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Chapter 23: Antiarrhythmic Agents Test Bank

Chapter 23: Antiarrhythmic Agents Test Bank

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Chapter 23: Antiarrhythmic Agents
Test Bank
MULTIPLE CHOICE
1.   Persistent atrial fibrillation (AF) is diagnosed in a patient who has valvular disease, and the cardiologist has prescribed warfarin (Coumadin). The patient is scheduled for electrical cardioversion in 3 weeks. The patient asks the primary care nurse practitioner (NP) why the procedure is necessary. The NP should tell the patient:
a.

this medication prevents clots but does not alter rhythm.

b.

if the medication proves effective, the procedure may be canceled.

c.

there are no medications that alter the arrhythmia causing AF.

d.

to ask the cardiologist if verapamil may be ordered instead of cardioversion.

2.   A patient undergoes a routine electrocardiogram (ECG), which reveals occasional premature ventricular contractions that are present when the patient is resting and disappear with exercise. The patient has no previous history of cardiovascular disease, and the cardiovascular examination is normal. The primary care NP should:
a.

prescribe quinidine (Quinidex Extentabs).

b.

tell the patient that treatment is not indicated.

c.

refer the patient to a cardiologist for further evaluation.

d.

consider using amiodarone if the patient develops other symptoms.

3.   The primary care NP sees a new patient for a routine physical examination. When auscultating the heart, the NP notes a heart rate of 78 beats per minute with occasional extra beats followed by a pause. History reveals no past cardiovascular disease, but the patient reports occasional syncope and shortness of breath. The NP should:
a.

order an ECG and refer to a cardiologist.

b.

schedule a cardiac stress test and a graded exercise test.

c.

order a complete blood count (CBC) and electrolytes and consider a trial of procainamide.

d.

prescribe a â-blocker and anticoagulant and order 24-hour Holter monitoring.

4.   A patient comes to the clinic with a history of syncope and weakness for 2 to 3 days. The primary care NP notes thready, rapid pulses and 3-second capillary refill. An ECG reveals a heart rate of 198 beats per minute with a regular rhythm. The NP should:
a.

administer intravenous fluids and obtain serum electrolytes.

b.

administer amiodarone in the clinic and observe closely for response.

c.

order digoxin and verapamil and ask the patient to return for a follow-up examination in 1 week.

d.

send the patient to an emergency department for evaluation and treatment.

5.   A patient who is taking trimethoprim-sulfamethoxazole for prophylaxis of urinary tract infections tells the primary care NP that a sibling recently died from a sudden cardiac arrest, determined to be from long QT syndrome. The NP should:
a.

schedule a treadmill stress test.

b.

order genetic testing for this patient.

c.

discontinue the trimethoprim-sulfamethoxazole.

d.

refer the patient to a cardiologist for further evaluation.

6.   The primary care NP refers a patient to a cardiologist who diagnoses long QT syndrome. The cardiologist has prescribed propranolol (Inderal). The patient exercises regularly and is not obese. The patient asks the NP what else can be done to minimize risk of sudden cardiac arrest. The NP should counsel the patient to:
a.

drink extra fluids when exercising.

b.

reduce stress with yoga and hot baths.

c.

ask the cardiologist about an implantable defibrillator.

d.

ask the cardiologist about adding procainamide to the drug regimen.

7.   A patient who has been taking quinidine for several years reports lightheadedness, fatigue, and weakness. The primary care NP notes a heart rate of 110 beats per minute. The serum quinidine level is 6 ìg/mL. The NP should:
a.

discontinue the medication immediately.

b.

reassure the patient that this is a therapeutic drug level.

c.

order an ECG, CBC, liver function tests (LFTs), and renal function tests.

d.

admit the patient to the hospital and obtain a cardiology consultation.


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