EVOLVE COMPREHENSIVE EXAM 1
QUESTIONS (HESI) WITH THE
LATEST SCORE.
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 at least likely to exacerbate asthma?
A. Pindolol (Visken).
B. Carteolol (Ocupress).
C. Metoprolol tartrate (Lopressor).
D. Propranolol hydrochloride (Inderal). - Correct Answer- Metoprolol
Tartrate( Lopressor)
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 the healthcare provider discontinued the medication because his
blood pressure has been normal for the past three months. Which instruction
should the use provide? - Correct Answer- Ask the health care provider about
tapering the drug dose over the next week.
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.
A client who is taking clonidine ( Catapres, Duraclon) reports drowsiness.
Which additional assessment should the nurse make? - Correct Answer- 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 (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? - Correct Answer- 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 (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. ? - Correct
Answer- Tricyclic antidepressants
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).
The nurse obtains a heart rate of 92 and a blood pressure of 110/76 prior to
administering a scheduled dose of verapamil (Calan) for a client with atrial
,flutter Which action should the nurse implement? - Correct Answer-
Administer the dose as prescribed
Verapamil slows sinoatrial (SA) nodal automaticity, delays atrioventricular
(AV) nodal conduction, which slows the ventricular rate, and is used to treat
atrial flutter, so (A) should be implemented, based on the client's heart rate
and blood pressure. (B and C) are not indicated. (D) delays the
administration of the scheduled dose.
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? - Correct Answer- Stimulate
contraction of the uterus
When the infant suckles at the breast, oxytocin is released by the posterior
pituitary to stimulates the "letdown" reflex, which causes the release of
colostrum, and contracts the uterus (C) to prevent uterine hemorrhage. (A
and B) do not support the client's need in the immediate period after the
emergency delivery. Although maternal-newborn bonding (D) is facilitated by
early breastfeeding, the priority is uterine contraction stimulation.
The nurse identifies a client’s needs and formulates the nursing problem of "
Imbalance nutrition: Less than body requirements, related to mental
impairment and decreased intake, as evidence by increasing confusion and
weight loss of more than 30 pounds over the last 6 months. " which short-
term goal is best for this client? - Correct Answer- Eat 50% of six small meals
each day by the end of the week
Short-term goals should be realistic and attainable and should have a
timeline of 7 to 10 days before discharge. (A) meets those criteria. (B) is
nurse-oriented. (C) may be beyond the capabilities of a confused client. (D)
is a long-term goal.
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 7:00 am and 3:30pm. Which client response should the nurse
document that indicates a successful outcome? - Correct Answer- Drinks 240
mL of fluid five times during the shift.
, The nurse should evaluate the client's outcome by observing the client's
performance of each expected behavior, so drinking 240 mL of fluid five or
six times during the shift (D) indicates a fluid intake of 1200 to 1440 mL,
which meets the objective of at least 1000 mL during the designated period.
(A) uses the term "adequate," which is not quantified. (B) is not the
objective, which establishes an intake of at least 1000 mL. (C) is not an
evaluation of the specific fluid intake.
a client who has active tuberculosis ( TB) is admitted to the medical unit.
What action is most important for the nurse to implement? - Correct Answer-
Assign the client to a negative air-flow room
Active tuberculosis requires implementation of airborne precautions, so the
client should be assigned to a negative pressure air-flow room (D). Although
(A and C) should be implemented for clients in isolation with contact
precautions, it is most important that air flow from the room is minimized
when the client has TB. (B) should be implemented when the client leaves
the isolation environment.
A client is receiving atonal (Tenormin) 25 mg PO after a myocardial
infraction. The nurse determines the clients apical pulse is 65 beats per
minute. What action should the nurse implement next? - Correct Answer-
Administer the medication
Atenolol, a beta-blocker, blocks the beta receptors of the sinoatrial node to
reduce the heart rate, so the medication should be administered (C) because
the client's apical pulse is greater than 60. (A, B, and D) are not indicated at
this time.
A 6 year old child is alert but quiet when brought to the emergency center
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 the basilar skull fracture? - Correct Answer-
Rhinorrhea or otorrhea with halo sign
Raccoon eyes (periorbital ecchymosis) and Battle's sign (ecchymosis behind
the ear over the mastoid process) are both signs of a basilar skull fracture,
so the nurse should assess for possible meningeal tears that manifest as a
Halo sign with CSF leakage from the ears or nose (D). (A) is consistent with
QUESTIONS (HESI) WITH THE
LATEST SCORE.
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 at least likely to exacerbate asthma?
A. Pindolol (Visken).
B. Carteolol (Ocupress).
C. Metoprolol tartrate (Lopressor).
D. Propranolol hydrochloride (Inderal). - Correct Answer- Metoprolol
Tartrate( Lopressor)
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 the healthcare provider discontinued the medication because his
blood pressure has been normal for the past three months. Which instruction
should the use provide? - Correct Answer- Ask the health care provider about
tapering the drug dose over the next week.
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.
A client who is taking clonidine ( Catapres, Duraclon) reports drowsiness.
Which additional assessment should the nurse make? - Correct Answer- 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 (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? - Correct Answer- 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 (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. ? - Correct
Answer- Tricyclic antidepressants
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).
The nurse obtains a heart rate of 92 and a blood pressure of 110/76 prior to
administering a scheduled dose of verapamil (Calan) for a client with atrial
,flutter Which action should the nurse implement? - Correct Answer-
Administer the dose as prescribed
Verapamil slows sinoatrial (SA) nodal automaticity, delays atrioventricular
(AV) nodal conduction, which slows the ventricular rate, and is used to treat
atrial flutter, so (A) should be implemented, based on the client's heart rate
and blood pressure. (B and C) are not indicated. (D) delays the
administration of the scheduled dose.
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? - Correct Answer- Stimulate
contraction of the uterus
When the infant suckles at the breast, oxytocin is released by the posterior
pituitary to stimulates the "letdown" reflex, which causes the release of
colostrum, and contracts the uterus (C) to prevent uterine hemorrhage. (A
and B) do not support the client's need in the immediate period after the
emergency delivery. Although maternal-newborn bonding (D) is facilitated by
early breastfeeding, the priority is uterine contraction stimulation.
The nurse identifies a client’s needs and formulates the nursing problem of "
Imbalance nutrition: Less than body requirements, related to mental
impairment and decreased intake, as evidence by increasing confusion and
weight loss of more than 30 pounds over the last 6 months. " which short-
term goal is best for this client? - Correct Answer- Eat 50% of six small meals
each day by the end of the week
Short-term goals should be realistic and attainable and should have a
timeline of 7 to 10 days before discharge. (A) meets those criteria. (B) is
nurse-oriented. (C) may be beyond the capabilities of a confused client. (D)
is a long-term goal.
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 7:00 am and 3:30pm. Which client response should the nurse
document that indicates a successful outcome? - Correct Answer- Drinks 240
mL of fluid five times during the shift.
, The nurse should evaluate the client's outcome by observing the client's
performance of each expected behavior, so drinking 240 mL of fluid five or
six times during the shift (D) indicates a fluid intake of 1200 to 1440 mL,
which meets the objective of at least 1000 mL during the designated period.
(A) uses the term "adequate," which is not quantified. (B) is not the
objective, which establishes an intake of at least 1000 mL. (C) is not an
evaluation of the specific fluid intake.
a client who has active tuberculosis ( TB) is admitted to the medical unit.
What action is most important for the nurse to implement? - Correct Answer-
Assign the client to a negative air-flow room
Active tuberculosis requires implementation of airborne precautions, so the
client should be assigned to a negative pressure air-flow room (D). Although
(A and C) should be implemented for clients in isolation with contact
precautions, it is most important that air flow from the room is minimized
when the client has TB. (B) should be implemented when the client leaves
the isolation environment.
A client is receiving atonal (Tenormin) 25 mg PO after a myocardial
infraction. The nurse determines the clients apical pulse is 65 beats per
minute. What action should the nurse implement next? - Correct Answer-
Administer the medication
Atenolol, a beta-blocker, blocks the beta receptors of the sinoatrial node to
reduce the heart rate, so the medication should be administered (C) because
the client's apical pulse is greater than 60. (A, B, and D) are not indicated at
this time.
A 6 year old child is alert but quiet when brought to the emergency center
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 the basilar skull fracture? - Correct Answer-
Rhinorrhea or otorrhea with halo sign
Raccoon eyes (periorbital ecchymosis) and Battle's sign (ecchymosis behind
the ear over the mastoid process) are both signs of a basilar skull fracture,
so the nurse should assess for possible meningeal tears that manifest as a
Halo sign with CSF leakage from the ears or nose (D). (A) is consistent with
