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vSim - Harry Hadley
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Evolve Comprehensive EXAM: HESI (ANSWERED+ RATIONALE)UPDATED SPRING
Critical 2022/2023
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 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. 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 not relevant.
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 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. 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 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.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.
, 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 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.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
, emergency delivery. Although maternal-newborn bonding (D) is facilitated by early breastfeeding, the
priority is uterine contraction stimulation.
11.ID: 6974875104
Which intervention should the nurse include in the plan of care for a female client with severe
postpartum depression who is admitted to the inpatient psychiatric unit?
A. Restrict visitors who irritate the client.
B. Full rooming-in for the infant and mother.
C. Supervised and guided visits with infant. Correct
D. Daily visits with her significant other.
Structured visits (C) provide an opportunity for the mother and infant to bond and should be
facilitated and encouraged according to the client's pace of progress. (A) is unrealistic and may not
be safe for the baby or the client. (B) is an unrealistic expectation. Although daily visits may provide
support, the significant 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 the hospital after falling off a bike and sustaining a fractured
bone. The healthcare provider explains the surgery needed to immobilize the fracture. Which action
should be implemented to obtain a valid informed consent?
A. Obtain the permission of the custodial parent for the surgery. Correct
B. Notify the non-custodial parent to also sign a consent form.
C. Instruct the client sign the consent before giving medications.
D. Obtain the signature of the client’s stepfather for the surgery. Incorrect
The client is a minor and cannot legally sign his own consent unless he is an emancipated minor, so
the consent should be obtained from the guardian for this client, which is the custodial parent (B). (A)
is not a legal option. A stepparent is not a legal guardian for a minor unless the child has been
adopted by the stepparent (C). The non-custodial parent does not need to co-sign this form (D).
13.ID: 6974876258
During a client assessment, the client says, "I can't walk very well." Which action should the nurse
implement first?
A. Predict the likelihood of the outcome.
B. Consider alternatives.
C. Choose the most successful approach.
D. Identify the problem. Correct
The sequential steps in problem-solving are to first identify the problem (B), then consider
alternatives (C), consider outcomes of the alternatives (D), predict the likelihood of the outcomes
occurring, and choose the alternative with the best chance of success (A).
14.ID: 6974875112
The nurse identifies a client's needs and formulates the nursing problem of, "Imbalanced nutrition:
less than body requirements, related to mental impairment and decreased intake, as evidenced by
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