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Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/EChapter 29

Question 1Type: MCSAThe nurse is teaching a class on rhythm abnormalities to patients who have experienced dysrhythmias. The nurse knows that teaching has been effective when a patient makes which statement?

1. "Dysrhythmias cause serious electrolyte imbalances; this results in heart block."2. "Dysrhythmias are the result of long-standing, uncontrolled hypertension."3. "Dysrhythmias interrupt the normal electrical pathways in the heart so it can't beat properly."4. "Dysrhythmias alter the blood flow through the heart and cause it to stop beating."Correct Answer: 3Rationale 1: All dysrhythmias cause a defect in the generation or conduction of electrical impulses across the myocardium. Lack of synchronization of the atria and ventricles may have profound consequences such as decreasing cardiac output. Dysrhythmias do not alter blood flow through the heart. Some dysrhythmias may result in heart block, but dysrhythmias do not cause electrolyte imbalances. Dysrhythmias do not result from hypertension.Rationale 2: All dysrhythmias cause a defect in the generation or conduction of electrical impulses across the myocardium. Lack of synchronization of the atria and ventricles may have profound consequences such as decreasing cardiac output. Dysrhythmias do not alter blood flow through the heart. Some dysrhythmias may result in heart block, but dysrhythmias do not cause electrolyte imbalances. Dysrhythmias do not result from hypertension.Rationale 3: All dysrhythmias cause a defect in the generation or conduction of electrical impulses across the myocardium. Lack of synchronization of the atria and ventricles may have profound consequences such as decreasing cardiac output. Dysrhythmias do not alter blood flow through the heart. Some dysrhythmias may result in heart block, but dysrhythmias do not cause electrolyte imbalances. Dysrhythmias do not result from hypertension.Rationale 4: All dysrhythmias cause a defect in the generation or conduction of electrical impulses across the myocardium. Lack of synchronization of the atria and ventricles may have profound consequences such as decreasing cardiac output. Dysrhythmias do not alter blood flow through the heart. Some dysrhythmias may result in heart block, but dysrhythmias do not cause electrolyte imbalances. Dysrhythmias do not result from hypertension.Global Rationale: Cognitive Level: ApplyingClient Need: Physiological Integrity

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 29-1Question 2Type: MCMAThe patient tells the nurse, "This educational video you gave me shows normal electrical conduction through the heart, but I still don't understand it. Can you explain it to me?" What is (are) the nurse's best response(s)?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.1. "Conduction through the bundle of His is the slowest in the heart."2. "Conduction begins in the sinoatrial (SA) node and travels to the atrioventricular (AV) node.3. "Conduction continues through the bundle branches to the Purkinje fibers."4. "Conduction travels from the atrioventricular (AV) node through the bundle of His."5. "The sinoatrial (SA) node is located in the left atrium."Correct Answer: 2,3,4Rationale 1: Conduction through the heart originates in the sinoatrial (SA) node, travels through the atrioventricular (AV) node through the bundle of His to the right and left bundle branches to the Purkinje fibers. Conduction through the atrioventricular (AV) node is the slowest in the heart. The sinoatrial (SA) node is located in the right atrium.Rationale 2: Conduction through the heart originates in the sinoatrial (SA) node, travels through the atrioventricular (AV) node through the bundle of His to the right and left bundle branches to the Purkinje fibers. Conduction through the atrioventricular (AV) node is the slowest in the heart. The sinoatrial (SA) node is located in the right atrium.Rationale 3: Conduction through the heart originates in the sinoatrial (SA) node, travels through the atrioventricular (AV) node through the bundle of His to the right and left bundle branches to the Purkinje fibers. Conduction through the atrioventricular (AV) node is the slowest in the heart. The sinoatrial (SA) node is located in the right atrium.Rationale 4: Conduction through the heart originates in the sinoatrial (SA) node, travels through the atrioventricular (AV) node through the bundle of His to the right and left bundle branches to the Purkinje fibers. Conduction through the atrioventricular (AV) node is the slowest in the heart. The sinoatrial (SA) node is located in the right atrium.Rationale 5: Conduction through the heart originates in the sinoatrial (SA) node, travels through the atrioventricular (AV) node through the bundle of His to the right and left bundle branches to the Purkinje fibers. Conduction through the atrioventricular (AV) node is the slowest in the heart. The sinoatrial (SA) node is located in the right atrium.Global Rationale: Cognitive Level: ApplyingClient Need: Physiological Integrity

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 29-2Question 3Type: MCMAThe patient tells the nurse, "My doctor says I have atrial fibrillation. Is this serious and how is it treated?" What is (are) the best response(s) by the nurse?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.1. "This condition is best treated with what we call antidysrhythmic drugs."2. "This is very common; your doctor will discuss the best treatment with you."3. "Depending upon your symptoms, your doctor may use an electrical shock."4. "This is quite serious; did your doctor mention a heart transplant?"5. "It is very serious, even more serious than a ventricular dysrhythmia."Correct Answer: 2,3Rationale 1: Atrial fibrillation is the most common type of dysrhythmia. The physician will determine whether to use nonpharmalogical techniques such as cardioversion, or an implantable cardioverter defibrillator (ICD), or medication. Medications can cause serious side effects and are normally reserved for patients with overt symptoms, or for patients whose condition cannot be controlled by other means. Ventricular dysrhythmias are more serious than atrial dysrhythmias because they are more likely to interfere with the normal function of the heart. Heart transplants are not indicated for patients with dysrhythmias.Rationale 2: Atrial fibrillation is the most common type of dysrhythmia. The physician will determine whether to use nonpharmalogical techniques such as cardioversion, or an implantable cardioverter defibrillator (ICD), or medication. Medications can cause serious side effects and are normally reserved for patients with overt symptoms, or for patients whose condition cannot be controlled by other means. Ventricular dysrhythmias are more serious than atrial dysrhythmias because they are more likely to interfere with the normal function of the heart. Heart transplants are not indicated for patients with dysrhythmias.Rationale 3: Atrial fibrillation is the most common type of dysrhythmia. The physician will determine whether to use nonpharmalogical techniques such as cardioversion, or an implantable cardioverter defibrillator (ICD), or medication. Medications can cause serious side effects and are normally reserved for patients with overt symptoms, or for patients whose condition cannot be controlled by other means. Ventricular dysrhythmias are more serious than atrial dysrhythmias because they are more likely to interfere with the normal function of the heart. Heart transplants are not indicated for patients with dysrhythmias.Rationale 4: Atrial fibrillation is the most common type of dysrhythmia. The physician will determine whether to use nonpharmalogical techniques such as cardioversion, or an implantable cardioverter defibrillator (ICD), or medication. Medications can cause serious side effects and are normally reserved for patients with overt symptoms, or for patients whose condition cannot be controlled by other means. Ventricular dysrhythmias are more serious than atrial dysrhythmias because they are more likely to interfere with the normal function of the heart. Heart transplants are not indicated for patients with dysrhythmias.Rationale 5: Atrial fibrillation is the most common type of dysrhythmia. The physician will determine whether to use nonpharmalogical techniques such as cardioversion, or an implantable cardioverter defibrillator (ICD), or medication. Medications can cause serious side effects and are normally reserved for patients with overt symptoms, or for patients whose condition cannot be controlled by other means. Ventricular dysrhythmias are more serious than atrial dysrhythmias because they are more likely to interfere with the normal function of the heart. Heart transplants are not indicated for patients with dysrhythmias.Global Rationale: Cognitive Level: ApplyingClient Need: Physiological Integrity

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 29-3Question 4Type: MCSAThe nurse has been teaching a class on dysrhythmias to a group of patients with this disorder. The nurse determines that teaching has been effective when a patient makes which statement?

1. "Our sodium, potassium, and magnesium levels must be okay for our hearts to have an electrical impulse."2. "Potassium is the most important electrolyte when it comes to the electrical impulse in our hearts."3. "Our sodium, potassium, and calcium levels must be okay for our hearts to have an electrical impulse."4. "Enhancing potassium and sodium is how our medications will work to prevent dysrhythmias."Correct Answer: 3Rationale 1: Changes in sodium, potassium, and calcium levels generate the action potential in myocardial cells. For this to occur, the patient must have normal levels of sodium, potassium, and calcium. Changes in sodium, potassium, and calcium, not magnesium, levels generate the action potential in myocardial cells. Antidysrhythmic drugs work by blocking, not enhancing, potassium, sodium, or calcium channels. Sodium, potassium, and calcium are equally important when it comes to the myocardial action potential.Rationale 2: Changes in sodium, potassium, and calcium levels generate the action potential in myocardial cells. For this to occur, the patient must have normal levels of sodium, potassium, and calcium. Changes in sodium, potassium, and calcium, not magnesium, levels generate the action potential in myocardial cells. Antidysrhythmic drugs work by blocking, not enhancing, potassium, sodium, or calcium channels. Sodium, potassium, and calcium are equally important when it comes to the myocardial action potential.Rationale 3: Changes in sodium, potassium, and calcium levels generate the action potential in myocardial cells. For this to occur, the patient must have normal levels of sodium, potassium, and calcium. Changes in sodium, potassium, and calcium, not magnesium, levels generate the action potential in myocardial cells. Antidysrhythmic drugs work by blocking, not enhancing, potassium, sodium, or calcium channels. Sodium, potassium, and calcium are equally important when it comes to the myocardial action potential.Rationale 4: Changes in sodium, potassium, and calcium levels generate the action potential in myocardial cells. For this to occur, the patient must have normal levels of sodium, potassium, and calcium. Changes in sodium, potassium, and calcium, not magnesium, levels generate the action potential in myocardial cells. Antidysrhythmic drugs work by blocking, not enhancing, potassium, sodium, or calcium channels. Sodium, potassium, and calcium are equally important when it comes to the myocardial action potential.Global Rationale: Cognitive Level: ApplyingClient Need: Physiological Integrity

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 29-4Question 5Type: MCSAThe patient asks the nurse, "My doctor said I need cardioversion for my dysrhythmia. Why can't I just take medication?" What is the nurse's best response?

1. "Antidysrhythmic medications have many side effects; cardioversion is considered safer."2. "Special diets are necessary with antidysrhythmic medications and they are hard to follow."3. "Antidysrhythmic medications don't really work very well for most dysrhythmias."4. "There is a high risk of seizures when you take antidysrhythmic medications."Correct Answer: 1Rationale 1: Antidysrhythmic medications can cause serious side effects and are normally reserved for patients with overt symptoms, or for patients whose condition cannot be controlled by other means, such as cardioversion. Medications are effective for dysrhythmias; however they have many side effects. There is no indication for a special diet when a patient is taking an antidysrhythmic drug. Antidysrhythmic drugs do not commonly cause seizures.Rationale 2: Antidysrhythmic medications can cause serious side effects and are normally reserved for patients with overt symptoms, or for patients whose condition cannot be controlled by other means, such as cardioversion. Medications are effective for dysrhythmias; however they have many side effects. There is no indication for a special diet when a patient is taking an antidysrhythmic drug. Antidysrhythmic drugs do not commonly cause seizures.Rationale 3: Antidysrhythmic medications can cause serious side effects and are normally reserved for patients with overt symptoms, or for patients whose condition cannot be controlled by other means, such as cardioversion. Medications are effective for dysrhythmias; however they have many side effects. There is no indication for a special diet when a patient is taking an antidysrhythmic drug. Antidysrhythmic drugs do not commonly cause seizures.Rationale 4: Antidysrhythmic medications can cause serious side effects and are normally reserved for patients with overt symptoms, or for patients whose condition cannot be controlled by other means, such as cardioversion. Medications are effective for dysrhythmias; however they have many side effects. There is no indication for a special diet when a patient is taking an antidysrhythmic drug. Antidysrhythmic drugs do not commonly cause seizures.Global Rationale: Cognitive Level: ApplyingClient Need: Physiological Integrity

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 29-5Question 6Type: MCSAThe patient says to the nurse, "My neighbor said my antidysrhythmic drug can actually cause me to have irregular heartbeats. How can this be?" What is the nurse's best answer?

1. "Your medication blocks the flow of the electrolytes in your heart, and this can cause irregular beats."2. "It is better to discuss you medication concerns with a professional, not a lay person like your neighbor."3. "You must take two baby aspirins every other day to avoid the irregular heartbeats."4. "Your medication is not the problem; it is when you mix it with over-the-counter (OTC) drugs that you develop irregular beats."Correct Answer: 1Rationale 1: Most antidysrhythmic drugs act by interfering with myocardial action potentials, blocking the action of sodium, potassium, and calcium channels and causing some irregular beats. Mixing the medication with over-the-counter (OTC) medications might result in irregular beats, but this is not the best answer. Anticoagulant medication is sometimes indicated, but it does not require taking two doses of baby aspirin. Although it is best to discuss medications with a professional, this response does not answer the patient's question.Rationale 2: Most antidysrhythmic drugs act by interfering with myocardial action potentials, blocking the action of sodium, potassium, and calcium channels and causing some irregular beats. Mixing the medication with over-the-counter (OTC) medications might result in irregular beats, but this is not the best answer. Anticoagulant medication is sometimes indicated, but it does not require taking two doses of baby aspirin. Although it is best to discuss medications with a professional, this response does not answer the patient's question.Rationale 3: Most antidysrhythmic drugs act by interfering with myocardial action potentials, blocking the action of sodium, potassium, and calcium channels and causing some irregular beats. Mixing the medication with over-the-counter (OTC) medications might result in irregular beats, but this is not the best answer. Anticoagulant medication is sometimes indicated, but it does not require taking two doses of baby aspirin. Although it is best to discuss medications with a professional, this response does not answer the patient's question.Rationale 4: Most antidysrhythmic drugs act by interfering with myocardial action potentials, blocking the action of sodium, potassium, and calcium channels and causing some irregular beats. Mixing the medication with over-the-counter (OTC) medications might result in irregular beats, but this is not the best answer. Anticoagulant medication is sometimes indicated, but it does not require taking two doses of baby aspirin. Although it is best to discuss medications with a professional, this response does not answer the patient's question.Global Rationale: Cognitive Level: ApplyingClient Need: Physiological Integrity

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 29-6Question 7Type: MCSAThe nurse is managing care for a group of patients receiving antidysrhythmic medication. Which assessment data will the nurse report to the physician?

1. Depression, irritability, fatigue, and nausea2. Anorexia, insomnia, confusion, and 11 pitting peripheral edema3. Low-grade fever, diaphoresis, weakness, and dry mucous membranes4. Palpitations, chest pain, weakness, and fatigueCorrect Answer: 4Rationale 1: Side effects of antidysrhythmic medications include palpitations, chest pain, weakness, and fatigue. Low-grade fever, diaphoresis, weakness, and dry mucous membranes are not side effects of antidysrhythmic medications. Anorexia, insomnia, confusion, and 11 pitting peripheral edema are not side effects of antidysrhythmic medications. Depression, irritability, fatigue, and nausea are not side effects of antidysrhythmic medications.Rationale 2: Side effects of antidysrhythmic medications include palpitations, chest pain, weakness, and fatigue. Low-grade fever, diaphoresis, weakness, and dry mucous membranes are not side effects of antidysrhythmic medications. Anorexia, insomnia, confusion, and 11 pitting peripheral edema are not side effects of antidysrhythmic medications. Depression, irritability, fatigue, and nausea are not side effects of antidysrhythmic medications.Rationale 3: Side effects of antidysrhythmic medications include palpitations, chest pain, weakness, and fatigue. Low-grade fever, diaphoresis, weakness, and dry mucous membranes are not side effects of antidysrhythmic medications. Anorexia, insomnia, confusion, and 11 pitting peripheral edema are not side effects of antidysrhythmic medications. Depression, irritability, fatigue, and nausea are not side effects of antidysrhythmic medications.Rationale 4: Side effects of antidysrhythmic medications include palpitations, chest pain, weakness, and fatigue. Low-grade fever, diaphoresis, weakness, and dry mucous membranes are not side effects of antidysrhythmic medications. Anorexia, insomnia, confusion, and 11 pitting peripheral edema are not side effects of antidysrhythmic medications. Depression, irritability, fatigue, and nausea are not side effects of antidysrhythmic medications.Global Rationale: Cognitive Level: ApplyingClient Need: Physiological Integrity

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 29-7Question 8Type: MCSAThe patient is receiving procainamide hydrochloride (Pronestyl) for treatment of a dysrhythmia. What is the best patient outcome for medication compliance?

1. The patient will take his medication with food.2. The patient will take his medication on an empty stomach.3. The patient will take his medication as directed, even if he is feeling well.4. The patient will monitor his pulse and hold his medication if his pulse is less than 60.Correct Answer: 3Rationale 1: It is very important for patients to understand that medication must be taken as directed, even if the patient is feeling well. Procainamide hydrochloride (Pronestyl) drug can be taken on an empty stomach. The beta-adrenergic blocking drugs cause bradycardia, not Group 1A cardiac antiarrhythmic drugs like procainamide hydrochloride (Pronestyl). Procainamide hydrochloride (Pronestyl) can be taken with food.Rationale 2: It is very important for patients to understand that medication must be taken as directed, even if the patient is feeling well. Procainamide hydrochloride (Pronestyl) drug can be taken on an empty stomach. The beta-adrenergic blocking drugs cause bradycardia, not Group 1A cardiac antiarrhythmic drugs like procainamide hydrochloride (Pronestyl). Procainamide hydrochloride (Pronestyl) can be taken with food.Rationale 3: It is very important for patients to understand that medication must be taken as directed, even if the patient is feeling well. Procainamide hydrochloride (Pronestyl) drug can be taken on an empty stomach. The beta-adrenergic blocking drugs cause bradycardia, not Group 1A cardiac antiarrhythmic drugs like procainamide hydrochloride (Pronestyl). Procainamide hydrochloride (Pronestyl) can be taken with food.Rationale 4: It is very important for patients to understand that medication must be taken as directed, even if the patient is feeling well. Procainamide hydrochloride (Pronestyl) drug can be taken on an empty stomach. The beta-adrenergic blocking drugs cause bradycardia, not Group 1A cardiac antiarrhythmic drugs like procainamide hydrochloride (Pronestyl). Procainamide hydrochloride (Pronestyl) can be taken with food.Global Rationale: Cognitive Level: ApplyingClient Need: Physiological Integrity

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 29-8Question 9Type: MCSAThe male patient has been receiving propranolol (Inderal) for treatment of a dysrhythmia for 6 weeks. What is an important question for the nurse to ask the patient when assessing medication compliance?

1. "Have you noticed any changes in your sexual functioning?"2. "Has your appetite increased or decreased?"3. "Have you noticed any changes in your bowel function?"4. "Have you noticed any difficulty in your ability to concentrate?"Correct Answer: 1Rationale 1: Side effects such as diminished libido and impotence may result in noncompliance in male patients. Change in bowel function is not an adverse effect of propranolol (Inderal). Appetite is not affected by propranolol (Inderal). Ability to concentrate is not an adverse effect of propranolol (Inderal) except in the elderly who are receiving high doses.Rationale 2: Side effects such as diminished libido and impotence may result in noncompliance in male patients. Change in bowel function is not an adverse effect of propranolol (Inderal). Appetite is not affected by propranolol (Inderal). Ability to concentrate is not an adverse effect of propranolol (Inderal) except in the elderly who are receiving high doses.Rationale 3: Side effects such as diminished libido and impotence may result in noncompliance in male patients. Change in bowel function is not an adverse effect of propranolol (Inderal). Appetite is not affected by propranolol (Inderal). Ability to concentrate is not an adverse effect of propranolol (Inderal) except in the elderly who are receiving high doses.Rationale 4: Side effects such as diminished libido and impotence may result in noncompliance in male patients. Change in bowel function is not an adverse effect of propranolol (Inderal). Appetite is not affected by propranolol (Inderal). Ability to concentrate is not an adverse effect of propranolol (Inderal) except in the elderly who are receiving high doses.Global Rationale: Cognitive Level: ApplyingClient Need: Physiological Integrity

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 29-10Question 10Type: MCSAThe patient with type 1 diabetes mellitus is receiving propranolol (Inderal). What is the best outcome for this patient?

1. The patient will maintain blood glucose within normal limits.2. The patient will decrease the required number of calories/day.3. The patient will maintain adequate peripheral circulation.4. The patient will perform activities of daily living.Correct Answer: 1Rationale 1: Propranolol (Inderal) should be used cautiously in patients with type 1 diabetes mellitus due to its hypoglycemic effects. Peripheral circulation should not be affected by propranolol (Inderal). Activities of daily living are important for any patient, but should not be affected by propranolol (Inderal). Propranolol (Inderal) should not affect the patient's appetite; the patient should not decrease calories.Rationale 2: Propranolol (Inderal) should be used cautiously in patients with type 1 diabetes mellitus due to its hypoglycemic effects. Peripheral circulation should not be affected by propranolol (Inderal). Activities of daily living are important for any patient, but should not be affected by propranolol (Inderal). Propranolol (Inderal) should not affect the patient's appetite; the patient should not decrease calories.Rationale 3: Propranolol (Inderal) should be used cautiously in patients with type 1 diabetes mellitus due to its hypoglycemic effects. Peripheral circulation should not be affected by propranolol (Inderal). Activities of daily living are important for any patient, but should not be affected by propranolol (Inderal). Propranolol (Inderal) should not affect the patient's appetite; the patient should not decrease calories.Rationale 4: Propranolol (Inderal) should be used cautiously in patients with type 1 diabetes mellitus due to its hypoglycemic effects. Peripheral circulation should not be affected by propranolol (Inderal). Activities of daily living are important for any patient, but should not be affected by propranolol (Inderal). Propranolol (Inderal) should not affect the patient's appetite; the patient should not decrease calories.Global Rationale: Cognitive Level: ApplyingClient Need: Physiological Integrity

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 29-8Question 11Type: MCSAThe nurse completes medication education with a patient who receives propranolol (Inderal). The nurse evaluates the education as effective when the patient makes which statement?

1. I must take my pulse every day and call my doctor if it is higher than 100."2. "I must call my doctor if my anxiety increases and I start worrying again."3. "I must take my pulse every day and call my doctor if it is less than 60."4. "I must call my doctor if I lose more than three pounds a week."Correct Answer: 3Rationale 1: Beta blockers decrease contractions of the myocardium and decrease the speed of conduction through the atrioventricular (AV) node. This can result in a significant decrease in heart rate, and the patient should let the physician know if his heart rate falls below 60. Beta blockers decrease, not increase, the heart rate. Beta blockers predispose the patient to weight gain, not weight loss. Beta blockers actually decrease, not increase, anxiety.Rationale 2: Beta blockers decrease contractions of the myocardium and decrease the speed of conduction through the atrioventricular (AV) node. This can result in a significant decrease in heart rate, and the patient should let the physician know if his heart rate falls below 60. Beta blockers decrease, not increase, the heart rate. Beta blockers predispose the patient to weight gain, not weight loss. Beta blockers actually decrease, not increase, anxiety.Rationale 3: Beta blockers decrease contractions of the myocardium and decrease the speed of conduction through the atrioventricular (AV) node. This can result in a significant decrease in heart rate, and the patient should let the physician know if his heart rate falls below 60. Beta blockers decrease, not increase, the heart rate. Beta blockers predispose the patient to weight gain, not weight loss. Beta blockers actually decrease, not increase, anxiety.Rationale 4: Beta blockers decrease contractions of the myocardium and decrease the speed of conduction through the atrioventricular (AV) node. This can result in a significant decrease in heart rate, and the patient should let the physician know if his heart rate falls below 60. Beta blockers decrease, not increase, the heart rate. Beta blockers predispose the patient to weight gain, not weight loss. Beta blockers actually decrease, not increase, anxiety.Global Rationale: Cognitive Level: ApplyingClient Need: Physiological Integrity

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 29-9Question 12Type: MCSAThe patient receives amiodarone (Cordarone). The nurse would be concerned about which additional medication that a consulting physician might order?

1. Oxycodone (OxyContin)2. Omeprazole (Prilosec)3. Digoxin (Lanoxin)4. Fluoxetine (Prozac)Correct Answer: 3Rationale 1: Amiodarone (Cordarone) can increase serum digoxin (Lanoxin) levels by as much as 70%, resulting in digoxin (Lanoxin) toxicity. Oxycodone (OxyContin) has no interactions with amiodarone (Cordarone). Fluoxetine (Prozac) has no interactions with amiodarone (Cordarone). Omeprazole (Prilosec) has no interactions with amiodarone (Cordarone).Rationale 2: Amiodarone (Cordarone) can increase serum digoxin (Lanoxin) levels by as much as 70%, resulting in digoxin (Lanoxin) toxicity. Oxycodone (OxyContin) has no interactions with amiodarone (Cordarone). Fluoxetine (Prozac) has no interactions with amiodarone (Cordarone). Omeprazole (Prilosec) has no interactions with amiodarone (Cordarone).Rationale 3: Amiodarone (Cordarone) can increase serum digoxin (Lanoxin) levels by as much as 70%, resulting in digoxin (Lanoxin) toxicity. Oxycodone (OxyContin) has no interactions with amiodarone (Cordarone). Fluoxetine (Prozac) has no interactions with amiodarone (Cordarone). Omeprazole (Prilosec) has no interactions with amiodarone (Cordarone).Rationale 4: Amiodarone (Cordarone) can increase serum digoxin (Lanoxin) levels by as much as 70%, resulting in digoxin (Lanoxin) toxicity. Oxycodone (OxyContin) has no interactions with amiodarone (Cordarone). Fluoxetine (Prozac) has no interactions with amiodarone (Cordarone). Omeprazole (Prilosec) has no interactions with amiodarone (Cordarone).Global Rationale: Cognitive Level: ApplyingClient Need: Physiological Integrity

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 29-8Question 13Type: MCSAThe physician has ordered amiodarone (Cordarone). Prior to starting this medication, the nurse would alert the physician to which laboratory result?

1. Sodium 140 mEq/L2. Potassium 3.1 mEq/L3. Potassium 5.1 mEq/L4. International normalized ratio (INR) of 12 secondsCorrect Answer: 2Rationale 1: Hypokalemia and hypomagnesemia should be corrected prior to initiating therapy with amiodarone (Cordarone). 5.1 mEq/L is a normal potassium level. 140 mEq/L is a normal sodium level. Twelve seconds is a normal international normalized ratio (INR) level.Rationale 2: Hypokalemia and hypomagnesemia should be corrected prior to initiating therapy with amiodarone (Cordarone). 5.1 mEq/L is a normal potassium level. 140 mEq/L is a normal sodium level. Twelve seconds is a normal international normalized ratio (INR) level.Rationale 3: Hypokalemia and hypomagnesemia should be corrected prior to initiating therapy with amiodarone (Cordarone). 5.1 mEq/L is a normal potassium level. 140 mEq/L is a normal sodium level. Twelve seconds is a normal international normalized ratio (INR) level.Rationale 4: Hypokalemia and hypomagnesemia should be corrected prior to initiating therapy with amiodarone (Cordarone). 5.1 mEq/L is a normal potassium level. 140 mEq/L is a normal sodium level. Twelve seconds is a normal international normalized ratio (INR) level.Global Rationale: Cognitive Level: ApplyingClient Need: Physiological Integrity

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 29-10Question 14Type: MCSAThe patient receives verapamil (Calan). The patient tells the nurse that he is nervous about taking this medicine. What is the best response by the nurse?

1. "This medicine is safe, and most patients do very well with it."2. "This medicine increases your blood pressure, but we will be monitoring that."3. "This medicine has many side effects, but you should be okay."4. "This medicine is a potassium channel blocker and is considered safe."Correct Answer: 1Rationale 1: Calcium channel blockers are safe medications that are well tolerated by most patients. All medications have side effects, but telling the patient that he should be okay is not very reassuring. Verapamil (Calan) is a calcium channel blocker, not a potassium channel blocker. Verapamil (Calan) lowers, not increases, blood pressure and decreases cardiac workload.Rationale 2: Calcium channel blockers are safe medications that are well tolerated by most patients. All medications have side effects, but telling the patient that he should be okay is not very reassuring. Verapamil (Calan) is a calcium channel blocker, not a potassium channel blocker. Verapamil (Calan) lowers, not increases, blood pressure and decreases cardiac workload.Rationale 3: Calcium channel blockers are safe medications that are well tolerated by most patients. All medications have side effects, but telling the patient that he should be okay is not very reassuring. Verapamil (Calan) is a calcium channel blocker, not a potassium channel blocker. Verapamil (Calan) lowers, not increases, blood pressure and decreases cardiac workload.Rationale 4: Calcium channel blockers are safe medications that are well tolerated by most patients. All medications have side effects, but telling the patient that he should be okay is not very reassuring. Verapamil (Calan) is a calcium channel blocker, not a potassium channel blocker. Verapamil (Calan) lowers, not increases, blood pressure and decreases cardiac workload.Global Rationale: Cognitive Level: ApplyingClient Need: Physiological Integrity

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 29-9Question 15Type: MCSAThe patient receives verapamil (Calan). The patient asks the nurse if it is okay to take herbal supplements with this medicine. What is the best response by the nurse?

1. "Using herbal supplements may increase your blood pressure too much."2. "Herbal supplements are okay as long as you take calcium salts with them."3. "Using herbal supplements may lower your blood pressure too much."4. "Most herbal supplements are okay, but you should avoid St. John's wort."Correct Answer: 3Rationale 1: Verapamil (Calan) should be used with caution with herbal supplements, such as hawthorn, because of the potential for additive hypotensive effects. All herbal supplements, not just St. John's wort, should be avoided. Taking calcium salts with herbal supplements will not affect the interactions with verapamil (Calan). Herbal supplements may lower, not increase, blood pressure.Rationale 2: Verapamil (Calan) should be used with caution with herbal supplements, such as hawthorn, because of the potential for additive hypotensive effects. All herbal supplements, not just St. John's wort, should be avoided. Taking calcium salts with herbal supplements will not affect the interactions with verapamil (Calan). Herbal supplements may lower, not increase, blood pressure.Rationale 3: Verapamil (Calan) should be used with caution with herbal supplements, such as hawthorn, because of the potential for additive hypotensive effects. All herbal supplements, not just St. John's wort, should be avoided. Taking calcium salts with herbal supplements will not affect the interactions with verapamil (Calan). Herbal supplements may lower, not increase, blood pressure.Rationale 4: Verapamil (Calan) should be used with caution with herbal supplements, such as hawthorn, because of the potential for additive hypotensive effects. All herbal supplements, not just St. John's wort, should be avoided. Taking calcium salts with herbal supplements will not affect the interactions with verapamil (Calan). Herbal supplements may lower, not increase, blood pressure.Global Rationale: Cognitive Level: ApplyingClient Need: Physiological Integrity

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 29-8Question 16Type: MCSAWhich of the following statements best explains what happens to cardiac output when the heart rate gets extremely high?

1. Cardiac output is not generally affected by rapid heart rates.2. Cardiac output lowers when the rapid rate doesnt allow enough time for complete filling of the heart chambers.3. Cardiac output will continue to increase as long as the heart rate continues to increase.4. Cardiac output will increase until the heart rate reaches 150 bpm, at which time it will no longer be affected.Correct Answer: 2Rationale 1: Cardiac output lowers when the rapid rate doesnt allow enough time for complete filling of the heart chambers.Rationale 2: Cardiac output lowers when the rapid rate doesnt allow enough time for complete filling of the heart chambers.Rationale 3: Cardiac output lowers when the rapid rate doesnt allow enough time for complete filling of the heart chambers.Rationale 4: Cardiac output lowers when the rapid rate doesnt allow enough time for complete filling of the heart chambers.Global Rationale: Cognitive Level: UnderstandingClient Need: Physiological Integrity

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 29-1Question 17Type: MCSAIn a person with a sinus rhythm, the primary purpose of the AV node is to

1. pace the heart at 4060 bpm.2. delay the impulse from the SA node.3. pace the heart at 60100 bpm.4. inhibit the impulse from the SA node.Correct Answer: 2Rationale 1: The AV node delays the impulse as it travels from the atria to the ventricles. The AV junction does pace the heart at 4060 bpm, but not when the SA node is pacing the heart. Rationale 2: The AV node delays the impulse as it travels from the atria to the ventricles. The AV junction does pace the heart at 4060 bpm, but not when the SA node is pacing the heart. Rationale 3: The AV node delays the impulse as it travels from the atria to the ventricles. The AV junction does pace the heart at 4060 bpm, but not when the SA node is pacing the heart. Rationale 4: The AV node delays the impulse as it travels from the atria to the ventricles. The AV junction does pace the heart at 4060 bpm, but not when the SA node is pacing the heart. Global Rationale: Cognitive Level: RememberingClient Need: Physiological Integrity

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 29-2Question 18Type: MCSAA person with a heart rate of 170 bpm and a normal QRS duration would most likely be experiencing a

1. yachydysrhythmia originating from the bundle branches.2. tachydysrhythmia originating from the atria.3. tachydysrhythmia originating from the ventricles.4. tachydysrhythmia originating from the Purkinje fibers.Correct Answer: 2Rationale 1: Given a normal QRS duration, the rhythm is not coming from the ventricles but from the atria. Rationale 2: Given a normal QRS duration, the rhythm is not coming from the ventricles but from the atria. Rationale 3: Given a normal QRS duration, the rhythm is not coming from the ventricles but from the atria. Rationale 4: Given a normal QRS duration, the rhythm is not coming from the ventricles but from the atria. Global Rationale: Cognitive Level: UnderstandingClient Need: Physiological Integrity

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 29-3Question 19Type: MCSADepolarization occurs when which two electrolytes rush into the cell?

1. Sodium and potassium2. Calcium and magnesium3. Calcium and sodium4. Chloride and potassiumCorrect Answer: 3Rationale 1: An action potential begins when sodium and calcium flow into the cell, resulting in depolarization. Rationale 2: An action potential begins when sodium and calcium flow into the cell, resulting in depolarization. Rationale 3: An action potential begins when sodium and calcium flow into the cell, resulting in depolarization. Rationale 4: An action potential begins when sodium and calcium flow into the cell, resulting in depolarization. Global Rationale: Cognitive Level: RememberingClient Need: Physiological Integrity

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 29-4Question 20Type: MCSAWhich adverse effect is shared among all antidysrhythmic drugs?

1. Edema2. Impotence3. Photosensitivity4. Prodysrhythmic effectsCorrect Answer: 4Rationale 1: All antidysrhythmic agents can worsen existing dysrhythmias or create new ones. Rationale 2: All antidysrhythmic agents can worsen existing dysrhythmias or create new ones. Rationale 3: All antidysrhythmic agents can worsen existing dysrhythmias or create new ones. Rationale 4: All antidysrhythmic agents can worsen existing dysrhythmias or create new ones. Global Rationale: Cognitive Level: RememberingClient Need: Physiological Integrity

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 29-8Question 21Type: MCSAWhich of the following drugs is the primary agent for paroxysmal supraventricular tachycardia (PSVT)?

1. Flecainide (Tambocor)2. Adenosine (Adenocard)3. Lidocaine (Xylocaine)4. Procainamide (Pronestyl)Correct Answer: 2Rationale 1: Adenosine is the drug of choice for PSVT. Procainamide may be used for supraventricular dysrhythmias, but is not the primary drug for PSVT. Lidocaine and flecainide are indicated for ventricular dysrhythmias. Rationale 2: Adenosine is the drug of choice for PSVT. Procainamide may be used for supraventricular dysrhythmias, but is not the primary drug for PSVT. Lidocaine and flecainide are indicated for ventricular dysrhythmias. Rationale 3: Adenosine is the drug of choice for PSVT. Procainamide may be used for supraventricular dysrhythmias, but is not the primary drug for PSVT. Lidocaine and flecainide are indicated for ventricular dysrhythmias. Rationale 4: Adenosine is the drug of choice for PSVT. Procainamide may be used for supraventricular dysrhythmias, but is not the primary drug for PSVT. Lidocaine and flecainide are indicated for ventricular dysrhythmias. Global Rationale: Cognitive Level: RememberingClient Need: Physiological Integrity

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 29-8Question 22Type: MCSAWhich antidysrhythmic agent also dilates coronary arteries, and is frequently used to treat angina?

1. Verapamil (Calan)2. Amiodarone (Cordarone)3. Procainamide (Pronestyl)4. Lidocaine (Xylocaine)Correct Answer: 1Rationale 1: Verapamil is a calcium channel blocker that is often used to treat angina by dilating coronary arteries. Rationale 2: Verapamil is a calcium channel blocker that is often used to treat angina by dilating coronary arteries. Rationale 3: Verapamil is a calcium channel blocker that is often used to treat angina by dilating coronary arteries. Rationale 4: Verapamil is a calcium channel blocker that is often used to treat angina by dilating coronary arteries. Global Rationale: Cognitive Level: RememberingClient Need: Physiological Integrity

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 29-8Question 23Type: MCSAWhich drug would be indicated for treating ventricular tachycardia?

1. Lidocaine (Xylocaine)2. Verapamil (Calan)3. Diltiazem (Cardizem)4. Atropine (Atropair)Correct Answer: 1Rationale 1: Lidocaine is a sodium channel blocker, and is indicated for ventricular dysrhythmias. Verapamil and diltiazem are calcium channel blockers indicated for atrial dysrhythmias. Atropine is a cholinergic-blocking agent, and causes an increase in heart rate. Rationale 2: Lidocaine is a sodium channel blocker, and is indicated for ventricular dysrhythmias. Verapamil and diltiazem are calcium channel blockers indicated for atrial dysrhythmias. Atropine is a cholinergic-blocking agent, and causes an increase in heart rate. Rationale 3: Lidocaine is a sodium channel blocker, and is indicated for ventricular dysrhythmias. Verapamil and diltiazem are calcium channel blockers indicated for atrial dysrhythmias. Atropine is a cholinergic-blocking agent, and causes an increase in heart rate. Rationale 4: Lidocaine is a sodium channel blocker, and is indicated for ventricular dysrhythmias. Verapamil and diltiazem are calcium channel blockers indicated for atrial dysrhythmias. Atropine is a cholinergic-blocking agent, and causes an increase in heart rate. Global Rationale: Cognitive Level: RememberingClient Need: Physiological Integrity

Client Need Sub: Nursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 29-8Question 24Type: MCMAThe nurse is writing a care plan for a patient who has been started on an antiarrhythmic drug for complaints of chest pain and palpitations. The patient says, "I can't do what I once did. I just do not have any energy." Which nursing diagnoses would the nurse likely include in this care plan?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.1. Decreased Cardiac Output2. Ineffective Breathing Pattern3. Activity Intolerance4. Ineffective Individual Coping5. Impaired Gas ExchangeCorrect Answer: 1,3Rationale 1: Decreased cardiac output is a common occurrence in patients who have palpitations and may be the etiology of the patient's chest pain.Rationale 2: There is no evidence that this patient is not breathing effectively and not enough information to decide that the patient is at risk of developing problems breathing.Rationale 3: The statement "I can't do what I once did" is an indicator that the patient is not tolerating normal amounts of activity.Rationale 4: There is no evidence that this patient is not coping with the illness.Rationale 5: To support this nursing diagnosis, the patient must have alterations in arterial blood gases.Global Rationale: Cognitive Level: AnalyzingClient Need: Physiological Integrity

Client Need Sub: Physiological AdaptationNursing/Integrated Concepts: Nursing Process: DiagnosisLearning Outcome: 29-8Question 25Type: MCMAThe nurse and a home health patient have established this expected outcome: "The patient will be free from adverse effects of administration of diltiazem (Cardizem)." Which finding indicates this outcome has not been met?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.1. The patient complains of headache at each visit by the nurse.2. The patient has 3+ edema in the ankles and feet.3. The patient says, "Everything I eat tastes like metal."4. The patient says, "I got so dizzy yesterday that I had to lie down for a while."5. The patient's face is flushed.Correct Answer: 1,2,4Rationale 1: Headache is a potential adverse effect of diltiazem.Rationale 2: Edema of the ankles and feet is a potential adverse effect of diltiazem.Rationale 3: Metallic taste is not an expected adverse effect of diltiazem.Rationale 4: Dizziness is an expected adverse effect of diltiazem.Rationale 5: Facial flushing is not an expected adverse effect of diltiazem.Global Rationale: Cognitive Level: AnalyzingClient Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 29-8Question 26Type: MCMAA patient is prescribed an additional once-daily antidysrhythmic drug to control persistent atrial fibrillation. What instructions should the nurse provide for this patient?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.1. "Take your first dose of this new medication before you go to bed tonight."2. "Do not eat or drink anything for 2 hours after taking the new medication."3. "Before you get out of bed in the morning, sit up on the side of the bed for a few minutes."4. "Plan to return to the clinic to have your electrolytes checked in 2 weeks."5. "Contact the clinic if you notice any loss of hair from your head."Correct Answer: 1,3,4Rationale 1: The addition of a second medication makes the patient prone to hypotension. Taking the drug right before bedtime is a safety precaution.Rationale 2: There is no reason to avoid oral intake for 2 hours after an antidysrhythmic medication.Rationale 3: Orthostatic hypotension can be an adverse effect of antidysrhythmic medications, particularly when multiple drugs are taken. Sitting on the side of the bed before arising is a safety precaution.Rationale 4: Electrolyte imbalance can occur secondary to drug therapy for dysrhythmia. Electrolyte levels should be monitored.Rationale 5: Hair loss is not an expected adverse effect of antidysrhythmic medications.Global Rationale: Cognitive Level: AnalyzingClient Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 29-8Question 27Type: MCMAA patient has been taking a potassium channel blocker for 4 weeks. Which statements would indicate to the nurse that additional time for teaching about the medication should be planned?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.1. "I got some sunglasses like you said. Do you like them?"2. "Do you have any idea what this rash on my neck and arm is?"3. "I must be getting cataracts. I can't see anything anymore."4. "I wear sunscreen whenever I am outdoors."5. "I think that medicine is making my hair gray."Correct Answer: 2,3,5Rationale 1: Potassium channel blockers can cause photosensitivity, and wearing sunglasses protects the eyes.Rationale 2: Potassium channel blockers can cause skin rashes.Rationale 3: Potassium channel blockers may cause blurred vision.Rationale 4: Potassium channel blockers cause increased risk of sunburn.Rationale 5: There is no connection between potassium channel blockers and the development of gray hair.Global Rationale: Cognitive Level: AnalyzingClient Need: Physiological Integrity

Client Need Sub: Physiological AdaptationNursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 29-8Question 28Type: MCMAThe nurse is providing information for a patient who will self-administer a twice-daily antidysrhythmic medication at home. Which patient statement would the nurse evaluate as indicating good understanding of this process?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.1. "If I get the flu, I should stop taking the medication until my fever goes down."2. "I should take my doses as close to 12 hours apart as I can."3. "If I forget a dose of medication I should take two pills for the next dose."4. "If I can't take the medication for a couple of days because I am sick, I should call the clinic for advice."5. "I should get my prescription refilled before I am completely out of medicine."Correct Answer: 2,4,5Rationale 1: Antidysrhythmic medications should not be stopped abruptly.Rationale 2: Doses of antidysrhythmic medications should be evenly spaced.Rationale 3: Antidysrhythmic medications should not be double-dosed to make up for missed doses.Rationale 4: The health care provider should be consulted if the patient is going to miss medication for more than 1 day.Rationale 5: Abrupt discontinuation of antidysrhythmic medications can have serious side effects, so an adequate supply of the medication should be available.Global Rationale: Cognitive Level: AnalyzingClient Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 29-8Question 29Type: MCMAA patient who has been taking medication for a month for an atrial dysrhythmia returns to the clinic for a checkup. Which statements indicate the nurse should plan extra time with the patient for additional teaching?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply.1. "Since I can't drink coffee anymore, I have started drinking diet cola in the mornings."2. "I have found that a glass of wine after work and one with dinner helps me to relax from my stressful job."3. "We have celebrated several birthdays since I saw you last. I love chocolate birthday cake."4. "I have really worked at stopping my smoking since I was last here."5. "My friends and I have found several restaurants in our area that offer good, low-fat meals."Correct Answer: 1,2,3Rationale 1: Unless the diet cola is decaffeinated, it should also be avoided.Rationale 2: Alcohol should be limited when taking medications for atrial arrhythmias.Rationale 3: Chocolate contains caffeine, which should be avoided when taking medications for atrial arrhythmias.Rationale 4: Smoking cessation should be encouraged in patients taking medications for atrial dysrhythmia.Rationale 5: Lowered fat intake is encouraged in patients taking medications for atrial arrhythmias.Global Rationale: Cognitive Level: AnalyzingClient Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 29-8Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.