Progressive Care Nursing Certification (PCCN) Practice Exam

After administering metoprolol, the physician decides to use IV diltiazem for a patient with rapid afib. What should the nurse anticipate as a precaution?

1. Calcium chloride

2. Synchronized cardioversion

3. Digoxin

4. Transcutaneous pacing

The correct answer is: Transcutaneous pacing

When a patient is being treated for rapid atrial fibrillation and is administered both metoprolol and IV diltiazem, it is important to consider the potential for bradycardia or significant atrioventricular (AV) block due to the combined effects of these medications. Both metoprolol, a beta-blocker, and diltiazem, a calcium channel blocker, can lead to a decrease in heart rate. Transcutaneous pacing could be an anticipated precaution because if the heart rate drops significantly, this intervention would serve as a backup method to manage pacing. It is essential for the nurse to be prepared for this possibility, as it allows for immediate support of the heart's rhythm and rate if the patient experiences severe bradycardia or an AV block as a response to the medications. Monitoring the patient closely for any changes in heart rhythm after administering these medications is crucial, and having transcutaneous pacing equipment readily available ensures prompt treatment can be provided if necessary. In contrast, the other options, while they may play roles in the management of certain cardiac conditions, do not address the immediate concern of potential bradycardia due to the combined administration of metoprolol and diltiazem. Therefore, trans