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NURS 4345HESI Critical Care Comprehensive Exam1
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NURS 4345HESI Critical Care Comprehensive Exam1Critical Care Comprehensive Exam 1
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). Incorrect
D. Metoprolol tartrate (Lopressor). Correct
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
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.
Correct
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? Correct
D. Does the client use any tobacco products?
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
4.ID: 6974873590
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
,NURS 4345HESI Critical Care Comprehensive Exam1
medication. What response is best for the nurse to provide?
,NURS 4345HESI Critical Care Comprehensive Exam1
A. Provide a more rapid induction of anesthesia.
B. Induce relaxation before induction of anesthesia.
C. Decrease the risk of bradycardia during surgery. Correct
D. Minimize the amount of analgesia needed postoperatively.
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.ID: 6974876286
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. Correct
C. Nonsteroidal antiinflammatory agents.
D. Insulin.
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 bleeding, but do not increase
urinary retention with opioids (D).
6.ID: 6974873559
A client with osteoarthritis is given a new prescription for a nonsteroidal
antiinflammatory 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 antiinflammatory response. Correct
C. Increase hepatotoxic side effects.
D. Cause gastrointestinal bleeding.
Nonsteroidal antiinflammatory drugs (NSAIDs) have antiinflammatory 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
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.ID: 6974876262
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. Correct
C. Sensory.
, NURS 4345HESI Critical Care Comprehensive Exam1
D. Kidney.
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
(NSAIDs), drugs
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.ID: 6974875110
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. Correct
D. Recheck the vital signs in 30 minutes and then administer the dose.
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.ID: 6974873583
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. Correct
B. Two acute illnesses.
C. One acute and one infectious illness. Incorrect
D. Two chronic illnesses.
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.ID: 6974877914
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. Correct
B. Initiate the lactation process.
C. Facilitate maternal-infant bonding.
D. Prevent neonatal hypoglycemia.
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
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