Published - Fri, 03 Mar 2023

NCLEX-RN Exam Questions - Part 11

1. The primary reason that an increase in heart rate (100 bpm) detrimental to the client with a myocardial infarction (MI) is that:

A) Stroke volume and blood pressure will drop proportionately
B) Systolic ejection time will decrease, thereby decreasing cardiac output
C) Decreased contractile strength will occur due to decreased filling time
D) Decreased coronary artery perfusion due to decreased diastolic filling time will occur, which will increase ischemic damage to the myocardium

2. 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

3. 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)

4. The following medications were noted on review of the clients home medication profile. Which of the medications would most likely potentiate or elevate serum digoxin levels?

A) KCl
B) Thyroid agents
C) Quinidine
D) Theophylline

5. In the client with a diagnosis of coronary artery disease, the nurse would anticipate the complication of bradycardia with occlusion of which coronary artery?

A) Right coronary artery
B) Left main coronary artery
C) Circumflex coronary artery
D) Left anterior descending coronary artery

1. Right Answer: D
Explanation: (A) Decreased stroke volume and blood pressure will occur secondary to decreased diastolic filling. (B) Tachycardia primarily decreases diastole; systolic time changes very little. (C) Contractility decreases owing to the decreased filling time and decreased time for fiber lengthening. (D) Decreased O2 supply due to decreased time for filling of the coronary arteriesincreases ischemia and infarct size. Tachycardia primarily robs the heart of diastolic time, which is the primary time for coronary artery filling.

2. Right Answer: A
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.

3. Right Answer: D
Explanation: (A) Norepinephrines side effects are primarily related to safe, effective care environment and include decreased peripheral perfusion and bradycardia. (B)Dobutamines side effects include increased heart rate and blood pressure, ventricular ectopy, nausea, and headache. (C) Propranolols 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.

4. Right Answer: C
Explanation: (A) Hypokalemia can cause digoxin toxicity. Administration of KCl would prevent this. (B) Thyroid agents decrease digoxin levels. (C) Quinidine increases digoxin levels dramatically. (D) Theophylline is not noted to have an effect on digoxin levels.

5. Right Answer: A
Explanation: (A) Sinus bradycardia and atrioventricular (AV) heart block are usually a result of right coronary artery occlusion. The right coronary artery perfuses the sinoatrial and AV nodes in mostindividuals. (B) Occlusion of the left main coronary artery causes bundle branch blocks and premature ventricular contractions. (C)Occlusion of the circumflex artery does not cause bradycardia. (D) Sinus tachycardia occurs primarily with left anterior descending coronary artery occlusion because this form of occlusion impairs left ventricular function.

80% DISCOUNT: NCLEX-RN PRACTICE EXAMS