A 59-year-old woman presented with an abrupt onset of palpitations accompanied by a vague complaint of feeling ill. Subsequent Holter monitoring revealed atrial fibrillation with a ventricular response up to 152 bpm. The patient's past history included primary hyperparathyroidism and intermittent claudication for 3 years, apparently due to peripheral occlusive arteriosclerosis. Which of the following drugs would be appropriate for the chronic control of the patient's arrhythmia?

Correct Answer: B

Rationale: The correct answer is B: Propranolol. Propranolol is a beta-blocker that can be used for rate control in atrial fibrillation. It works by blocking the effects of adrenaline on the heart, slowing the heart rate and reducing the force of contraction. In this case, the patient has atrial fibrillation with a rapid ventricular response, and propranolol can help slow the heart rate to a more appropriate level. A: Digoxin is primarily used for rate control in patients with heart failure, not as the first-line agent for atrial fibrillation with a rapid ventricular response. C: Verapamil is a calcium channel blocker that can also be used for rate control in atrial fibrillation, but beta-blockers are generally preferred in patients with concomitant peripheral artery disease. D: Lidocaine is a local anesthetic and antiarrhythmic agent used for ventricular arrhythmias, not appropriate for atrial fibrillation.

Correct Answer: D

Rationale: The correct answer is D) Both (a) and (b) - Terminate anginal attacks and decrease the frequency of anginal attacks. The rationale behind this is that antianginal drugs work in different ways to achieve these benefits. Some medications like nitroglycerin help terminate acute anginal episodes by dilating blood vessels, increasing blood flow, and reducing the workload on the heart. Others like beta-blockers or calcium channel blockers help decrease the frequency of anginal attacks by reducing myocardial oxygen demand, improving oxygen supply to the heart, and controlling heart rate and blood pressure. Option A) Terminate anginal attacks is correct, as mentioned above, some antianginal drugs are fast-acting and can provide immediate relief during an anginal episode. Option B) Decrease the frequency of anginal attacks is also correct because long-term use of antianginal medications can help prevent or reduce the frequency of anginal episodes by improving overall heart function and reducing the workload on the heart. Option C) Retard the progression of coronary artery disease is incorrect because while some antianginal drugs can help manage symptoms and improve quality of life for patients with coronary artery disease, they do not directly slow down or reverse the progression of the underlying disease process. In an educational context, understanding the benefits of antianginal drugs is crucial for healthcare professionals caring for patients with angina or coronary artery disease. By knowing how these medications work and the specific benefits they offer, healthcare providers can make informed decisions about treatment options, educate patients on medication use and expected outcomes, and ultimately improve patient outcomes and quality of life.

Correct Answer: A

Rationale: In the treatment of atrial fibrillation, digitalization is necessary prior to quinidine because it prevents a paradoxical increase in ventricular rate. Digitalis glycosides like digoxin help to control the ventricular response by reducing the conduction through the atrioventricular (AV) node, thereby preventing rapid ventricular rates commonly seen in atrial fibrillation. By slowing down the ventricular response, digitalization provides a more stable hemodynamic state before initiating quinidine therapy. Option B, stating that quinidine is only effective in the presence of digitalis, is incorrect. Quinidine is effective on its own in treating atrial fibrillation and does not require digitalis for its efficacy. Option C, suggesting that digitalization reduces the dose and side effects of quinidine, is also incorrect. Digitalization does not directly impact the dose or side effects of quinidine. Option D, stating that digitalization antagonizes the extracardiac effects of quinidine, is also incorrect. The primary reason for digitalization prior to quinidine is related to the control of ventricular rate in atrial fibrillation rather than the extracardiac effects of quinidine. In an educational context, understanding the rationale behind the specific order of medications in treating atrial fibrillation is crucial for healthcare professionals. By grasping the importance of digitalization before quinidine, providers can optimize patient care and outcomes in managing cardiac arrhythmias effectively.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) It blocks the sodium channels in the heart. Class I anti-arrhythmic medications, like sodium channel blockers, work by inhibiting the fast inward sodium current during phase 0 of the cardiac action potential. This results in a decreased rate of depolarization and a decreased conduction velocity in cardiac tissues. By blocking sodium channels, these medications help to stabilize the cardiac cell membrane and prevent abnormal electrical impulses that can lead to arrhythmias. Option A) It blocks the calcium channels in the heart is incorrect because class IV anti-arrhythmic medications, like calcium channel blockers, work by blocking calcium channels to slow conduction through the AV node, not class I drugs. Option B) It increases the conduction through the AV node is incorrect because class II anti-arrhythmic medications, like beta-blockers, work by decreasing conduction through the AV node, not class I drugs. Option C) It decreases the excitability of the SA node is incorrect because class III anti-arrhythmic medications, like potassium channel blockers, work by prolonging repolarization and refractoriness, affecting the SA node, not class I drugs. Understanding how different classes of anti-arrhythmic medications work is crucial for nurses and healthcare providers to effectively manage and monitor patients with cardiac arrhythmias. By knowing the mechanisms of action of these medications, healthcare professionals can make informed decisions when administering and monitoring these drugs, ultimately improving patient outcomes and safety.

Correct Answer: B

Rationale: Gemfibrozil is a fibric acid derivative used to lower cholesterol levels. The correct answer is B) It increases the hypoglycemic effect of sulfonylurea drugs. This is because gemfibrozil can potentiate the effects of sulfonylurea drugs leading to hypoglycemia, a dangerous drop in blood sugar levels. Option A, "It increases the digoxin level," is incorrect because gemfibrozil does not interact with digoxin in this manner. Option C, "It lowers the theophylline level," is incorrect as gemfibrozil does not typically impact theophylline levels. Option D, "It cannot be taken with cimetidine," is incorrect as there is no significant interaction between gemfibrozil and cimetidine. In an educational context, it is crucial for nurses to understand drug interactions to ensure safe medication administration. Knowledge of potential interactions like the potentiation of sulfonylurea drugs' hypoglycemic effects by gemfibrozil can help prevent adverse drug events and improve patient outcomes. Nurses need to educate clients about these interactions to promote medication adherence and safety.