1. A nurse is teaching a cardiac patient about the ability of the heart to generate an
electrical impulse. Which of the following teaching points should the nurse convey to
the patient?
A) “There are many different parts of your heart that can initiate an electrical impulse.”
B) “Electrical signals travel along the blood vessels that provide oxygen to your heart.”
C) “Your heart depends on your brainstem to initiate electrical signals.”
D) “The lining of your left ventricle is the site where electrical signals usually originate.”
Ans: A
Feedback:
Any part of the conduction system can spontaneously start an impulse, but the sinoatrial
(SA) node normally has the fastest rate of automaticity and therefore the faster rate of
spontaneous impulse formation. The SA node is located in the right atrium. The brain
does not initiate the electrical signal. Conduction does not exclusively follow blood
vessels.
2. A patient is administered medications for the treatment of a rapid dysrhythmia. What is
the mechanism of action for these medications?
A) Reducing automaticity
B) Increasing conduction
C) Repolarizing myocardial cells
D) Reducing refractory period
Ans: A
Feedback:
Drugs used for the treatment of rapid dysrhythmias mainly reduce automaticity. They
slow the conduction of electrical impulses through the heart. They spontaneously
depolarize myocardial cells. They prolong the refractory period of myocardial cells.
3. A patient is being treated with quinidine to reduce automaticity. The nurse should
advocate for a lower-than-normal dose if the patient has a history of
A) type 1 or type 2 diabetes.
B) primary hypertension.
C) liver disease.
D) chronic obstructive pulmonary disease.
Ans: C
Feedback:
Hepatic impairment increases the plasma half-life of several antidysrhythmic drugs,
including quinidine, and patients with hepatic impairment usually receive a reduced
dosage.
4. A patient has been prescribed disopyramide (Norpace) to treat chronic ventricular
tachycardia. The nurse's subsequent cardiac assessments and monitoring should be
planned in the knowledge that this drug has the potential to cause what health problem?
A) New-onset chest pain
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, B) Mitral valve regurgitation
C) Acute renal failure
D) New dysrhythmias
Ans: C
Feedback:
For disopyramide, the Food and Drug Administration (FDA) has issued a black box
warning because of the drug's known prodysrhythmic properties. It is not specifically
linked to chest pain, valvular regurgitation, or renal failure.
5. A patient is admitted to the emergency room with a ventricular dysrhythmia associated
with an acute myocardial infarction. The physician has ordered a bolus of lidocaine IV.
What assessment should the nurse make prior to administering this medication?
A) Assess for lidocaine administration in the patient's history.
B) Determine the patient's ability to swallow.
C) Assess the patient's nutritional history for allergies.
D) Determine if the patient has had a reaction to local anesthesia.
Ans: D
Feedback:
Lidocaine is contraindicated in patients allergic to local anesthetic agents. It is important
to determine if the patient has been administered lidocaine in the past, but it is
imperative to ascertain any untoward effects. The medication will be administered
intravenously, so it is not necessary to assess the patient's ability to swallow. However,
swallowing can be impaired after administration and should be assessed. It is not
necessary to do a nutritional assessment at this time.
6. A physician has ordered lidocaine IV for a patient with a ventricular dysrhythmia. The
nurse has administered a bolus of lidocaine. What is the recommended rate for
continuous infusion of lidocaine IV?
A) 0.25 to 0.75 mg/min
B) 10 to 20 mg/min
C) 1 to 4 mg/min
D) 6 to 8 mg/min
Ans: C
Feedback:
A continuous infusion of lidocaine IV after a bolus is 1 to 4 mg/min. The administration
of 0.25 to 0.75 mg/min would be too small of a dosage. The administration of 10 to 20
or 6 to 8 mg/min would be too large.
7. A patient is receiving an antidysrhythmic medication intravenously. How often should
the patient's blood pressure be assessed?
A) Once per shift
B) Every 1 to 5 minutes
C) Every 15 minutes
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