HESI COMPREHENSIVE EXAM
1. The nurse is assessing an older adult client and determines that the client's left upper eyelid
droops, covering more of the iris than the right eyelid. Which description should the nurse use
to document this finding?: Ptosis on the lefteyelid
Ptosis is the term to describe an eyelid droop that covers a large portion of the iris (A), which
may result from oculomotor nerve or eyelid muscle disorder. (B) ischaracterized by rapid,
rhythmic movement of both eyes. (C) is a distortion of thelens of the eye, causing decreased
visual acuity. (D) is a term used to describe aprotrusion of the eyeballs that occurs with
hyperthyroidism.
2. The nurse obtains the pluse rate of 89 beats/min for an infant before administering
digoxin (Lanoxin) which action should the nurse take?: Withholdthe medication and contact the
healthcare provider
Bradycardia is an early sign of digoxin toxicity, so if the infant's pulse rate is less than 100
beats/minute, digoxin should be withheld and the healthcare provider should be notified (D).
Assessing the respiratory rate (A) is not indicated before administering Lanoxin. (B and C)
place the infant at further risk for digoxin toxicity.
3. The nurse is developing a teaching plan for an adolescent with a Milwaukee brace. Which
instruction should the nurse include?: Wear the brace over a
T-shirt 23 hours a day.
Idiopathic scoliosis is an abnormal lateral curvature of the spine in adolescent females. Early
treatment uses a Milwaukee brace that places pressure against the
lateral spinal curvature, under the neck, and against the iliac crest, so it should be worn for 23
hours per day over a T-shirt (D) which reduces friction and chafing of theskin. (A, B, and C)
reduce the effectiveness of the brace.
4. A 9 year old is hospitalized for the neutropenia and is placed in reverse isolation. The
child asks the nurse " why do you have to wear a gown and mask when you are in my room?"
How should the nurse respond?: " To protectyou because you can get an infection very easily
Reverse isolation precaution implement measures to protect the client from exposure to
microorganisms from others (B). Although microbes are prevalent in all environments, (A)
does not adequately answer the child's question. Reverseisolation should be implemented until
the client's white blood cell increases (C).Neutropenia in this child does not place others (D)
at risk for infection.
5. A male client who had abdominal surgery has a nasogastric tube to suction, oxygen per
nasal cannula, and complains of dry mouth. Which action should the nurse implement?:
,Apply a water soluble lubricant to the lips, oral mucosa and nares.
To ease the client's discomfort, a water soluble lubricant to the lips and nares assiststo keep the
mucous membranes moist (D). (A) is a petroleum-based product and should not be used
because it is flammable. (B and C) should not be given to the client with a nasogastric tube to
suction because it can cause further distension andinterfere with fluid and electrolyte balance.
6. The nurse is assessing the laboratory results for a client who is admittedwith renal failure
and osteodystrophy. Which findings are consistent with thisclient's clincail picture ?: Serum
potassium of 5.5 mEq and total calcium of 6 mg/dl.
In renal failure, normal serum electrolyte balance is altered because the kidneys failto activate
vitamin D, calcium absorption is impaired, and serum calcium decreases,which stimulates the
release of PTH causing resorption of calcium and phosphate from the bone. A decreased
tubular excretion and a decreased glomerular filtrationrate results in hypocalcemia,
hyperphosphatemia, and hyperkalemia (C). (A) is reflective of a non-renal cause, such as
dehydration or liver pathology. (B) is more indicative of infection. Renal failure causes anemia
and hyperphosphatemia, not (D).
7. A 56 year old female client is receiving intracavitary radiation via a radium implant. Which
nurse should be assigned to care for this client?: A nurse with marfran's syndrome who is
postmenopausal.
A client receiving intracavity radiation poses a radiation hazard as long as the intracavity
radiation source is in place. A nurse's ability to care of this client is not affected by Marfan's
syndrome (B), which is a hereditary disorder of connective tissues, bones, muscles, ligaments
and skeletal structures. The goal is to limit any one staff member's exposure to the calculated
time span based on the half-life of radium, such as the number of minutes at the bedside per
day, so (A) should not beassigned. (C) should not be exposed to the radiation due to the possible
effect on thefetus. A radiation exposure decreases the immune response in the client who should
not be exposed to the potential inadvertent transmission of an infectious organism (D).
8. Which info should the nurse provide a client who has undergone cry-
rosyrgery for stage 1A cervical cancer?: Use a sanitary napkin instead of atampon.
Clients should avoid the use of tampons for 3 to 6 weeks (D) after the procedure toreduce the
risk of infection. A heavy, watery vaginal discharge is expected during this time, so (A) is
unnecessary. Sexual intercourse should be avoided for up to 6 weeks, so (B) is inaccurate. (C)
is not a side effect of the procedure but may indicatehuman papillomavirus or a cancerous
lesion and should be reported.
9. A client with asthma receives a prescription for high blood pressure dur-ing a clinic visit.
Which prescription should the nurse anticipate the client to receive that is at least likely to
exacerbate asthma?: Metoprolol Tartrate( Lopressor)
, The best antihypertensive agent for clients with asthma is metoprolol (Lopressor) (C), a beta2
blocking agent which is also cardioselective 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.
10. A male client who has been taking propranolol ( inderal) for 18 months tellsthe nurse the
healthcare provider discontinued the medication because his blood pressure has been normal
for the past three months. Which instructionshould the use provide?: 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 shouldbe recommended.
11. A client who is taking clonidine ( Catapres, Duraclon) reports drowsiness. Which
additional assessment should the nurse make?: How long has the clientbeen 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.
12. The nurse is preparing to admister atropine, an anticholinergic, to a clientwho is
scheduled for a cholecystectomy. The client asks the nurse to explainth reason for the
prescribed medication. What response is best for the nurseto 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 (B) during surgicalanesthesia. (A, C and D) do
not address the therapeutic action of atropine use perioperatively.
13. 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
urniary retention in this geriatric client. ?: 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 antiinflammatory agents (D) can increase the risk for
1. The nurse is assessing an older adult client and determines that the client's left upper eyelid
droops, covering more of the iris than the right eyelid. Which description should the nurse use
to document this finding?: Ptosis on the lefteyelid
Ptosis is the term to describe an eyelid droop that covers a large portion of the iris (A), which
may result from oculomotor nerve or eyelid muscle disorder. (B) ischaracterized by rapid,
rhythmic movement of both eyes. (C) is a distortion of thelens of the eye, causing decreased
visual acuity. (D) is a term used to describe aprotrusion of the eyeballs that occurs with
hyperthyroidism.
2. The nurse obtains the pluse rate of 89 beats/min for an infant before administering
digoxin (Lanoxin) which action should the nurse take?: Withholdthe medication and contact the
healthcare provider
Bradycardia is an early sign of digoxin toxicity, so if the infant's pulse rate is less than 100
beats/minute, digoxin should be withheld and the healthcare provider should be notified (D).
Assessing the respiratory rate (A) is not indicated before administering Lanoxin. (B and C)
place the infant at further risk for digoxin toxicity.
3. The nurse is developing a teaching plan for an adolescent with a Milwaukee brace. Which
instruction should the nurse include?: Wear the brace over a
T-shirt 23 hours a day.
Idiopathic scoliosis is an abnormal lateral curvature of the spine in adolescent females. Early
treatment uses a Milwaukee brace that places pressure against the
lateral spinal curvature, under the neck, and against the iliac crest, so it should be worn for 23
hours per day over a T-shirt (D) which reduces friction and chafing of theskin. (A, B, and C)
reduce the effectiveness of the brace.
4. A 9 year old is hospitalized for the neutropenia and is placed in reverse isolation. The
child asks the nurse " why do you have to wear a gown and mask when you are in my room?"
How should the nurse respond?: " To protectyou because you can get an infection very easily
Reverse isolation precaution implement measures to protect the client from exposure to
microorganisms from others (B). Although microbes are prevalent in all environments, (A)
does not adequately answer the child's question. Reverseisolation should be implemented until
the client's white blood cell increases (C).Neutropenia in this child does not place others (D)
at risk for infection.
5. A male client who had abdominal surgery has a nasogastric tube to suction, oxygen per
nasal cannula, and complains of dry mouth. Which action should the nurse implement?:
,Apply a water soluble lubricant to the lips, oral mucosa and nares.
To ease the client's discomfort, a water soluble lubricant to the lips and nares assiststo keep the
mucous membranes moist (D). (A) is a petroleum-based product and should not be used
because it is flammable. (B and C) should not be given to the client with a nasogastric tube to
suction because it can cause further distension andinterfere with fluid and electrolyte balance.
6. The nurse is assessing the laboratory results for a client who is admittedwith renal failure
and osteodystrophy. Which findings are consistent with thisclient's clincail picture ?: Serum
potassium of 5.5 mEq and total calcium of 6 mg/dl.
In renal failure, normal serum electrolyte balance is altered because the kidneys failto activate
vitamin D, calcium absorption is impaired, and serum calcium decreases,which stimulates the
release of PTH causing resorption of calcium and phosphate from the bone. A decreased
tubular excretion and a decreased glomerular filtrationrate results in hypocalcemia,
hyperphosphatemia, and hyperkalemia (C). (A) is reflective of a non-renal cause, such as
dehydration or liver pathology. (B) is more indicative of infection. Renal failure causes anemia
and hyperphosphatemia, not (D).
7. A 56 year old female client is receiving intracavitary radiation via a radium implant. Which
nurse should be assigned to care for this client?: A nurse with marfran's syndrome who is
postmenopausal.
A client receiving intracavity radiation poses a radiation hazard as long as the intracavity
radiation source is in place. A nurse's ability to care of this client is not affected by Marfan's
syndrome (B), which is a hereditary disorder of connective tissues, bones, muscles, ligaments
and skeletal structures. The goal is to limit any one staff member's exposure to the calculated
time span based on the half-life of radium, such as the number of minutes at the bedside per
day, so (A) should not beassigned. (C) should not be exposed to the radiation due to the possible
effect on thefetus. A radiation exposure decreases the immune response in the client who should
not be exposed to the potential inadvertent transmission of an infectious organism (D).
8. Which info should the nurse provide a client who has undergone cry-
rosyrgery for stage 1A cervical cancer?: Use a sanitary napkin instead of atampon.
Clients should avoid the use of tampons for 3 to 6 weeks (D) after the procedure toreduce the
risk of infection. A heavy, watery vaginal discharge is expected during this time, so (A) is
unnecessary. Sexual intercourse should be avoided for up to 6 weeks, so (B) is inaccurate. (C)
is not a side effect of the procedure but may indicatehuman papillomavirus or a cancerous
lesion and should be reported.
9. A client with asthma receives a prescription for high blood pressure dur-ing a clinic visit.
Which prescription should the nurse anticipate the client to receive that is at least likely to
exacerbate asthma?: Metoprolol Tartrate( Lopressor)
, The best antihypertensive agent for clients with asthma is metoprolol (Lopressor) (C), a beta2
blocking agent which is also cardioselective 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.
10. A male client who has been taking propranolol ( inderal) for 18 months tellsthe nurse the
healthcare provider discontinued the medication because his blood pressure has been normal
for the past three months. Which instructionshould the use provide?: 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 shouldbe recommended.
11. A client who is taking clonidine ( Catapres, Duraclon) reports drowsiness. Which
additional assessment should the nurse make?: How long has the clientbeen 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.
12. The nurse is preparing to admister atropine, an anticholinergic, to a clientwho is
scheduled for a cholecystectomy. The client asks the nurse to explainth reason for the
prescribed medication. What response is best for the nurseto 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 (B) during surgicalanesthesia. (A, C and D) do
not address the therapeutic action of atropine use perioperatively.
13. 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
urniary retention in this geriatric client. ?: 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 antiinflammatory agents (D) can increase the risk for
