A patient is undergoing treatment for a ventricular arrhythmia with amiodarone.
The patient has been given a 150 mg bolus of amiodarone IV and is currently on a continuous infusion of 1 mg/min.
The nurse observes a heart rate of 60 beats per minute and a blood pressure of 88/54 mm Hg. What action should the nurse take next, in addition to notifying the provider?

Increase the amiodarone infusion rate to 1.5 mg/min.

Decrease the amiodarone infusion rate to 0.5 mg/min.

Continue the amiodarone infusion at 1 mg/min.

Discontinue the amiodarone infusion.

Answer and Explanation

The Correct Answer is B

Choice A rationale:

Increasing the amiodarone infusion rate would worsen the patient's bradycardia and hypotension. Amiodarone is a class III antiarrhythmic drug that works by prolonging the action potential duration in cardiac cells. This can lead to a decrease in heart rate and contractility.

Increasing the dose in this patient could lead to further hemodynamic compromise.

Choice B rationale:

Decreasing the amiodarone infusion rate is the most appropriate action in this situation. This will help to mitigate the drug's effects on the patient's heart rate and blood pressure.

A dose reduction may allow the heart rate to recover to a safer level while still maintaining the antiarrhythmic benefits of amiodarone.

Choice C rationale:

Continuing the amiodarone infusion at the current rate is not appropriate, as it is likely to worsen the patient's bradycardia and hypotension.

Maintaining the current dose could lead to further clinical deterioration.

Choice D rationale:

Discontinuing the amiodarone infusion entirely may not be necessary at this point. The patient's arrhythmia may still require treatment with amiodarone.

A dose reduction may be sufficient to address the patient's hemodynamic instability while still providing therapeutic benefits.

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Correct Answer is D

Explanation

Choice A rationale:

Glipizide does not directly enhance glucose transport into the muscles. This action is primarily mediated by insulin, which increases the expression of glucose transporter proteins (GLUT4) on muscle cell membranes, facilitating glucose uptake.

While glipizide can indirectly improve glucose transport into muscles by increasing insulin levels, it's not the primary mechanism of action.

Choice B rationale:

Glipizide does not directly facilitate glucose utilization by body cells. This process also largely depends on insulin, which activates intracellular pathways that promote glucose metabolism and energy production.

Although glipizide can indirectly enhance glucose utilization by increasing insulin availability, it's not the main mechanism responsible for its glucose-lowering effects.

Choice C rationale:

Glipizide does not boost glucose levels. In fact, it has the opposite effect, lowering blood glucose levels by stimulating insulin secretion.

Elevating glucose levels would be counterproductive in diabetes management, as the goal is to maintain blood glucose within a healthy range.

Choice D rationale (correct answer):

Glipizide belongs to a class of medications called sulfonylureas, which act primarily by stimulating insulin secretion from pancreatic beta cells.

Insulin is a hormone that plays a crucial role in regulating blood glucose levels. It promotes glucose uptake by various tissues, including muscles, liver, and adipose tissue, and it inhibits glucose production by the liver.

By triggering insulin release, glipizide effectively lowers blood glucose levels. This helps to prevent the long-term complications of diabetes, such as damage to blood vessels, nerves, and organs.

A. Insulin glargine (Lantus) B. Acarbose (Precose) C. Metformin (Glucophage) D. Glipizide (Glucotrol)

Correct Answer is C

Explanation

Choice A rationale:

Insulin glargine (Lantus) is a long-acting insulin that does not have any immediate effect on blood glucose levels. It is not typically a concern for patients undergoing CT scans with contrast.

However, it is important to monitor blood glucose levels closely in patients with diabetes who are receiving insulin therapy, as the contrast media used in CT scans can sometimes cause hyperglycemia.

Choice B rationale:

Acarbose (Precose) is an alpha-glucosidase inhibitor that works by slowing the absorption of carbohydrates from the intestines. This can help to reduce blood glucose levels after meals.

Acarbose is not typically a concern for patients undergoing CT scans with contrast. However, it is important to note that acarbose can sometimes cause gastrointestinal side effects, such as bloating, gas, and diarrhea. These side effects may be worsened by the contrast media used in CT scans.

Choice C rationale:

Metformin (Glucophage) is a biguanide that works by reducing glucose production in the liver and increasing insulin sensitivity in the muscles. It is a commonly used medication for the treatment of type 2 diabetes.

Metformin is a concern for patients undergoing CT scans with contrast because it can increase the risk of lactic acidosis. Lactic acidosis is a serious condition that can occur when there is a buildup of lactic acid in the blood. It can be caused by metformin, as well as by other factors such as dehydration, kidney problems, and liver problems.

The contrast media used in CT scans can also increase the risk of lactic acidosis. This is because the contrast media can sometimes cause kidney damage, which can impair the body's ability to remove lactic acid from the blood.

For this reason, metformin is typically discontinued for 48 hours before a CT scan with contrast. It is also important to ensure that patients are well-hydrated before and after the scan.

Choice D rationale:

Glipizide (Glucotrol) is a sulfonylurea that works by stimulating the release of insulin from the pancreas. It is a commonly used medication for the treatment of type 2 diabetes.

Glipizide is not typically a concern for patients undergoing CT scans with contrast. However, it is important to monitor blood glucose levels closely in patients with diabetes who are receiving sulfonylurea therapy, as the contrast media used in CT scans can sometimes cause hypoglycemia.

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Naxlex Comprehensive Predictor Exams

A patient with type 2 diabetes is prescribed glipizide (Glucotrol) 10 mg orally before meals.The patient inquires, “What is the mechanism of action of this medication in managing my diabetes?” How should the nurse respond?

Correct Answer is D

Explanation

A client with diabetes is scheduled for a CT scan of the abdomen with oral and IV contrast. Which medication would be of concern?

Correct Answer is C

Explanation

A patient arrives at the hospital emergency department via EMS, complaining of being “lightheaded”. The patient has a heart rate of 42 and BP 90/50 mmHg.What medication should the RN anticipate being prescribed and administered immediately?

A patient was admitted to the intensive care unit with cardiogenic shock and a blood pressure of 78/38. Which vasopressor medication does the nurse identify as the first-line treatment for cardiogenic shock?

A client is brought to the emergency room unconscious, with a pulse, and with a blood glucose of 40. The client is wearing a Medic-Alert bracelet indicating that he has Type 1 diabetes mellitus.What order should the nurse anticipate?

A patient who is experiencing chest pain and shortness of breath is brought to the emergency department.The nurse assesses a heart rate of 98 beats per minute, bilateral lung crackles, and an oxygen saturation of 90%. What will the nurse expect to administer initially to this patient?

Which patient would be a concern for the nurse when administering mannitol (Osmitrol)?

The client asks the nurse about storing insulin. Which response by the nurse is correct?

A client is ordered to receive insulin lispro (Humalog) at mealtimes. When should the nurse instruct the client to administer the medication?