Comprehensive HESI Module Exam NEW
LATEST VERSION UPDATE 2024-2025
BEST STUDYING MATERIAL WITH
VERIFIED ANSWERS
Phenelzine sulfate is prescribed for a client with depression. The nurse provides
information to the client about the adverse effects of the medication and tells the client
to contact the primary health care provider immediately if he/she experiences what
sign/symptom?
Neck stiffness or soreness
Feelings of depression
Dry mouth
Restlessness - Ans - Neck stiffness or soreness
Rationale: The client is taught to immediately contact the primary health care provider if
the client experiences any occipital headache radiating frontally and neck stiffness or
soreness, which could be the first sign of a hypertensive crisis. Phenelzine sulfate, a
monoamine oxidase inhibitor (MAOI), is an antidepressant and is used to treat
depression. Hypertensive crisis, an adverse effect of this medication, is characterized
by hypertension, frontally radiating occipital headache, neck stiffness and soreness,
nausea, vomiting, sweating, fever and chills, clammy skin, dilated pupils, and
palpitations. Tachycardia, bradycardia, and constricting chest pain may also be present.
Dry mouth and restlessness are common side effects of the medication.
Risperidone is prescribed for a client hospitalized in the mental health unit for the
treatment of a psychotic disorder. Which finding in the client's medical record would
prompt the nurse to contact the prescribing primary health care provider before
administering the medication?
The client has a history of cataracts.
The client takes a prescribed antihypertensive.
The client has a history of hypothyroidism.
The client is allergic to acetylsalicylic acid (aspirin). - Ans - The client takes a prescribed
antihypertensive.
Rationale: Risperidone is an antipsychotic medication. Contraindications to the use of
risperidone include cardiac disorders, cerebrovascular disease, dehydration,
hypovolemia, and therapy with antihypertensive agents. Risperidone is used with
caution in clients with a history of seizures. History of cataracts, hypothyroidism, or
allergy to aspirin does not affect the administration of this medication.
A client who has been undergoing long-term therapy with an antipsychotic medication is
admitted to the inpatient mental health unit. Which finding does the nurse, knowing that
,long-term use of an antipsychotic medication can cause tardive dyskinesia, monitor in
the client?
Tongue protrusion
Hypertension
Fever
Diarrhea - Ans - Tongue protrusion
Rationale: The clinical manifestations include abnormal movements (dyskinesia) and
involuntary movements of the mouth, tongue ("flycatcher tongue"), and face. Tardive
dyskinesia is a severe reaction associated with long-term use of antipsychotic
medications. In its most severe form, tardive dyskinesia involves the fingers, arms,
trunk, and respiratory muscles. When this occurs, the medication is discontinued. Fever,
diarrhea, and hypertension are not characteristics of tardive dyskinesia.
A nurse is reviewing the record of a client scheduled for electroconvulsive therapy
(ECT). Which diagnosis, if noted on the client's record, would indicate a need to contact
the primary health care provider who is scheduled to perform the ECT?
Peripheral vascular disease
Hypothyroidism
Recent stroke
History of glaucoma - Ans - Recent stroke
Rationale: Several conditions pose risks in the client scheduled for ECT. Among them
are recent myocardial infarction or stroke and cerebrovascular malformations or
intracranial lesions. Hypothyroidism, glaucoma, and peripheral vascular disease are not
contraindications to this treatment.
The nurse is caring for a client who just returned to the surgical unit after having a
suprapubic prostatectomy. What type of medication does the nurse expect to be
ordered?
Antidyskinetics
Phenothiazines
Antispasmodics
Benzodiazepines - Ans - Antispasmodics
Rationale: Antispasmodics are prescribed for bladder spasms related to a suprapubic
prostatectomy. This surgery involves removal of the prostate gland by an abdominal
incision with a bladder incision. Phenothiazines are a class of antipsychotic
medications. Antidyskinetics have an anticholinergic action and are used to treat
Parkinson's disease and some of the acute movement disorders that may be caused by
antipsychotic agents. Benzodiazepines are central nervous system (CNS) depressants
and can cause sedation and psychomotor slowing. They can also intensify depression
, caused by other drugs. Benzodiazepines have some potential for abuse and should be
used with caution in clients known to abuse alcohol or other psychoactive medications.
A nurse reviewing the medical record of a client with a diagnosis of infiltrating ductal
carcinoma of the breast notes documentation of the presence of peau d'orange skin. On
the basis of this notation, which finding would the nurse expect to note on assessment
of the client's breast?
This question has images. Think: What does peau d'orange look like? - Ans - Rationale:
Peau d'orange (French for "orange peel") is the term used to describe skin dimpling,
resembling the skin of an orange, at the location of a breast mass. This change, along
with increased vascularity, nipple retraction, or ulceration, may indicate advanced
disease. Erythema, or reddening, of the breast indicates inflammation such as that
resulting from cellulitis or a breast abscess. Paget's disease is a rare type of breast
cancer that is manifested as a red, scaly nipple; discharge; crusting lasting more than a
few weeks. In nipple retraction, the nipple is pointed or pulled in an abnormal direction.
It is suggestive of malignancy.
The mother of an adolescent diagnosed with type 1 diabetes mellitus tells the nurse that
her child is a member of the school soccer team and expresses concern about her
child's participation in sports. What does the nurse tell the mother after providing
information to the mother about diet, exercise, insulin, and blood glucose control?
To administer additional insulin before a soccer game if the blood glucose level is 240
mg/dL (13.3 mmol/L) or higher and ketones are present.
To always administer less insulin on the days of soccer games
That the child should eat a carbohydrate snack about a half-hour before each soccer
game
That it is best not to encourage the child to participate in sports activities - Ans - That
the child should eat a carbohydrate snack about a half-hour before each soccer game
Rationale: The child with diabetes mellitus who is active in sports requires additional
food intake in the form of a carbohydrate snack about a half-hour before the anticipated
activity. Additional food will need to be consumed, often as frequently as every 45
minutes to 1 hour, during prolonged periods of activity. If the blood glucose level is
increased (240 mg/dL [13.3 mmol/L] or more) and ketones are present before planned
exercise, the activity should be postponed until the blood glucose has been controlled.
Moderate to high ketone values should be reported to the primary health care provider.
There is no reason for the child to avoid participating in sports.
A client diagnosed with chronic kidney disease who requires dialysis three times a week
for the rest of his life says to the nurse, "Why should I even bother to watch what I eat
and drink? It doesn't really matter what I do if I'm never going to get better!" On the
basis of the client's statement, the nurse determines that the client is experiencing
which problem?
LATEST VERSION UPDATE 2024-2025
BEST STUDYING MATERIAL WITH
VERIFIED ANSWERS
Phenelzine sulfate is prescribed for a client with depression. The nurse provides
information to the client about the adverse effects of the medication and tells the client
to contact the primary health care provider immediately if he/she experiences what
sign/symptom?
Neck stiffness or soreness
Feelings of depression
Dry mouth
Restlessness - Ans - Neck stiffness or soreness
Rationale: The client is taught to immediately contact the primary health care provider if
the client experiences any occipital headache radiating frontally and neck stiffness or
soreness, which could be the first sign of a hypertensive crisis. Phenelzine sulfate, a
monoamine oxidase inhibitor (MAOI), is an antidepressant and is used to treat
depression. Hypertensive crisis, an adverse effect of this medication, is characterized
by hypertension, frontally radiating occipital headache, neck stiffness and soreness,
nausea, vomiting, sweating, fever and chills, clammy skin, dilated pupils, and
palpitations. Tachycardia, bradycardia, and constricting chest pain may also be present.
Dry mouth and restlessness are common side effects of the medication.
Risperidone is prescribed for a client hospitalized in the mental health unit for the
treatment of a psychotic disorder. Which finding in the client's medical record would
prompt the nurse to contact the prescribing primary health care provider before
administering the medication?
The client has a history of cataracts.
The client takes a prescribed antihypertensive.
The client has a history of hypothyroidism.
The client is allergic to acetylsalicylic acid (aspirin). - Ans - The client takes a prescribed
antihypertensive.
Rationale: Risperidone is an antipsychotic medication. Contraindications to the use of
risperidone include cardiac disorders, cerebrovascular disease, dehydration,
hypovolemia, and therapy with antihypertensive agents. Risperidone is used with
caution in clients with a history of seizures. History of cataracts, hypothyroidism, or
allergy to aspirin does not affect the administration of this medication.
A client who has been undergoing long-term therapy with an antipsychotic medication is
admitted to the inpatient mental health unit. Which finding does the nurse, knowing that
,long-term use of an antipsychotic medication can cause tardive dyskinesia, monitor in
the client?
Tongue protrusion
Hypertension
Fever
Diarrhea - Ans - Tongue protrusion
Rationale: The clinical manifestations include abnormal movements (dyskinesia) and
involuntary movements of the mouth, tongue ("flycatcher tongue"), and face. Tardive
dyskinesia is a severe reaction associated with long-term use of antipsychotic
medications. In its most severe form, tardive dyskinesia involves the fingers, arms,
trunk, and respiratory muscles. When this occurs, the medication is discontinued. Fever,
diarrhea, and hypertension are not characteristics of tardive dyskinesia.
A nurse is reviewing the record of a client scheduled for electroconvulsive therapy
(ECT). Which diagnosis, if noted on the client's record, would indicate a need to contact
the primary health care provider who is scheduled to perform the ECT?
Peripheral vascular disease
Hypothyroidism
Recent stroke
History of glaucoma - Ans - Recent stroke
Rationale: Several conditions pose risks in the client scheduled for ECT. Among them
are recent myocardial infarction or stroke and cerebrovascular malformations or
intracranial lesions. Hypothyroidism, glaucoma, and peripheral vascular disease are not
contraindications to this treatment.
The nurse is caring for a client who just returned to the surgical unit after having a
suprapubic prostatectomy. What type of medication does the nurse expect to be
ordered?
Antidyskinetics
Phenothiazines
Antispasmodics
Benzodiazepines - Ans - Antispasmodics
Rationale: Antispasmodics are prescribed for bladder spasms related to a suprapubic
prostatectomy. This surgery involves removal of the prostate gland by an abdominal
incision with a bladder incision. Phenothiazines are a class of antipsychotic
medications. Antidyskinetics have an anticholinergic action and are used to treat
Parkinson's disease and some of the acute movement disorders that may be caused by
antipsychotic agents. Benzodiazepines are central nervous system (CNS) depressants
and can cause sedation and psychomotor slowing. They can also intensify depression
, caused by other drugs. Benzodiazepines have some potential for abuse and should be
used with caution in clients known to abuse alcohol or other psychoactive medications.
A nurse reviewing the medical record of a client with a diagnosis of infiltrating ductal
carcinoma of the breast notes documentation of the presence of peau d'orange skin. On
the basis of this notation, which finding would the nurse expect to note on assessment
of the client's breast?
This question has images. Think: What does peau d'orange look like? - Ans - Rationale:
Peau d'orange (French for "orange peel") is the term used to describe skin dimpling,
resembling the skin of an orange, at the location of a breast mass. This change, along
with increased vascularity, nipple retraction, or ulceration, may indicate advanced
disease. Erythema, or reddening, of the breast indicates inflammation such as that
resulting from cellulitis or a breast abscess. Paget's disease is a rare type of breast
cancer that is manifested as a red, scaly nipple; discharge; crusting lasting more than a
few weeks. In nipple retraction, the nipple is pointed or pulled in an abnormal direction.
It is suggestive of malignancy.
The mother of an adolescent diagnosed with type 1 diabetes mellitus tells the nurse that
her child is a member of the school soccer team and expresses concern about her
child's participation in sports. What does the nurse tell the mother after providing
information to the mother about diet, exercise, insulin, and blood glucose control?
To administer additional insulin before a soccer game if the blood glucose level is 240
mg/dL (13.3 mmol/L) or higher and ketones are present.
To always administer less insulin on the days of soccer games
That the child should eat a carbohydrate snack about a half-hour before each soccer
game
That it is best not to encourage the child to participate in sports activities - Ans - That
the child should eat a carbohydrate snack about a half-hour before each soccer game
Rationale: The child with diabetes mellitus who is active in sports requires additional
food intake in the form of a carbohydrate snack about a half-hour before the anticipated
activity. Additional food will need to be consumed, often as frequently as every 45
minutes to 1 hour, during prolonged periods of activity. If the blood glucose level is
increased (240 mg/dL [13.3 mmol/L] or more) and ketones are present before planned
exercise, the activity should be postponed until the blood glucose has been controlled.
Moderate to high ketone values should be reported to the primary health care provider.
There is no reason for the child to avoid participating in sports.
A client diagnosed with chronic kidney disease who requires dialysis three times a week
for the rest of his life says to the nurse, "Why should I even bother to watch what I eat
and drink? It doesn't really matter what I do if I'm never going to get better!" On the
basis of the client's statement, the nurse determines that the client is experiencing
which problem?
