HESI Critical Care Comprehensive Exam | Questions and Answers with Rationales | Already Rated A | Latest 2022/2023
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Course
HESI (HESI)
Institution
Chamberlain College Of Nursing
HESI Critical Care Comprehensive Exam | Questions and Answers with Rationales | Already Rated A | Latest 2022/2023
1. 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 l...
HESI Critical Care Comprehensive Exam |
Questions and Answers with Rationales |
Already Rated A | Latest 2022/2023
1. 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).
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.
2. 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.
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.
3. 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?
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.
4. 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.
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.
5. 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.
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).
6. A client with osteoarthritis is given a new prescription for a nonsteroidal anti-inflammatory
drug (NSAID). The client asks the nurse, "How is this medication different from the
acetaminophen I have been taking?" Which information about the therapeutic action of
NSAIDs should the nurse provide?
,A. Are less expensive.
B. Provide anti-inflammatory response.
C. Increase hepatotoxic side effects.
D. Cause gastrointestinal bleeding.
RATIONALE:
Nonsteroidal anti-inflammatory drugs (NSAIDs) have anti-inflammatory properties (B), which
relieves pain associated with osteoarthritis and differs from acetaminophen, a non-narcotic
analgesic and antipyretic. (A) does not teach the client about the medication's actions. Although
NSAIDs are irritating to the gastrointestinal (GI) system and can cause GI bleeding (C),
instructions to take with food in the stomach to manage this as an expected side effect should be
included, but this does not answer the client's question. Acetaminophen is potentially hepatotoxic
(D), not NSAIDs.
7. 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?
A. Cardiorespiratory.
B. Liver.
C. Sensory.
D. Kidney.
RATIONALE:
Acetaminophen and alcohol are both metabolized in the liver. This places the client at risk for
hepatotoxicity, so monitoring liver (A) function is the most important assessment because the
combination of acetaminophen and alcohol, even in moderate amounts, can cause potentially
fatal liver damage. Other non-narcotic analgesics, such as n onsteroidal anti-inflammatory drugs
(NSAIDs), are more likely to promote adverse renal effects (B). Acetaminophen does not place
the client at risk for toxic reactions related to (C or D).
8. 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?
A. Give intravenous (IV) calcium gluconate.
B. Withhold the drug and notify the healthcare provider.
C. Administer the dose as prescribed.
D. Recheck the vital signs in 30 minutes and then administer the dose.
RATIONALE:
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.
, 9. 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?
A. One chronic and one acute illness.
B. Two acute illnesses.
C. One acute and one infectious illness.
D. Two chronic illnesses.
RATIONALE:
The plan of care should include goals that are specific for chronic and acute illnesses. Adult-
onset diabetes is a life-long chronic disease, whereas influenza is an acute illness with a short-
term duration (C). (A, B, and D) do not include the correct duration categories for this situation.
10. Following an emergency Cesarean delivery, the nurse encourages the new mother to
breastfeed her newborn. The client asks why she should breastfeed now. Which information
should the nurse provide?
A. Stimulate contraction of the uterus.
B. Initiate the lactation process.
C. Facilitate maternal-infant bonding.
D. Prevent neonatal hypoglycemia.
RATIONALE:
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.
11. A client who has active tuberculosis (TB) is admitted to the medical unit. What action is
most important for the nurse to implement?
A. Fit the client with a respirator mask.
B. Assign the client to a negative air-flow room.
C. Don a clean gown for client care.
D. Place an isolation cart in the hallway.
RATIONALE:
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.
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