Review Practice Exercise 1

Drugs Used to Treat Dysrhythmias > Pharmacology

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Practice Exercise 1

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Total Questions : 3

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Question 1:

A nurse in an outpatient facility is assessing a client who has taken procainamide (Pronestyl) to treat dysrhythmias for the last 12 months. The nurse should assess the client for which of the following adverse effects? Select all that apply

A. Hypertension B. Widened QRS complex C. Narrowed QT interval D. Easy bruising E. Swollen joints

Answer and Explanation

Choice A:

Hypertension. Procainamide does not typically cause hypertension; instead, it can sometimes lead to hypotension, particularly when administered intravenously. Therefore, hypertension is not a standard adverse effect.

Choice B:

Widened QRS complex. Procainamide slows ventricular conduction by blocking sodium channels. This prolongation of depolarization can be detected on an electrocardiogram (ECG) as a widened QRS complex. Persistent QRS widening may increase the risk of life-threatening ventricular arrhythmias, making monitoring essential during long-term therapy.

Choice C:

Narrowed QT interval. Procainamide prolongs the action potential and repolarization, which actually increases the QT interval, not narrows it. A narrowed QT interval is unrelated to procainamide therapy.

Choice D:

Easy bruising. Procainamide can induce bone marrow suppression, including thrombocytopenia, which reduces platelet counts and increases bleeding risk. Easy bruising or spontaneous bleeding is an important indicator of hematologic toxicity and requires prompt evaluation and possible medication adjustment or discontinuation.

Choice E:

Swollen joints. Long-term procainamide therapy can trigger drug-induced lupus erythematosus (DILE), characterized by musculoskeletal complaints such as arthralgia, myalgia, and swollen joints. Recognition of these symptoms is critical to prevent prolonged patient discomfort and complications, and discontinuation of the drug is often necessary for resolution.

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Question 2:

The nurse is administering lidocaine to a client. Which condition, if present in the client, is a caution for the use of this drug?

A. Tachycardia B. Hypertension C. Ventricular dysrhythmias D. Renal dysfunction

Answer and Explanation

Choice A:

Tachycardia. While lidocaine affects cardiac conduction, the presence of tachycardia is not a contraindication or primary caution for administration. Lidocaine may actually be indicated in some cases to treat ventricular tachyarrhythmias. Careful monitoring of heart rate is important, but tachycardia alone does not pose a high risk of toxicity.

Choice B:

Hypertension. Elevated blood pressure does not affect the metabolism or excretion of lidocaine. The drug’s safety is not directly impacted by systemic hypertension, although blood pressure should always be monitored during administration.

Choice C:

Ventricular dysrhythmias. These are the therapeutic indication for lidocaine, not a caution. Presence of ventricular dysrhythmias signals the need for treatment, provided there are no significant comorbidities such as severe renal or hepatic dysfunction.

Choice D:

Renal dysfunction. Lidocaine is metabolized primarily by the liver but has metabolites excreted by the kidneys. In clients with renal impairment, these metabolites can accumulate, potentially leading to central nervous system toxicity (drowsiness, confusion, seizures) and cardiovascular effects such as hypotension, bradycardia, or worsening arrhythmias. Nursing considerations include performing a thorough renal assessment, monitoring serum creatinine and BUN levels, observing for neurologic or cardiac changes, and adjusting the infusion rate or dose according to renal status.

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Question 3:

The nurse is providing discharge teaching to a client newly prescribed propafenone for recurrent atrial fibrillation. Which client statement indicates correct understanding of the teaching?

A. “I should stop taking the medication if I feel palpitations.” B. “This medication will cure my heart rhythm problem.” C. “I will take this medication only when symptoms occur.” D. “I will report dizziness to the healthcare provider.”

Answer and Explanation

Choice A:

“I should stop taking the medication if I feel palpitations.” Abrupt discontinuation of propafenone is unsafe and may precipitate rebound dysrhythmias or worsening atrial fibrillation. Palpitations should be reported, not managed independently by stopping the drug, as they may indicate either inadequate control or a proarrhythmic effect requiring medical evaluation.

Choice B:

“This medication will cure my heart rhythm problem.” Propafenone does not cure atrial fibrillation. It helps control rhythm and reduce recurrence, but atrial fibrillation is typically a chronic condition requiring long-term management. This statement reflects unrealistic expectations and inadequate understanding of the drug’s role.

Choice C:

“I will take this medication only when symptoms occur.” Propafenone is prescribed on a scheduled basis to maintain therapeutic plasma levels and prevent dysrhythmia recurrence. PRN use is inappropriate and can lead to ineffective rhythm control and increased arrhythmic risk.

Choice D:

“I will report dizziness to the healthcare provider.” Dizziness is a clinically significant adverse effect of propafenone. The drug slows myocardial conduction and may reduce cardiac output, leading to hypotension, bradycardia, or transient cerebral hypoperfusion. This manifests as dizziness or light-headedness. Additionally, propafenone has beta-adrenergic blocking properties, further increasing the risk of hemodynamic instability. Prompt reporting allows the healthcare provider to assess for dose-related toxicity, conduction abnormalities, and to adjust therapy as needed.

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Practice Exercise 1

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