A client accidentally took double their dose of metoprolol when confused about the directions. The nurse expects which of the following to occur?
The client will experience bradycardia.
✓
The client will experience torsade de pointes.
The client will experience tachycardia.
The client will experience a long QT interval.
Correct Answer
The client will experience bradycardia.
Metoprolol is a beta-adrenergic blocker that slows the heart rate. If a client takes too much metoprolol, they may experience bradycardia.
Question 2
A nurse has an order to administer verapamil to a client with atrial fibrillation. The client has a past medical history of hyperlipidemia, type 2 diabetes, myasthenia gravis, and congestive heart failure. Which disease state may be exacerbated by administration of verapamil?
Congestive heart failure
✓
Myasthenia gravis
Hyperlipidemia
Type 2 diabetes
Correct Answer
Congestive heart failure
Verapamil is a nondihydropyridine calcium channel blocker. It can decrease cardiac contractility, which can exacerbate congestive heart failure.
Question 3
A nurse is creating a monitoring protocol for drugs that require special monitoring of the QT interval. Which drug will be included?
Lidocaine
Procainamide
✓
Mexiletine
Flecainide
Correct Answer
Procainamide
Procainamide is a sodium channel blocker antidysrhythmic drug, but it also has activity as a potassium channel blocker. Potassium blocker drugs require monitoring of the QT interval.
Question 4
A nurse provided education to a client who will be taking quinidine long term. Which response from the client indicates the teaching was effective?
"I should start taking a laxative to prevent the most common side effect, constipation."
"I should drink grapefruit juice to ensure my vitamin levels are adequate."
"If I experience excessive diarrhea, I should alert my provider."
✓
"Quinine is another name for quinidine and may be on my prescription bottle."
Correct Answer
"If I experience excessive diarrhea, I should alert my provider."
Quinidine is associated with a high incidence of diarrhea. Because diarrhea can cause electrolyte abnormalities, excessive diarrhea should be reported to the health care provider.
Question 5
Which of the following is an adverse effect of metoprolol?
Torsade de pointes
Tachycardia
Edema
Fatigue
✓
Correct Answer
Fatigue
Metoprolol is a beta-adrenergic blocker. Beta-adrenergic blockers can cause fatigue.
Question 6
Which arrhythmia is associated with potassium channel blockers?
Atrioventricular block
Torsade de pointes
✓
Sinus tachycardia
Supraventricular tachycardia
Correct Answer
Torsade de pointes
Potassium channel blockers slow repolarization and are associated with torsade de pointes, a serious ventricular dysrhythmia.
Question 7
A client is admitted to the emergency department with symptoms of dizziness and hypotension after returning from a beach vacation. The nurse notices a bluish-gray color to their skin. Which medication does the nurse suspect the client takes?
Diltiazem
Flecainide
Amiodarone
✓
Dofetilide
Correct Answer
Amiodarone
Amiodarone can cause photosensitivity resulting in a bluish-gray color of sun-exposed skin.
Question 8
A client is discussing chronic medication options to treat their atrial fibrillation with rapid ventricular response. The client prefers to avoid hospitalization overnight for initiation. Which of the following medications would be the best option?
Dofetilide
Metoprolol tartrate
✓
Mexiletine
Sotalol
Correct Answer
Metoprolol tartrate
Metoprolol tartrate does not require inpatient initiation. Dofetilide and sotalol require inpatient initiation. Mexiletine is used for ventricular arrhythmias.
Question 9
Which antidysrhythmic medication would increase the risk for statin-related adverse effects in a client who takes simvastatin?
Diltiazem
✓
Dofetilide
Mexiletine
Metoprolol
Correct Answer
Diltiazem
Diltiazem and verapamil have FDA warnings concerning interactions with simvastatin. Diltiazem and verapamil inhibit the metabolism of simvastatin, increasing simvastatin plasma levels and the risk for adverse effects.
Question 10
An 85-year-old client takes digoxin for atrial fibrillation and is admitted to the hospital with acute kidney injury. What signs and symptoms does the nurse expect the client to be experiencing?
Because digoxin is eliminated by the kidneys, acute kidney injury puts the client at risk for digoxin toxicity. Some symptoms of digoxin toxicity are stomach upset, visual changes, and confusion.