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NURS 4345 HESI Critical Care Comprehensive Exam 1
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Critical Care Comprehensive Exam 11. A client with asthma receives a prescription for high blood pressure during a clinic visit.
Which prescription should thenurse anticipate theclient 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
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 thebeta2 receptors in thelungs,
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 thenurse that
thehealthcare provider discontinued themedication because his blood pressure has been normal
for thepast three months. Which instruction should thenurse provide?
A. Obtain another antihypertensive prescription to avoid withdrawal symptoms.
B. Stop themedication and keep an accurate record of blood pressure.
C. Report any uncomfortable symptoms after stopping themedication.
D. Ask thehealthcare provider about tapering thedrug dose over thenext week. Correct
Although thehealthcare provider discontinued thepropranolol, measures to prevent rebound
cardiac excitation, such as progressively reducing thedose over one to two weeks (C), should be
recommended to prevent rebound tachycardia, hypertension, and ventricular dysrhythmias.
Abrupt cessation (A and B) of thebeta-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 thenurse make?
A. Has theclient experienced constipation recently?
B. Did theclient miss any doses of themedication?
C. How long has theclient been taking themedication? Correct
D. Does theclient use any tobacco products?
,Drowsiness can occur in theearly weeks of treatment with clonidine and with continued use
becomes less intense, so thelength of time theclient has been on themedication (A) provides
information to direct additional instruction. (B, C, and D) are not relevant.
4.ID: 6974873590
The nurse is preparing to administer atropine, an anticholinergic, to a client who is scheduled for
a cholecystectomy. theclient asks thenurse to explain thereason for theprescribed medication.
What response is best for thenurse to provide?
A. Provide a more rapid induction of anesthesia.
B. Induce relaxation before induction of anesthesia.
C. Decrease therisk of bradycardia during surgery. Correct
D. Minimize theamount of analgesia needed postoperatively.
Atropine may be prescribed preoperatively to increase theautomaticity of thesinoatrial node and
prevent a dangerous reduction in heart rate (B) during surgical anesthesia. (A, C and D) do not
address thetherapeutic action of atropine use perioperatively.
5.ID: 6974876286
An 80-year-old client is given morphine sulphate for postoperative pain. Which concomitant
medication should thenurse 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 theolder client. Although tricyclic antidepressants
and antihistamines with opioids can exacerbate urinary retention, theconcurrent use of (A and B)
with opioids do not. Nonsteroidal antiinflammatory agents (D) can increase therisk 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). theclient asks thenurse, "How is this medication different from theacetaminophen I
have been taking?" Which information about thetherapeutic action of NSAIDs should thenurse
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 theclient about themedication's actions. Although
NSAIDs are irritating to thegastrointestinal (GI) system and can cause GI bleeding (C),
instructions to take with food in thestomach to manage this as an expected side effect should be
included, but this does not answer theclient'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 thenurse to monitor?
A. Cardiorespiratory.
B. Liver. Correct
C. Sensory.
D. Kidney.
Acetaminophen and alcohol are both metabolized in theliver. This places theclient at risk for
hepatotoxicity, so monitoring liver (A) function is themost important assessment because
thecombination 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
theclient 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 thenurse
implement?
A. Give intravenous (IV) calcium gluconate.
B. Withhold thedrug and notify thehealthcare provider.
C. Administer thedose as prescribed. Correct
D. Recheck thevital signs in 30 minutes and then administer thedose.
Verapamil slows sinoatrial (SA) nodal automaticity, delays atrioventricular (AV) nodal
conduction, which slows theventricular rate, and is used to treat atrial flutter, so (A) should be
implemented, based on theclient's heart rate and blood pressure. (B and C) are not indicated. (D)
delays theadministration of thescheduled dose.
9.ID: 6974873583
A client is admitted to thehospital with a diagnosis of Type 2 diabetes mellitus and influenza.
Which categories of illness should thenurse develop goals for theclient'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 thecorrect duration categories for this situation.
10.ID: 6974877914
Following an emergency Cesarean delivery, thenurse encourages thenew mother to breastfeed
her newborn. theclient asks why she should breastfeed now. Which information should thenurse
provide?
A. Stimulate contraction of theuterus. Correct
B. Initiate thelactation process.
C. Facilitate maternal-infant bonding.
D. Prevent neonatal hypoglycemia.
When theinfant suckles at thebreast, oxytocin is released by theposterior pituitary to stimulates
the"letdown" reflex, which causes therelease of colostrum, and contracts theuterus (C) to prevent
uterine hemorrhage. (A and B) do not support theclient's need in theimmediate period after
theemergency delivery. Although maternal-newborn bonding (D) is facilitated by early
breastfeeding, thepriority is uterine contraction stimulation.
11.ID: 6974875104
Which intervention should thenurse include in theplan of care for a female client with severe
postpartum depression who is admitted to theinpatient psychiatric unit?
A. Restrict visitors who irritate theclient.
B. Full rooming-in for theinfant and mother.
C. Supervised and guided visits with infant. Correct
D. Daily visits with her significant other.
Structured visits (C) provide an opportunity for themother and infant to bond and should be
facilitated and encouraged according to theclient's pace of progress. (A) is unrealistic and may
not be safe for thebaby or theclient. (B) is an unrealistic expectation. Although daily visits may
provide support, thesignificant other may not be able to be there every day (D) based on other
family responsibilities.
12.ID: 6974873535
A 16-year-old male client is admitted to thehospital after falling off a bike and sustaining a
fractured bone. thehealthcare provider explains thesurgery needed to immobilize thefracture.
Which action should be implemented to obtain a valid informed consent?
A. Obtain thepermission of thecustodial parent for thesurgery. Correct
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