Which of the following drugs would be appropriate for the patient at this time?

Correct Answer: G

Rationale: Ibutilide is the correct choice as it is a class III antiarrhythmic drug used for converting atrial fibrillation/flutter. It has a rapid onset of action and is effective in patients with normal renal function. Amiodarone (B) is a class III antiarrhythmic but is not first-line due to its potential side effects. Procainamide (C) is a class Ia antiarrhythmic and may not be suitable for this patient. Sotalol (D) is a class III antiarrhythmic but has a higher risk of proarrhythmia compared to ibutilide.

Correct Answer: B

Rationale: The correct statement about the action of nitrates on coronary vessels is option B) They preferentially dilate conducting arteries without affecting resistance arterioles. This is the right answer because nitrates primarily act by dilating veins, which reduces preload and consequently decreases cardiac oxygen demand. This dilation also affects conducting arteries, like the large epicardial coronary arteries, leading to increased blood flow to the myocardium. Option A is incorrect because nitrates do not increase total coronary flow significantly; instead, they redistribute blood flow within the coronary circulation. Option C is incorrect because nitrates do not selectively dilate autoregulatory arterioles; their effect is more prominent on conducting arteries. Option D is incorrect because nitrates increase subendocardial blood flow more than subepicardial blood flow due to their preferential dilation of larger coronary arteries. From an educational perspective, understanding the mechanism of action of nitrates on coronary vessels is crucial for healthcare professionals managing patients with cardiovascular diseases like angina pectoris. Knowing how nitrates affect coronary circulation helps in optimizing treatment strategies and ensuring better patient outcomes. This knowledge also forms the basis for further learning about the pharmacological management of cardiovascular conditions.

Correct Answer: B

Rationale: In the context of cardiovascular drugs, the correct answer to the question is B) Depression of cardiac contractility. Quinidine is a class I antiarrhythmic drug that primarily works by blocking sodium channels in cardiac myocytes. The depression of cardiac contractility is not a desirable effect clinically because it can lead to a decrease in cardiac output and exacerbate heart failure in patients with compromised cardiac function. Option A) Shortening of A-V nodal refractory period due to vagolytic action is a useful property of quinidine as it can help in managing certain types of arrhythmias by affecting the conduction of electrical impulses in the heart. Option C) Decrease in the automaticity of the normal pacemaker is also a desirable effect of quinidine as it helps in reducing abnormal electrical activity in the heart and can be beneficial in treating arrhythmias. Option D) Reduction in the slope of slow diastolic depolarization is another useful property of quinidine as it can help in stabilizing the heart's electrical activity and preventing the occurrence of certain types of arrhythmias. From an educational perspective, understanding the pharmacological properties of cardiovascular drugs like quinidine is crucial for healthcare professionals involved in the management of cardiac conditions. Knowing the desired effects as well as the potential adverse effects of these drugs is essential for safe and effective patient care. This knowledge helps in making informed decisions regarding drug selection, dosing, monitoring, and managing potential drug interactions or adverse effects.

Correct Answer: B

Rationale: In this question, the correct answer is B) Beta blocker. Class II anti-arrhythmic agents, such as beta blockers, work by blocking beta-adrenergic receptors in the heart, leading to a decrease in heart rate and contractility. This effect helps in managing arrhythmias by stabilizing the heart's electrical activity. Option A) Calcium channel blocker primarily works by blocking calcium channels, affecting the heart's contractility and conductivity. While calcium channel blockers are used in various cardiovascular conditions, they do not belong to Class II anti-arrhythmic agents. Option C) Sodium channel blocker, like Class I anti-arrhythmic agents, work by blocking sodium channels in the heart, affecting the depolarization phase of cardiac action potentials. This class is different from Class II agents. Option D) ACE inhibitor is not an anti-arrhythmic agent. ACE inhibitors work by inhibiting the conversion of angiotensin I to angiotensin II, primarily used in conditions like hypertension and heart failure. Understanding the classification and mechanisms of action of different cardiovascular drugs is crucial for healthcare professionals to make informed decisions in managing patients with cardiac conditions. Identifying the correct Class II anti-arrhythmic agents, such as beta blockers, ensures appropriate treatment selection and optimal patient outcomes.

Correct Answer: C

Rationale: Gemfibrozil is a fibric acid derivative used to lower cholesterol and triglyceride levels in the blood. The correct answer is C) Active gallbladder disease. Gemfibrozil can increase the risk of gallstones and aggravate existing gallbladder conditions. Educating the client about this contraindication is crucial to prevent complications. Option A) History of MI is incorrect because gemfibrozil can actually benefit individuals with a history of MI by reducing their risk of cardiovascular events. Option B) History of elevated triglyceride levels is incorrect because this is the very condition gemfibrozil is used to treat. Option D) Taking aspirin with gemfibrozil is incorrect because there are no known significant interactions between these two medications. In an educational context, it's important for nurses to understand the contraindications of medications to provide safe and effective care to their patients. By explaining the rationale behind the correct answer and why the other options are incorrect, nurses can better guide patients in their medication management and promote positive health outcomes.