HESI CRITICAL CARE EXAM DETAILED
ANSWERS AND A+ ULTIMATE GUIDE.
A 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
least likely to
exacerbate asthma?
A. Carteolol (Ocupress).
B. Propranolol hydrochloride (Inderal).
C. Pindolol (Visken).
D. Metoprolol tartrate (Lopressor) - CorreCt Answers -D. Metoprolol
tartrate (Lopressor).
RATIONALE:
The best antihypertensive agent for clients with asthma is metoprolol
(Lopressor) (C), a beta2
blocking agent which is also cardio-selective and less likely to cause
bronchoconstriction.
Pindolol (A) is a beta2 blocker that can cause bronchoconstriction and
increase asthmatic
symptoms. Although carteolol (B) is a beta blocking agent and an effective
antihypertensive
agent used in managing angina, it can increase a client's risk for
bronchoconstriction due to its
nonselective beta blocker action. Propranolol (D) also blocks the beta2
receptors in the lungs,
,causing bronchoconstriction, and is not indicated in clients with asthma
and other obstructive
pulmonary disorders.
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 three months. Which instruction should the nurse provide?
A. Obtain another antihypertensive prescription to avoid withdrawal
symptoms.
B. Stop the medication and keep an accurate record of blood pressure
C. Report any uncomfortable symptoms after stopping the medication.
D. Ask the healthcare provider about tapering the drug dose over the next
week. - CorreCt Answers -D. Ask the healthcare provider about tapering the
drug dose over the next week.
RATIONALE:
Although the healthcare provider discontinued the propranolol, measures
to prevent rebound
cardiac excitation, such as progressively reducing the dose over one to two
weeks (C), should be
recommended to prevent rebound tachycardia, hypertension, and
ventricular dysrhythmias.
Abrupt cessation (A and B) of the beta-blocking agent may precipitate
tachycardia and rebound
hypertension, so gradual weaning should be recommended. (D) is not
indicated.
,A client who is taking clonidine (Catapres, Duraclon) reports drowsiness.
Which additional
assessment should the nurse make?
A. Has the client experienced constipation recently?
B. Did the client miss any doses of the medication?
C. How long has the client been taking the medication?
D. Does the client use any tobacco products? - CorreCt Answers -C. How
long has the client been taking the medication?
RATIONALE:
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 (A) provides
information to direct additional instruction. (B, C, and D) are not relevant.
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?
A. Provide a more rapid induction of anesthesia.
B. Induce relaxation before induction of anesthesia.
C. Decrease the risk of bradycardia during surgery.
D. Minimize the amount of analgesia needed postoperatively. - CorreCt
Answers -C. Decrease the risk of bradycardia during surgery.
RATIONALE:
, Atropine may be prescribed preoperatively to increase the automaticity of
the sinoatrial node and
prevent a dangerous reduction in heart rate (B) during surgical anesthesia.
(A, C and D) do not
address the therapeutic action of atropine use perioperatively.
An 80-year-old client is given morphine sulphate for postoperative pain.
Which concomitant
medication should the nurse question that poses a potential development of
urinary retention in
this geriatric client?
A. Antacids.
B. Tricyclic antidepressants.
C. Nonsteroidal anti-inflammatory agents.
D. Insulin. - CorreCt Answers -B. Tricyclic antidepressants.
RATIONALE:
Drugs with anticholinergic properties, such as tricyclic antidepressants (C),
can exacerbate
urinary retention associated with opioids in the older client. Although
tricyclic antidepressants
and antihistamines with opioids can exacerbate urinary retention, the
concurrent use of (A and B)
with opioids do not. Nonsteroidal anti-inflammatory agents (D) can
increase the risk for
bleeding, but do not increase urinary retention with opioids (D).
ANSWERS AND A+ ULTIMATE GUIDE.
A 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
least likely to
exacerbate asthma?
A. Carteolol (Ocupress).
B. Propranolol hydrochloride (Inderal).
C. Pindolol (Visken).
D. Metoprolol tartrate (Lopressor) - CorreCt Answers -D. Metoprolol
tartrate (Lopressor).
RATIONALE:
The best antihypertensive agent for clients with asthma is metoprolol
(Lopressor) (C), a beta2
blocking agent which is also cardio-selective and less likely to cause
bronchoconstriction.
Pindolol (A) is a beta2 blocker that can cause bronchoconstriction and
increase asthmatic
symptoms. Although carteolol (B) is a beta blocking agent and an effective
antihypertensive
agent used in managing angina, it can increase a client's risk for
bronchoconstriction due to its
nonselective beta blocker action. Propranolol (D) also blocks the beta2
receptors in the lungs,
,causing bronchoconstriction, and is not indicated in clients with asthma
and other obstructive
pulmonary disorders.
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 three months. Which instruction should the nurse provide?
A. Obtain another antihypertensive prescription to avoid withdrawal
symptoms.
B. Stop the medication and keep an accurate record of blood pressure
C. Report any uncomfortable symptoms after stopping the medication.
D. Ask the healthcare provider about tapering the drug dose over the next
week. - CorreCt Answers -D. Ask the healthcare provider about tapering the
drug dose over the next week.
RATIONALE:
Although the healthcare provider discontinued the propranolol, measures
to prevent rebound
cardiac excitation, such as progressively reducing the dose over one to two
weeks (C), should be
recommended to prevent rebound tachycardia, hypertension, and
ventricular dysrhythmias.
Abrupt cessation (A and B) of the beta-blocking agent may precipitate
tachycardia and rebound
hypertension, so gradual weaning should be recommended. (D) is not
indicated.
,A client who is taking clonidine (Catapres, Duraclon) reports drowsiness.
Which additional
assessment should the nurse make?
A. Has the client experienced constipation recently?
B. Did the client miss any doses of the medication?
C. How long has the client been taking the medication?
D. Does the client use any tobacco products? - CorreCt Answers -C. How
long has the client been taking the medication?
RATIONALE:
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 (A) provides
information to direct additional instruction. (B, C, and D) are not relevant.
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?
A. Provide a more rapid induction of anesthesia.
B. Induce relaxation before induction of anesthesia.
C. Decrease the risk of bradycardia during surgery.
D. Minimize the amount of analgesia needed postoperatively. - CorreCt
Answers -C. Decrease the risk of bradycardia during surgery.
RATIONALE:
, Atropine may be prescribed preoperatively to increase the automaticity of
the sinoatrial node and
prevent a dangerous reduction in heart rate (B) during surgical anesthesia.
(A, C and D) do not
address the therapeutic action of atropine use perioperatively.
An 80-year-old client is given morphine sulphate for postoperative pain.
Which concomitant
medication should the nurse question that poses a potential development of
urinary retention in
this geriatric client?
A. Antacids.
B. Tricyclic antidepressants.
C. Nonsteroidal anti-inflammatory agents.
D. Insulin. - CorreCt Answers -B. Tricyclic antidepressants.
RATIONALE:
Drugs with anticholinergic properties, such as tricyclic antidepressants (C),
can exacerbate
urinary retention associated with opioids in the older client. Although
tricyclic antidepressants
and antihistamines with opioids can exacerbate urinary retention, the
concurrent use of (A and B)
with opioids do not. Nonsteroidal anti-inflammatory agents (D) can
increase the risk for
bleeding, but do not increase urinary retention with opioids (D).
