HESI comp exam 1 QUESTION AND ANSWER 2022~2023

HESI comp exam 1 QUESTION AND ANSWER 2022~2023A client with asthma receives a prescription for high blood pressure during a clinic visit. Which prescription should the nurse anticipate the client to receive that is at least likely to exacerbate asthma? Metoprolol tartrate (Lopressor) Best antihypertensive med for asthmatics. Beta2 blocking agent -- also a cardioselective and less likely to cause bronchoconstriction. A male client who has been taking propranolol (Inderal) for 18 months tells the nurse that the healthcare provider discontinued the medication because his blood pressure has been normal for the past 3 months. Which instruction should the nurse provide? Ask the healthcare provider about tapering the drug dose over the next week. HCP discontinued drug BUT measures to prevent rebound cardiac excitation, such as progressively reducing the dose over 1 or 2 weeks, should be recommended to prevent rebound tachycardia, hypertension, and ventricular dysrhythmias. A client who is taking clonidine ( Catapres, Duraclon) reports drowsiness. Which additional assessment should the nurse make? How long has the client been taking the medication? Drowsiness can occur in the early weeks of treatment with clonidine and with continued use becomes less intense, so the length of time the client has been on the medication provides information to direct additional instruction. The nurse is preparing to administer atropine, an anticholinergic, to a client who is scheduled for a cholecystectomy. The client asks the nurse to explain the reason for the prescribed medication. What response is best for the nurse to provide? Decrease the risk of bradycardia during surgery Atropine may be prescribed preoperatively to increase the automaticity of the sinoatrial node and prevent a dangerous reduction in heart rate during surgical anesthesia. An 80-year old client is given morphine sulfate for post-op pain. Which concomitant med should the nurse question that poses a potential development of urinary retention in this geriatric client? Tricyclic antidepressants Drugs with anticholinergic properties can exacerbate urinary retention associated with opioids in the older client. A client with osteoarthritis is given a new script for a NSAID. The client asks the nurse, "How is this med different from the acetaminophen I have been taking?" Which information about the therapeutic action of NSAIDs should the nurse provide? Provide anti-inflammatory response NSAIDs relieve pain associated with osteoarthritis and differs from acetaminophen(a non-narcotic & antipyretic). Also potentially hepatotoxic. A client with cancer has a history of alcohol abuse and is taking acetaminophen (Tylenol) for pain. Which organ function is most important for the nurse to monitor? Liver Acetaminophen & alcohol both metabolized in the liver. Pt at risk of hepatotoxicity & potentially fatal liver damage. The nurse obtains a heart rate of 92 and a BP of 110/76 prior to administering a scheduled does of verapamil (Calan) for a client with atrial flutter. Which action should the nurse implement? Administer the dose as prescribed. Verapamil slows SA nodal automaticity, delays AV nodal conduction, slowing ventricular rate & treats atrial flutter. HR is above 60 and BP is WNL. A client is admitted to the hospital with a diagnosis of Type 2 diabetes mellitus and influenza. Which categories of illness should the nurse develop goals for the client's plan of care? One chronic and one acute illness Adult onset DM is life-long chronic disease. Influenza is acute illness with short term duration. Following an emergency Cesarean delivery the nurse encourages the new mother to breastfed her newborn. The client asks why she should breastfeed now. Which info should the nurse provide? Stimulate contraction of the uterus Infant suckling breast releases oxytocin by the posterior pituitary and stimulates the "letdown" reflex. Causing release of colostrum & contracts the uterus to prevent uterine hemorrhage. Which intervention should the nurse include in the plan of care for a female client with severe postpartum depression who is admitted to the inpatient psychiatric unit? Supervised and guided visits with infant. Structured visits provide an opportunity for the mother and infant to bond and should be facilitated and encouraged according to the client's pace of progress. A 16-year-old male client is admitted to the hospital after falling off a bike and sustaining a fractured bone. The HCP explains the surgery needed to immobilize the fracture. Which action should be implemented to obtain a valid informed consent? Obtain the permission of the custodial parent for the surgery. Pt is a minor and cannot legally sign his own consent unless he is an emancipated minor. Consent should be obtained from the guardian, custodial parent. During a client assessment, the client says, "I can't walk very well." Which action should the nurse implement first? Identify the problem Sequential problem solving steps: 1) Identify the problem, 2) consider alternatives, 3) consider outcomes of the alternatives, 4) predict the likelihood of the outcomes occurring and choose best chance of success. The nurse identifies a client's needs and formulates the nursing problem of, "Imbalanced nutrition: less than body requirements, related to mental impairment and decreased intake, as evidenced by increasing confusion and weight loss of more than 30 lbs over the last 6 months." Which short term goal is best for this pt? Eat 50% of six small meals each day by the end of one week Short term goals: realistic & attainable, time frame 7-10 days before discharge A male client is angry and is leaving the hospital AMA. The client demands to take his chart with him and states it's "his" and doesn't want contact with the hospital anymore. How should the nurse respond? The chart is the property of the hospital but I will see that a cope is made for you. Pt has legal right to the information in it even if leaving AMA The nurse manager is assisting a nurse with improving organizational skills and time management. Which nursing activity is the priority in pre-planning a schedule for selected nursing activities in the daily assignment? Medication administration Med admin is based on a prescribed schedule that is time-sensitive in the delivery of nursing care and should be priority in scheduling nursing activities in a daily assignment. What nursing delivery of care provides the nurse to plan and direct care of a group of clients over a 24-hour period? Primary nursing is a model of delivery of care where a nurse us accountable for planning care for clients around the clock. Two unlicensed assistive personnel (UAP) are arguing on the unit about who deserves to take a break first. What is the most important basic guideline that the nurse should follow in resolving the conflict? Deal with the issues and not personalities Issues are concrete and is 1 of 7 important key behaviors in managing conflict. Personalities include emotional reactions (not concrete). The nurse is caring for a client who is unable to void. The plan of care establishes an objective for the client to ingest at least 1000 mL of fluid between 7a and 330p. Which client response should the nurse document that indicates successful outcome? Drinks 240 mL of fluid 5 times during the shift which indicates fluid intake of mL meeting the objective. The nurse plans a teaching session with a client but postpones the planned session based on which nursing problem? Activity intolerance related to post-op pain Pain, fatigue, or anxiety can interfere with the ability to pay attention & participate in learning. A client who has active TB is admitted to the medical unit. What action is most important for the nurse to implement? Assign the client to a negative air-flow room active TB requires airborne precautions A client is receiving atenolol (Tenormin) 25 mg PO after a MI. The nurse determines the client's apical pulse is 65 bpm. What action should the nurse implement next? Administer the medication Apical pulse is >60 bpm The nurse is assessing a client and identifies a bruit over the thyroid. This finding is consistent with which interpretation? Hyperthyroidism enlargement of the thyroid gland (AKA goiter). Bruit may be auscultated d/t increase in glandular vascularity which increases as it becomes hyperactive. A 6-year-old child is alert by quiet when brought the the ER with periorbital ecchymosis and ecchymosis behind the ears. The nurse suspects potential child abuse and continues to assess the child for additional manifestations of a basilar skull fracture. What assessment finding would be consistent with a basilar skull fracture? Rhinorrhoea or otorrhoea with Halo sign Raccoon eyes (periorbital ecchymosis) and Battle's sign (ecchymosis behind the ears over mastoid process) are both signs of a basilar skill fracture. Nurse should assess possible meningeal tear that manifest as a Halo sign with CSF leakage from ears or nose