Unclassified Antidysrhythmics

Every question here, with the answer

1. A nurse is about to give digoxin to a client with atrial fibrillation. The apical heart rate is 56 beats per minute. What should the nurse do?

   1. Withhold the dose and notify the health care provider.
   2. Give the dose with extra fluids.
   3. Give the dose and recheck in an hour.
   4. Give the dose and have the client lie flat.

   Answer: Withhold the dose and notify the health care provider.

   Digoxin slows the heart rate, and it is commonly withheld when the apical rate is below 60 beats per minute. The other options still give a drug that will slow the rate further.

2. A nurse is giving adenosine for paroxysmal supraventricular tachycardia. Which technique is correct?

   1. Give it intramuscularly into the deltoid.
   2. Mix it in a 250 mL bag and infuse over an hour.
   3. Give it as a rapid IV bolus close to the client, followed immediately by a rapid saline flush.
   4. Give it slowly over 10 minutes through a central line.

   Answer: Give it as a rapid IV bolus close to the client, followed immediately by a rapid saline flush.

   Adenosine's half-life is under 10 seconds, so it is pushed rapidly into a peripheral IV as close to the client as possible and followed at once by a rapid saline flush. Slow, diluted or intramuscular routes let it be metabolized before it reaches the heart.

3. Seconds after an adenosine push, the monitor shows a brief flat line and the client says, "I feel like my heart stopped." What does the nurse recognise?

   1. An expected, short-lived effect of adenosine
   2. A sign that the dose was too small
   3. An allergic reaction to the drug
   4. Digoxin toxicity

   Answer: An expected, short-lived effect of adenosine

   Brief asystole with a sensation of the heart stopping is expected after adenosine because AV conduction is blocked briefly; it is short lived due to the very short half-life. It does not indicate allergy, underdosing, or digoxin toxicity.

4. A client taking digoxin calls the clinic. Which reported symptoms could indicate digoxin toxicity? Select all that apply.

   1. Palpitations
   2. Nausea and stomach upset
   3. Dizziness and fatigue
   4. Changes in vision
   5. Increased appetite

   Answer: Palpitations, Nausea and stomach upset, Dizziness and fatigue, Changes in vision

   Digoxin toxicity shows as gastrointestinal upset, vision changes, dizziness, fatigue and palpitations from premature ventricular contractions. Increased appetite is not listed; anorexia is an adverse effect.

5. Atropine is being considered for a client with symptomatic bradycardia. Which findings in the history should the nurse report to the provider? Select all that apply.

   1. Recent ankle sprain
   2. Heart transplant
   3. Myasthenia gravis
   4. Seasonal allergies
   5. Urinary retention

   Answer: Heart transplant, Myasthenia gravis, Urinary retention

   Atropine may not work after heart transplant because vagal innervation is lost, and its anticholinergic effects can worsen myasthenia gravis and urinary retention. Allergies and a sprain are not concerns in the section.

6. A client going home on digoxin also has chronic kidney disease. Why does the nurse monitor renal function?

   1. Kidney function affects only IV digoxin.
   2. Digoxin improves kidney function, so the dose must rise.
   3. Digoxin directly damages the kidneys.
   4. Digoxin can accumulate when kidney function is decreased.

   Answer: Digoxin can accumulate when kidney function is decreased.

   Digoxin is eliminated by the kidneys, so it accumulates when kidney function falls and toxicity becomes more likely. The section does not describe direct kidney damage, improved kidney function, or a route-only effect.