The RN in the intensive care unit has been administering ondansetron (Zofran) to a patient every 4-6 hours for nausea.
The RN notices that the patient has developed Q-T prolongation per the cardiac monitor.
Suddenly, the patient develops a wide-complex arrhythmia and is quickly determined to be in Torsades de Pointes. What is the 1st line drug for treatment?
Amiodarone.
Lidocaine.
Atropine.
Magnesium Sulfate.
The Correct Answer is D
Choice A rationale:
Amiodarone is an antiarrhythmic medication that is often used to treat ventricular tachycardia and ventricular fibrillation. However, it is not the first-line drug for Torsades de Pointes. In fact, amiodarone can actually worsen QT prolongation and increase the risk of Torsades de Pointes.
It's important to note that amiodarone has a long half-life and can accumulate in the body over time, further increasing the risk of QT prolongation.
Additionally, amiodarone can have several serious side effects, including pulmonary toxicity, thyroid dysfunction, and liver damage.
Choice B rationale:
Lidocaine is another antiarrhythmic medication that is sometimes used to treat ventricular arrhythmias. However, it is also not the first-line drug for Torsades de Pointes.
Lidocaine is less likely to worsen QT prolongation than amiodarone, but it can still have this effect in some patients.
Additionally, lidocaine has a short half-life and must be given as a continuous infusion, which can be challenging in a critical care setting.
Choice C rationale:
Atropine is a medication that is used to increase heart rate. It is not effective in treating Torsades de Pointes and is not indicated in this situation.
Atropine works by blocking the vagus nerve, which slows heart rate. In Torsades de Pointes, the heart rate is already very fast, so atropine would not be helpful.
Additionally, atropine can have several side effects, including dry mouth, blurred vision, and urinary retention.
Choice D rationale:
Magnesium sulfate is the first-line drug for treating Torsades de Pointes. It works by stabilizing the electrical activity of the heart and preventing further episodes of arrhythmia.
Magnesium sulfate is a relatively safe medication with few side effects. It can be given as an intravenous infusion or as an intramuscular injection.
Studies have shown that magnesium sulfate is effective in terminating Torsades de Pointes and preventing recurrences.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale:
Sildenafil (Viagra) is a phosphodiesterase-5 (PDE-5) inhibitor that is primarily used to treat erectile dysfunction. However, it also has vasodilatory effects, meaning it widens blood vessels. This can lead to a significant drop in blood pressure, especially when combined with nitroglycerin, another potent vasodilator.
Nitroglycerin is commonly used to treat chest pain (angina) and heart failure. It works by relaxing the smooth muscles in blood vessels, which allows them to widen and increase blood flow to the heart. This can help to relieve chest pain and improve heart function.
When sildenafil and nitroglycerin are taken together, their combined vasodilatory effects can cause a severe drop in blood pressure, known as hypotension. This can lead to a number of serious complications, including: dizziness, lightheadedness, fainting, heart attack, stroke.
The risk of hypotension is particularly high in patients who are already taking other medications that can lower blood pressure, such as alpha-blockers or nitrates. It is also important to note that the effects of sildenafil can last for up to 24-48 hours, so it is important to avoid taking nitroglycerin within this timeframe.
Due to the significant risk of hypotension, it is generally recommended that sildenafil be avoided within 24-48 hours of nitroglycerin administration.
Rationales for other choices:
Choice B: Aspirin
Aspirin is an antiplatelet medication that is often used to prevent blood clots. It does not have significant vasodilatory effects and does not interact with nitroglycerin in a way that would contraindicate its use.
Choice C: Adenosine
Adenosine is a medication that is used to treat certain types of arrhythmias (irregular heartbeats). It can cause a brief drop in blood pressure, but this effect is usually mild and transient. Adenosine does not interact with nitroglycerin in a way that would contraindicate its use.
Choice D: Oxygen
Oxygen is a gas that is often used to treat patients with respiratory problems. It does not have any direct vasodilatory effects and does not interact with nitroglycerin.
Correct Answer is A
Explanation
Choice A rationale:
Oxytocin is a hormone that stimulates uterine contractions. It is not a tocolytic, which is a medication that inhibits uterine contractions. In fact, oxytocin is often used to induce labor or to augment labor that is progressing slowly.
It acts on the myofibrils in the uterine muscle, causing them to contract more forcefully and frequently. This leads to cervical dilation and effacement, and ultimately to the birth of the baby.
Oxytocin is typically administered as an intravenous (IV) infusion. The dosage is carefully titrated to achieve the desired effect on the uterus.
It is important to note that oxytocin can have serious side effects, including uterine hyperstimulation, fetal distress, and postpartum hemorrhage. Therefore, it should only be used under the close supervision of a healthcare provider.
Choice B rationale:
Magnesium sulfate is a tocolytic that is often used to prevent preterm labor. It works by relaxing the smooth muscle of the uterus.
It is typically administered as an IV infusion. The dosage is carefully monitored to ensure that the magnesium level in the blood does not become too high.
Side effects of magnesium sulfate can include flushing, nausea, vomiting, and headache. In rare cases, it can also cause serious complications such as respiratory depression and cardiac arrest.
Choice C rationale:
Nifedipine is a calcium channel blocker that is sometimes used as a tocolytic. It works by relaxing the smooth muscle of the uterus and blood vessels.
It is typically administered as an oral tablet. Side effects of nifedipine can include headache, dizziness, flushing, and low blood pressure.
Choice D rationale:
Indomethacin is a nonsteroidal anti-inflammatory drug (NSAID) that is sometimes used as a tocolytic. It works by inhibiting the production of prostaglandins, which are substances that promote uterine contractions.
It is typically administered as an oral tablet or suppository. Side effects of indomethacin can include nausea, vomiting, heartburn, and diarrhea.
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