Houston Community College

NURSING REVIEW

Exam A
QUESTION 1
To appropriately monitor therapy and client progress, the nurse should be aware that increased myocardial
work and O2 demand will occur with which of the following?
A. Positive inotropic therapy
B. Negative chronotropic therapy
C. Increase in balance of myocardial O2 supply and demand
D. Afterload reduction therapy
Correct Answer: A
Section: Questions Set A
Explanation
Explanation/Reference:
Explanation:
(A) Inotropic therapy will increase contractility, which will increase myocardial O2 demand. (B) Decreased
heart rate to the point of bradycardia will increase coronary artery filling time. This should be used
cautiously because tachycardia may be a compensatory mechanism to increase cardiac output. (C) The
goal in the care of the MI client with angina is to maintain a balance between myocardial O2 supply and
demand. (D) Decrease in systemic vascular resistance by drug therapy, such as IV nitroglycerin or
nitroprusside, or intra-aortic balloon pump therapy, would decrease myocardial work and O2 demand.
QUESTION 2
The nurse would need to monitor the serum glucose levels of a client receiving which of the following
medications, owing to its effects on glycogenolysis and insulin release?
A. Norepinephrine (Levophed)
B. Dobutamine (Dobutrex)
C. Propranolol (Inderal)
D. Epinephrine (Adrenalin)
Correct Answer: D
Section: Questions Set A
Explanation
Explanation/Reference:
Explanation:
(A) Norepinephrine’s side effects are primarily related to safe, effective care environment and include
decreased peripheral perfusion and bradycardia. (B) Dobutamine’s side effects include increased heart
rate and blood pressure, ventricular ectopy, nausea, and headache. (C) Propranolol’s side effects include
elevated blood urea nitrogen, serum transaminase, alkaline phosphatase, and lactic dehydrogenase. (D)
Epinephrine increases serum glucose levels by increasing glycogenolysis and inhibiting insulin release.
Prolonged use can elevate serum lactate levels, leading to metabolic acidosis, increased urinary
catecholamines, false elevation of blood urea nitrogen, and decreased coagulation time.
QUESTION 3
Which of the following medications requires close observation for bronchospasm in the client with chronic
obstructive pulmonary disease or asthma?
A. Verapamil (Isoptin)
B. Amrinone (Inocor)
C. Epinephrine (Adrenalin)
D. Propranolol (Inderal)
Correct Answer: D