability of propranolol. Sotalol is administered by oral route only.

Question 6

6. The nurse is caring for a patient who reports insomnia since starting the antiarrhythmic agent
   prescribed for him or her. What antiarrhythmic agent would the nurse expect this patient is taking?
   A) Disopyramide (Norpace)
   B) Amiodarone (Cordarone)
   C) Procainamide (Pronestyl)
   D) Propranolol (Inderal)

Answer 6

Ans: D
Feedback:
Class II antiarrhythmics can cause insomnia. The adverse effects associated with class II
antiarrhythmics are related to the effects of blocking beta-receptors in the sympathetic nervous system.
CNS effects include dizziness, insomnia, unusual dreams, and fatigue. Disopyramide and procainamide
are class I agents and do not cause insomnia. Amiodarone is a class III drug and is not associated with
insomnia.

Question 7

7. A patient with impaired renal function is to receive dofetilide (Tikosyn) for conversion of atrial
   fibrillation. What is the nurse’s priority assessment before administering the drug?
   A) Check the patient’s creatinine level.
   B) Measure the urine output.
   C) Listen to breath sounds
   D) Measure the PR interval on the electrocardiogram

Answer 7

Ans: A
Feedback:
When giving dofetilide to a patient with renal dysfunction, the dosage must be calculated according to
the patient’s creatinine level to ensure the therapeutic effect while limiting toxicity. This drug can only
be administered by oral route. Intake and output as well as breath sounds may need to be assessed but
are not rela

Question 8

8. A nurse is caring for a patient who has had disopyramide (Norpace), ordered. Before administering
   disopyramide (Norpace) what is the nurse’s priority action to maintain safety?
   A) Offer the patient something to drink.
   B) Ask the patient if he or she needs to void.
   C) Raise all side rails.
   D) Place the call button within reach

Answer 8

Ans: C
Feedback:
When administering disopyramide, the nurse should make sure that all side-rails are up. The central
nervous system effects of the drug can include dizziness, drowsiness, fatigue, twitching, mouth
numbness, slurred speech, vision changes, and tremors that can progress to convulsions. The other three
options are appropriate and placing the call button within reach can also be considered a safety
measure; however nothing has a higher priority than raising the bed’s side-rails.

Question 9

9. The nurse sees a patient in an outpatient setting who is given a new prescription for an antiarrhythmic
   medication to treat premature atrial contractions (PAC). The nurse has limited time with the patient and
   addresses what priority nursing diagnosis?
   A) Decreased cardiac output
   B) Alteration in comfort
   C) Deficient knowledge
   D) Potential for injury

Answer 9

Ans: C
Feedback:
The patient received a new prescription and needs information about how to take the medication, when
to call the provider, and potential adverse effects so the priority nursing diagnosis is deficient
knowledge. It is unknown what arrhythmia the patient is treating and without this information it is
impossible to know what the impact on cardiac output, comfort and potential for injury may be.

Question 10

10. You are caring for a patient who takes an antiarrhythmic agent. What would be a priority nursing
    assessment before administering this drug?
    A) Assess mental status.
    B) Assess breath sounds.
    C) Assess pulses and blood pressure.
    D) Assess urine output.

Answer 10

Ans: C
Feedback:
The nurse should continually monitor cardiac rate and rhythm when administering an antiarrhythmic
agent to detect potentially serious adverse effects and to evaluate drug effectiveness. All of the other
options are appropriate assessments but are not the priority assessment

Question 11

11. The nurse is caring for a patient receiving propranolol. What problems, reported by the patient, does the
    nurse suspect is caused by the drug? (Select all that apply.)
    A) Seizures
    B) Rash
    C) Atrioventricular (AV) block
    D) Bronchospasm
    E) Dreams

Answer 11

Ans: C, D, E
Feedback:
The adverse effects associated with class II antiarrhythmics are related to the effects of blocking beta- receptors in the sympathetic nervous system. Central nervous system effects include dizziness,
insomnia, unusual dreams, and fatigue. Cardiovascular symptoms can include hypotension,
bradycardia, AV block, arrhythmias, and alterations in peripheral perfusion. Respiratory effects can
include bronchospasm and dyspnea. GI problems frequently include nausea, vomiting, anorexia,
constipation, and diarrhea. Other effects to anticipate include a loss of libido, decreased exercise
tolerance, and alterations in blood glucose levels. Seizures and rash are not usually associated with the
adverse effects of propranolol

Question 12

12. The nurse teaches the patient receiving propranolol (Inderal) at home for management of a ventricular
dysrhythmia to monitor what parameter?
A) Daily fluid intake
B) Daily blood pressure
C) Weekly weight
D) Weekly pulse

Answer 12

Ans: B
Feedback:
Hypotension can occur with propranolol, which is a beta-blocker, so patients should check their blood
pressure and pulse every day. Propranolol does not require that fluid intake be measured. propranolol
also will not require daily weight taking, but it may be necessary with a diagnosis of propranolol.

Question 13

13. The emergency department nurse is administering IV lidocaine to a patient. What adverse effect of
    lidocaine therapy should the nurse assess for?
    A) Dysphagia
    B) Dizziness
    C) Excessive bruising
    D) Tinnitus

Answer 13

Ans: B
Feedback:
Adverse effects include dizziness, light-headedness, fatigue, arrhythmias, cardiac arrest, nausea,
vomiting, anaphylactoid reactions, hypotension, and vasodilation. Dysphagia, bruising, and tinnitus are
not usually associated with lidocaine.

Question 14

14. The nurse administers a bolus of lidocaine and follows it with a continuous infusion at what rate?
A) 0.25 to 0.75 mg/min
B) 1 to 4 mg/min
C) 6 to 8 mg/min
D) 10 to 20 mg/min

Answer 14

Ans: B
Feedback:
Lidocaine may be delivered at 1 to 4 mg/min after a bolus. Therefore, the other options are incorrect

Question 15

15. The nurse administers what drug to terminate supraventricular tachycardia?
A) Lidocaine (Lidocaine Parenteral)
B) Flecainide (Tambocor)
C) Adenosine (Adenocard)
D) Dronedarone (Multaq)

Answer 15

Ans: C
Feedback:
Adenosine depresses conduction at the atrioventricular node and is used to restore NSR (normal sinus
rhythm) in patients with paroxysmal supraventricular tachycardia. Adenosine is used to treat
supraventricular tachycardias, including those caused by the use of alternate conduction pathways in
adults. Lidocaine is used to treat life-threatening ventricular arrhythmias during myocardial infarction
or cardiac surgery; it is also used as a bolus injection in emergencies when monitoring is not available
to document exact arrhythmia. Flecainide is used to treat life-threatening ventricular arrhythmias in
adults; prevention of paroxysmal atrial tachycardia (PAT) in symptomatic patients with no structural
heart defect. Dronedarone is used to treat paroxysmal or persistent atrial fibrillation or atrial flutter in
patients with multiple risk factors for coronary artery disease who are currently in sinus rhythm or
scheduled for conversion.

Question 16

16. For what condition would the nurse expect to administer lidocaine via IV drip?
    A) Decrease in arterial oxygen saturation (SaO2)
    B) Increase in blood pressure
    C) Multiple premature ventricular contractions (PVCs)
    D) Increase in intracranial pressure (ICP)

Answer 16

Ans: C
Feedback:
Lidocaine drips are indicated for the treatment of life-threatening ventricular arrhythmias such as long
or frequent runs of PVCs. Lidocaine would not be indicated for the treatment of hypoxia, hypertension,
or increased ICP.

Question 17

17. The nurse is caring for a patient who takes an antiarrhythmic agent and is reporting a complete lack of
    appetite. Which cardiac antiarrhythmic agent would the nurse suspect the patient is taking?
    A) Diltiazem (Cardizem)
    B) Propranolol (Inderal)
    C) Lidocaine (Lidocaine Parenteral)
    D) Amiodarone (Cordarone)

Answer 17

Ans: B
Feedback:
Propranolol frequently causes gastrointestinal (GI) problems such as nausea, vomiting, anorexia,
constipation, and diarrhea. Diltiazem could cause nausea and vomiting but would not cause anorexia.
Lidocaine can lead to changes in taste, nausea, and vomiting but does not cause anorexia. Amiodarone
has adverse effects including nausea, vomiting, GI distress, weakness, dizziness, hypotension, heart
failure, arrhythmia, a potentially fatal liver toxicity, and ocular abnormalities but does not cause
anorexia.

Question 18

18. A 92-year-old patient is being sent home on disopyramide (Norpace) for a ventricular arrhythmia. He
    asks the nurse why he must continue to take this drug. The nurse’s best response would be that failure
    to treat a ventricular arrhythmia may what?
    A) Lead to renal failure
    B) Result in hypertension
    C) Result in death
    D) Cause heart failure

Answer 18

Ans: C
Feedback:
Ventricular arrhythmias cause a dramatic reduction in cardiac output and will result in death if not
treated. The patient needs to be taught the importance of taking his medication every day as ordered.
Generally, ventricular arrhythmias are not associated with renal failure, hypertension, or heart failure.

Question 19

19. The nurse is providing drug teaching for a patient who is to be discharged taking dofetilide (Tikosyn).
    What drug will the nurse teach the patient to avoid due to a drug-drug interaction?
    A) Cimetidine
    B) Furosemide
    C) Acetaminophen
    D) Antacids

Answer 19

Ans: A
Feedback:
There is an increased risk of serious adverse effects if dofetilide is combined with ketoconazole,
cimetidine, or verapamil, so these combinations should be avoided. There is no known increased risk
associated with furosemide, acetaminophen, or antacids but other specific drug drug interaction are
reported, so it is important to check a current drug handbook before administering these medications.

Question 20

20. The patient asks the nurse, Will I have to take this antiarrhythmic agent for the rest of my life? The
    nurse, having reviewed the CAST study, responds by saying what?
    A) Yes, you will have to take this drug for life.
    B) The drug is indicated for short-term treatment of life-threatening ventricular arrhythmias.
    C) This drug may need to be changed but you’ll take an antiarrhythmic for life.
    D) After the arrhythmia is corrected, the drug will be stopped.

Answer 20

Ans: B
Feedback: The CAST study, a large research study run by the National Heart and Lung Institute, found that longterm
treatment of arrhythmias may have an uncertain effect on mortality, and in some cases may
actually lead to increased cardiac death, which is the basis for the current indication for antiarrhythmics
to be used only short-term to treat life-threatening ventricular arrhythmias

Question 21

21. What patient factor would result in the nurse administering a reduced dosage of disopyramide
(Norpace)?
A) Dehydration
B) Hypertension
C) Renal impairment
D) Chronic diarrhea

Answer 21

Ans: C
Feedback:
Caution should be used with renal or hepatic dysfunction, which could interfere with the
biotransformation and excretion of these drugs. Caution is not indicated with the findings of
dehydration, hypertension, or chronic diarrhea.

Question 22

22. The nurse is administering an intravenous infusion of amiodarone (Cordarone). What should the nurse
    be aware of?
    A) The possible drug drug interaction with nonsteroidal anti-inflammatory drugs (NSAIDs)
    B) The possible development of very serious cardiac arrhythmias
    C) The possible development of peripheral edema
    D) The possible development of a fatal renal toxicity

Answer 22

Ans: B
Feedback:
Amiodarone has been associated with a potentially fatal liver toxicity rather than a renal toxicity, ocular
abnormalities, and the development of very serious cardiac arrhythmias. Sotalol may have a loss of
effectiveness if combined with NSAIDs. Diltiazem is associated with peripheral edema.

Question 23

23. The nurse reviews the patient’s medical history and determines class II antiarrhythmics are
    contraindicated due to the patient’s history of what condition?
    A) Asthma
    B) Colitis
    C) Migraine headache
    D) Antidiarrheals

Answer 23

Ans: A
Feedback:
Class II antiarrhythmics are contraindicated in patients with asthma because they could worsen the
condition due to blockage of beta-receptors. They are not contraindicated in patients with colitis,
migraine headache, or diarrhea.

Question 24

24. What would the nurse teach the diabetic patient to monitor for when beginning a class II
    antidysrhythmic drug regimen in addition to insulin?
    A) Weight loss
    B) Reduced peripheral perfusion
    C) Hypoglycemia
    D) Exercise intolerance

Answer 24

Ans: C
Feedback:
Increased hypoglycemia is possible if these drugs are combined with insulin; so patients should be
taught to monitor their blood sugar levels often. Recurrent hypoglycemic episodes may indicate the
need to reduce insulin dosage, but this advice would need to come from the health care provider. Class
II antiarrhythmic drugs are normally not associated with weight loss, reduced peripheral perfusion, or
exercise intolerance.

Question 25

25. The nurse assesses the patient’s rhythm strip and notes several premature ventricular contractions, which the nurse recognizes is caused by what? A) Stimulation of the ventricles from an ectopic focus in the ventricles B) Stimulation of the ventricles from the atrioventricular node C) Stimulation of the ventricles from the Purkinje fibers D) Stimulation of the ventricles from the bundle of His

Answer 25

Ans: A Feedback: Premature ventricular contractions are stimulations of the cells caused by an ectopic focus in the ventricles causing an early contraction. The source of these ectopic foci could be anywhere within the ventricles, but the end result is reduced cardiac output due to reduced force of contraction.

Question 26

``` 26. When the nurse is caring for a patient with a cardiac arrhythmia, the priority goal for the patient is what? A) To maintain nutritional intake B) To maintain fluid intake C) To maintain cardiac output D) To maintain urine output ```

Answer 26

Ans: C Feedback: Disruptions in the normal rhythm of the heart can interfere with myocardial contractions and affect the cardiac output, the amount of blood pumped with each beat. Arrhythmias that seriously disrupt cardiac output can be fatal. Therefore, the primary goal of treating a cardiac arrhythmia is to maintain adequate cardiac output to support life. The other goals may be important to individual patient care, but sustaining life takes priority.

Question 27

27. The nurse is caring for a 3-year-old awaiting a heart transplant who requires an antiarrhythmic agent to control a supraventricular arrhythmia. What drug, if ordered, would the nurse question? A) Digoxin B) Propranolol C) Procainamide D) Verapamil

Answer 27

Ans: D Feedback: Verapamil should be avoided in children and, if ordered, would require the nurse to question the drug. Adenosine, propranolol, procainamide, and digoxin have been successfully used to treat supraventricular arrhythmias, with propranolol and digoxin being the drugs of choice for long-term management

Question 28

28. The nurse suspects drug toxicity in the patient who has been receiving lidocaine by infusion over the past 2 days to control a ventricular arrhythmia. What assessment would the nurse perform to determine the accuracy of the suspicion of toxicity? A) Neurological assessment B) Serum lidocaine level C) Renal function studies D) Hepatic function studies

Answer 28

Ans: B Feedback: If lidocaine is used for ventricular arrhythmias related to cardiac surgery or digoxin toxicity, serum levels should be monitored regularly to determine the appropriate dose and to avoid the potential for serious proarrhythmias and other adverse effects. Neurological assessment may indicate adverse effects but would not confirm lidocaine toxicity. Renal and hepatic function would not confirm lidocaine toxicity

Question 29

29. The nurse performs an electrocardiogram and finds the older adult patient is in atrial fibrillation (AF). Time of onset is unknown but could be as long as 3 months earlier when the patient was last assessed. What drug will the nurse expect to be ordered? A) Anticoagulant B) Digoxin C) Quinidine D) Ibutilide

Answer 29

Ans: A Feedback: If the onset of AF is not known and it is suspected that the atria may have been fibrillating for longer than 1 week, the patient is better off staying in AF without drug therapy or electrocardioversion. Prophylactic oral anticoagulants are given to decrease the risk of clot formation and emboli being pumped into the system. In 2011, the American Heart Association and American College of Cardiology endorsed dabigatran (Pradaxa) as the anticoagulant of choice for prophylaxis in AF. Conversion in this case could result in potentially life-threatening embolization of the lungs, brain, or other tissues. Administration of other antiarrhythmics would not be indicated.

Question 30

30. What nursing assessment will the nurse perform to determine the hemodynamic effect of the patient’s arrhythmia? A) Obtain an electrocardiographic rhythm strip. B) Obtain a serum drug level. C) Assess the patient’s level of consciousness. D) Assess the patient’s blood pressure (BP) and pulse rat

Answer 30

Ans: D Feedback: BP and pulse rate are indicators of the hemodynamic effect of arrhythmias and are nursing measures that do not require a physician’s order. Obtaining an electrocardiogram or checking drug levels requires a physician’s order. The patient will be conscious and alert with non-life-threatening arrhythmias, even when cardiac output is reduced. Serum drug levels would indicate the therapeutic or toxic level of drugs in the body but would not indicate hemodynamic effects of the drug.

Question 31

31. What class of antiarrhythmics will the nurse administer to the patient in symptomatic paroxysmal tachycardia because it markedly depresses phase 0 with extreme slowing of conduction? A) Class Ib B) Class Ic C) Class II D) Class III

Answer 31

Ans: B Feedback: Class Ic drugs markedly depress phase 0, with a resultant extreme slowing of conduction, but have little effect on the duration of the action potential. As a result, they are indicated for the treatment of paroxysmal tachycardia. Class Ib drugs depress phase 0 somewhat and actually shorten the duration of the action potential. The class II antiarrhythmics are beta-adrenergic blockers that block beta-receptors, causing a depression of phase 4 of the action potential. The class III antiarrhythmics block potassium channels and slow the outward movement of potassium during phase 3 of the action potential, thus prolonging it.

Question 32

32. What class of antiarrhythmic agents does the nurse administer to slow the outward movement of potassium during phase 3 of the action potential? A) Class Ib B) Class Ic C) Class II D) Class III

Answer 32

Ans: D Feedback: The class III antiarrhythmics block potassium channels and slow the outward movement of potassium during phase 3 of the action potential, prolonging it. Class Ib drugs depress phase 0 somewhat and actually shorten the duration of the action potential. Class Ic drugs markedly depress phase 0, with a resultant extreme slowing of conduction, but have little effect on the duration of the action potential. The class II antiarrhythmics are beta-adrenergic blockers that block beta-receptors, causing a depression of phase 4 of the action potential.

Question 33

33. What class of antiarrhythmic agents does the nurse administer to depress generation of the action potentials and delaying phases 1 and 2 of repolarization? A) Class Ib B) Class II C) Class III D) Class IV

Answer 33

``` Ans: D Feedback: The class IV antiarrhythmics block the movement of calcium ions across the cell membrane, depressing the generation of action potentials and delaying phases 1 and 2 of repolarization, which slows automaticity and conduction. Class Ib drugs depress phase 0 somewhat and actually shorten the duration of the action potential. The class II antiarrhythmics are beta-adrenergic blockers that block beta-receptors, causing a depression of phase 4 of the action potential. The class III antiarrhythmics block potassium channels and slow the outward movement of potassium during phase 3 of the action potential, thus prolonging it. ```

Question 34

34. The nurse is teaching a class for newly hired cardiac care nurses and is discussing dronedarone (Multaq). What statement, if made by the nurse, is accurate? (Select all that apply.) A) Dronedarone has properties of all four classes of antiarrhythmics. B) Dronedarone reduces the risk of hospitalization in patients in atrial fibrillation. C) Dronedarone has many drug drug interactions that need to be reviewed. D) It is an oral drug taken once a day. E) Common adverse effects of dronedarone include ventricular arrhythmias.

Answer 34

Ans: A, B, C Feedback: Dronedarone has properties of all four classes of antiarrhythmics and the mechanism by which it helps suppress atrial arrhythmias is not fully understood. It is used to reduce the risk of hospitalization in patients with paroxysmal or persistent atrial fibrillation or flutter who have risk factors for cardiovascular disease and who are in sinus rhythm or are scheduled to be converted to sinus rhythm. The drug is taken orally twice a day. Many drug drug interactions have been associated with the drug and this situation should always be reviewed before starting or stopping any drugs while on this drug. Grapefruit juice should not be consumed while taking this drug. The most common adverse effects seen with dronedarone are heart failure, prolonged QT interval, nausea, diarrhea, and rash. It should never be used during pregnancy because it has been associated with fetal abnormalities.

Question 35

``` 35. What class of antiarrhythmic agent would the nurse be most likely to administer to a lactating new mother? A) Class Ib B) Class II C) Class III D) Class IV ```

Answer 35

Ans: B Feedback: Class I, III, and IV agents should not be used during lactation; if they are needed, another method of feeding the baby should be used. This leaves only class II drugs for consideration if the mother is lactating.