The client has a diagnosis of junctional rhythm. The nurse would expect to find which of the following during the assessment of vital signs?
a. Heart
... [Show More] rate < 30
b. Heart rate 40-60
c. Heart rate 60-100
d. Heart rate 100-120
Answer: b. Heart rate 40-60
Objective: Classify dysrhythmias based on their location and type of rhythm abnormality.
Rationale: The AV node has a property of automaticity and can generate action potentials and continue heart contractions of 40-60 beats per minute.
Cognitive Level: Assessment
Client Need: Physiological Integrity
Nursing Process: Application
The nurse in the telemetry unit explains two nonpharmacological treatments such as ___________, or ___________, can be used to treat dysrhythmias.
a. ECG; pacemaker
b. Cardioversion; defibrillation
c. Aspirin; Plavix
d. Exercise; stress test
Answer: b. Cardioversion; defibrillation
Objective: Identify the importance of nonpharmacological therapies in the treatment of dysrhythmias.
Rationale: The more serious types of dysrhythmias are corrected through electrical shock of the heart, a treatment called elective cardioversion, or defibrillation.
Cognitive Level: Implementation
Client Need: Health Promotion and Maintenance
Nursing Process: Comprehension
The client is scheduled for implantable cardioverter defibrillators (ICD) for treatment of a dysrhythmia. The nurse explains that the action of this procedure is to:
a. Trigger electrical impulses to the heart.
b. Take over SA node function.
c. Block AV node transmission of impulses.
d. Increase ventricular conduction.
Answer: a. Trigger electrical impulses to the heart.
Objective: Identify the importance of nonpharmacological therapies in the treatment of dysrhythmias.
Rationale: Implantable cardioverter defibrillators (ICD) are placed in clients to restore normal rhythm by either pacing the heart or giving it an electric shock when dysrhythmias occur. Temporary cessation of electrical activity will stimulate the ICD to release a charge to the SA node to automatically return conduction to normal sinus rhythm.
Cognitive Level: Implementation
Client Need: Health Promotion and Maintenance
Nursing Process: Application
A priority nursing intervention for a client receiving quinidine sulfate (Quinidex) for treatment of dysrhythmias is:
a. Monitoring for GERD.
b. Monitoring respiratory status.
c. Monitoring for constipation.
d. Monitoring blood glucose.
Answer: b. Monitoring respiratory status.
Objective: Know representative drug examples for each of the drug classes listed in Drugs at a Glance, and explain their mechanisms of action, primary actions, and important adverse effects.
Rationale: Quinidine can cause an arterial embolism related to formation of small clots in the atrium that occur while the client is treated for atrial fibrillation.
Cognitive Level: Implementation
Client Need: Physiological Integrity
Nursing Process: Analysis
The nurse recognizes that the action of beta blockers for treatment of dysrhythmias is:
a. Positive inotropic effect.
b. Negative inotropic effect.
c. Positive chronotropic effect.
d. Negative chronotropic effect.
Answer: d. Negative chronotropic effect.
Objective: Identify the primary mechanisms of antidysrhythmic drugs.
Rationale: Beta blockers slow the heart rate (negative chronotropic effect) and decrease conduction velocity through the AV node.
Cognitive Level: Evaluation
Client Need: Physiological Integrity
Nursing Process: Knowledge
A client with a diagnosis of cardiac dysrhythmias and a history of type I diabetes mellitus is placed on propranolol therapy. The client asks the nurse if the drug will affect insulin needs. The best response by the nurse would be that:
a. The drug will have no effect on insulin needs.
b. The drug might cause hypoglycemia.
c. The drug could cause hyperglycemia.
d. The client should ask the physician this question.
Answer: b. The drug might cause hypoglycemia.
Objective: Know representative drug examples for each of the drug classes listed in Drugs at a Glance, and explain their mechanisms of action, primary actions, and important adverse effects.
Rationale: There is increased incidence of hypoglycemia with type I diabetes mellitus, because propranolol can inhibit glycogenolysis.
Cognitive Level: Implementation
Client Need: Health Promotion and Maintenance
Nursing Process: Synthesis
The nurse notes third-degree heart block on the EKG of a client receiving diltiazem (Cardizem) for treatment of a supraventricular dysrhythmia. The appropriate action by the nurse is to:
a. Administer the next dose as prescribed, and monitor the EKG.
b. Hold the next dose, document the EKG finding, and notify the physician.
c. Treat the heart block, and continue the Cardizem.
d. Increase IV fluids, and administer half the dose of Cardizem.
Answer: b. Hold the next dose, document the EKG finding, and notify the physician.
Objective: Describe the nurse's role in the pharmacologic management of clients with dysrhythmias.
Rationale: Diltiazem (Cardizem) should never be given to clients with sick sinus syndrome, heart block, hypotension, cardiogenic shock, or severe HF. The drug can produce lethal ventricular dysrhythmias.
Cognitive Level: Implementation
Client Need: Physiological Integrity
Nursing Process: Analysis
The nurse discusses mineral therapy with a client diagnosed with atrial fibrillation. Which of the following deficiencies will the nurse most likely discuss with the client?
a. Iron
b. Calcium
c. Magnesium
d. Sodium
Answer: c. Magnesium
Objective: Use the nursing process to care for clients receiving drug therapy for dysrhythmias.
Rationale: Magnesium deficiency is associated with dysrhythmias, including atrial fibrillation, premature atrial and ventricular contractions, ventricular tachycardia, and ventricular fibrillation. This might be related to its role in maintaining intracellular potassium.
Cognitive Level: Implementation
Client Need: Health Promotion and Maintenance
Nursing Process: Application
The nurse adjusts the care plan of a client of Asian descent who is receiving propranolol to include increased monitoring of:
a. Heart rate.
b. Blood pressure.
c. Glucose.
d. Potassium.
Answer: a. Heart rate.
Objective: Use the nursing process to care for clients receiving drug therapy for dysrhythmias.
Rationale: Studies show that lack of the drug-metabolizing enzyme mephenytoin hydroxylase causes Asians to metabolize propranolol more quickly than do Caucasians. The nurse should assess for high early buildup and overdose.
Cognitive Level: Planning
Client Need: Physiological Integrity
Nursing Process: Synthesis
When planning care for a client receiving treatment for cardiac dysrhythmias, an appropriate client outcome would be:
a. The client will avoid use of caffeine during therapy.
b. The client will maintain heart rate below 60 beats per minute.
c. The client will limit fluid intake to 1000 mL/day.
d. The client will limit cigarettes to 15/day.
Answer: a. The client will avoid use of caffeine during therapy.
Objective: Use the nursing process to care for clients receiving drug therapy for dysrhythmias.
Rationale: Causes of dysrhythmias include electrolyte imbalance, hyperthyroidism, anxiety, caffeine ingestion, and tobacco use. The client should be taught to avoid caffeine and tobacco.
Cognitive Level: Planning
Client Need: Physiological Integrity
Nursing Process: Application
A client with type 1 diabetes on insulin therapy reports that he takes propranolol (Inderal) for his hypertension. The nurse will teach the client to check glucose levels more frequently because of what concern?
1. The propranolol can produce insulin resistance.
2. The two drugs used together will increase the risk of ketoacidosis.
3. propranolol will increase insulin requirements by antagonizing the effects at the receptors.
4. The propranolol may mask symptoms of hypoglycemia
Answer: 4. The propranolol may mask symptoms of hypoglycemia
Rationale: Beta blockers such as propranolol decrease the body's adrenergic "fight-or-flight" resposes and may diminish or mask the symptoms and signals of hypoglycemia that a client with diabetes normally perceives as blood glucose drops. Options a, b and c are incorrect. Beta blockers may inhibit glycogenolysis, resulting in hypoglycemia, and have no effect on the development of insulin resistance.
Cognitive Level: Analyzing
Nursing Process: Implementation
Client Need: Physiological Integrity
When monitoring for therapeutic effect of any antidysrhythmic drug, the nurse would be sure to assess which essential parameter?
1. Pulse
2. Blood pressure
3. Drug level
4. Hourly urine output
Answer: 1. Pulse
Rationale: In the absence of ECG monitoring, the nurse would assess the pulse for rate, regularity, quality, and volume, noting any changes. The nurse should also teach the client to monitor the pulse for rate and regularity, before sending the client home. Options b, c, and d are incorrect. The nurse is monitoring for the therapeutic effects of antidysrhythmic therapy. Although blood pressure and drug level may also be monitored, they do not evaluate the therapeutic effects of the drug. Urine output may change related to the type of drug given and any effects on cardiac output, but frequent output monitoring is not indicated in routine antidysrhythmic therapy and will not assess for therapeutic drug effect.
Cognitive Level: Analyzing
Nursing Process: Evaluation
Client Need: Physiological Integrity
Verapamil (Calan, Covera-HS, Verelan) should be used with extra caution or is contraindicated in clients with which cardiovascular condition?
1. Hypertension
2. Tachycardia
3. Heart Failure
4. Angina
Answer: 3. Heart Failure
Rationale: Calcium channel blockers such as verapamil (Calan) are used cautiously or are contraindicated in clients with heart failure because the drug may cause bradycardia, which may precipitate or worsen heart failure. Options a, b and d are incorrect. Verapamil and calcium channel blockers are often prescribed to treat hypertension, tachycardia, and angina.
Cognitive Level: Analyzing
Nursing Process: Assessment
Client Need: Physiological Integrity
Common adverse effects of antidysrhythmic medications include which of the following? (Select all that apply)
1. Hypotension
2. Hypertension
3. Dizziness
4. Weakness
5. Panic attacks
Answers:
1. Hypotension
3. Dizziness
4. Weakness
Rationale: Because antidysrhythmics can slow the heart rate, the client may experience hypotension, dizziness, or weakness. Options b and e are incorrect. Some antidysrhythmics classes such as beta blockers and calcium channel blockers are used in the treatment of hypertension, which is a therapeutic rather than adverse effect of the drug. Antidysrhythmics are not used in the treatment of panic disorders.
Cognitive Level: Analyzing
Nursing Process: Assessment
Client Need: Physiological Integrity [Show Less]