EVOLVE COMPREHENSIVE EXAM HESI
1 PRACTICE REVIEW WITH
RATIONALES
FULL NURSING CONTENT CLINICAL
JUDGMENT AND EXAM READINESS
UPDATED 2026
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 at least likely
to exacerbate asthma?
A. Pindolol (Visken).
B. Carteolol (Ocupress).
C. Metoprolol tartrate (Lopressor).
D. Propranolol hydrochloride (Inderal). - Answer--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.
A male client who has been taking propranolol ( inderal) for 18 months tells the nurse
the healthcare provider discontinued the medication because his blood pressure has
been normal for the past three months. Which instruction should the use provide? -
Answer--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 should be
recommended.
A client who is taking clonidine ( Catapres, Duraclon) reports drowsiness. Which
additional assessment should the nurse make? - Answer--How long has the client been
taking the medication
The nurse should evaluate the client's outcome by observing the client's performance of
each expected behavior, so drinking 240 mL of fluid five or six times during the shift (D)
indicates a fluid intake of 1200 to 1440 mL, which meets the objective of at least 1000
mL during the designated period. (A) uses the term "adequate," which is not quantified.
(B) is not the objective, which establishes an intake of at least 1000 mL. (C) is not an
evaluation of the specific fluid intake.
a client who has active tuberculosis ( TB) is admitted to the medical unit. What action is
most important for the nurse to implement? - Answer--Assign the client to a negative
air-flow room
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.
,A client is receiving atonal (tenormin) 25 mg PO after a myocardial infraction. The nurse
determines the clinents apical pulse is 65 beats per minute. What action should the
nurse implement next? - Answer--Administer the medication
Atenolol, a beta-blocker, blocks the beta receptors of the sinoatrial node to reduce the
heart rate, so the medication should be administered (C) because the client's apical
pulse is greater than 60. (A, B, and D) are not indicated at this time.
A 6 year old child is alert but quiet when brought to the emergency center with periobital
ecchymosis and ecchymosis behind the ears. The nurse suspects potential child abuse
and continues to assess the child for additional manifestations of a basilar skull fracture.
What assessment finding would be consistent with the basilar skull fracture? -
Answer--Rhinorrhoea or otorrhoea with halo sign
Raccoon eyes (periorbital ecchymosis) and Battle's sign (ecchymosis behind the ear
over the mastoid process) are both signs of a basilar skull fracture, so the nurse should
assess for possible meningeal tears that manifest as a Halo sign with CSF leakage from
the ears or nose (D). (A) is consistent with orbital fractures. (B) occurs with wrenching
traumas of the shoulder or arm fractures. (C) occurs with blunt abdominal injuries.
The nurse is assessing a client who complains of weight loss, racing heart rate and
difficulty sleeping. The nurse determines the client has moist skin with fine hair,
prominent eyes, lid retrace, and a staring expression. These findings are consistent with
which disorder? - Answer--Graves disease
This client is exhibiting symptoms associated with hyperthyroidism or Grave's disease
(A), which is an autoimmune condition affecting the thyroid. (B, C, and D) are not
associated with these symptoms.
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? - Answer--Ptosis on the left eyelid
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) is characterized
by rapid, rhythmic movement of both eyes. (C) is a distortion of the lens of the eye,
causing decreased visual acuity. (D) is a term used to describe a protrusion of the
eyeballs that occurs with hyperthyroidism.
, 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.
The nurse is preparing to admister atropine, an anticholinergic, to a client who is
scheduled for a cholecystectomy. The client asks the nurse to explain th reason for the
prescribed medication. What response is best for the nurse to provide? -
Answer--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 surgical anesthesia. (A,
C and D) do not address the therapeutic action of atropine use perioperatively.
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. ? - Answer--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 bleeding, but do not increase urinary retention with opioids
(D).
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? - Answer--Admister the dose as prescribed
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.
following an emergency Cesarean delivery the nurse encourages the new mother to
breastfed her newborn . the client asks why she should breastfeed now. Which info
should the nurse provide? - Answer--Stimulate contraction of the uterus
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
1 PRACTICE REVIEW WITH
RATIONALES
FULL NURSING CONTENT CLINICAL
JUDGMENT AND EXAM READINESS
UPDATED 2026
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 at least likely
to exacerbate asthma?
A. Pindolol (Visken).
B. Carteolol (Ocupress).
C. Metoprolol tartrate (Lopressor).
D. Propranolol hydrochloride (Inderal). - Answer--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.
A male client who has been taking propranolol ( inderal) for 18 months tells the nurse
the healthcare provider discontinued the medication because his blood pressure has
been normal for the past three months. Which instruction should the use provide? -
Answer--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 should be
recommended.
A client who is taking clonidine ( Catapres, Duraclon) reports drowsiness. Which
additional assessment should the nurse make? - Answer--How long has the client been
taking the medication
The nurse should evaluate the client's outcome by observing the client's performance of
each expected behavior, so drinking 240 mL of fluid five or six times during the shift (D)
indicates a fluid intake of 1200 to 1440 mL, which meets the objective of at least 1000
mL during the designated period. (A) uses the term "adequate," which is not quantified.
(B) is not the objective, which establishes an intake of at least 1000 mL. (C) is not an
evaluation of the specific fluid intake.
a client who has active tuberculosis ( TB) is admitted to the medical unit. What action is
most important for the nurse to implement? - Answer--Assign the client to a negative
air-flow room
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.
,A client is receiving atonal (tenormin) 25 mg PO after a myocardial infraction. The nurse
determines the clinents apical pulse is 65 beats per minute. What action should the
nurse implement next? - Answer--Administer the medication
Atenolol, a beta-blocker, blocks the beta receptors of the sinoatrial node to reduce the
heart rate, so the medication should be administered (C) because the client's apical
pulse is greater than 60. (A, B, and D) are not indicated at this time.
A 6 year old child is alert but quiet when brought to the emergency center with periobital
ecchymosis and ecchymosis behind the ears. The nurse suspects potential child abuse
and continues to assess the child for additional manifestations of a basilar skull fracture.
What assessment finding would be consistent with the basilar skull fracture? -
Answer--Rhinorrhoea or otorrhoea with halo sign
Raccoon eyes (periorbital ecchymosis) and Battle's sign (ecchymosis behind the ear
over the mastoid process) are both signs of a basilar skull fracture, so the nurse should
assess for possible meningeal tears that manifest as a Halo sign with CSF leakage from
the ears or nose (D). (A) is consistent with orbital fractures. (B) occurs with wrenching
traumas of the shoulder or arm fractures. (C) occurs with blunt abdominal injuries.
The nurse is assessing a client who complains of weight loss, racing heart rate and
difficulty sleeping. The nurse determines the client has moist skin with fine hair,
prominent eyes, lid retrace, and a staring expression. These findings are consistent with
which disorder? - Answer--Graves disease
This client is exhibiting symptoms associated with hyperthyroidism or Grave's disease
(A), which is an autoimmune condition affecting the thyroid. (B, C, and D) are not
associated with these symptoms.
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? - Answer--Ptosis on the left eyelid
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) is characterized
by rapid, rhythmic movement of both eyes. (C) is a distortion of the lens of the eye,
causing decreased visual acuity. (D) is a term used to describe a protrusion of the
eyeballs that occurs with hyperthyroidism.
, 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.
The nurse is preparing to admister atropine, an anticholinergic, to a client who is
scheduled for a cholecystectomy. The client asks the nurse to explain th reason for the
prescribed medication. What response is best for the nurse to provide? -
Answer--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 surgical anesthesia. (A,
C and D) do not address the therapeutic action of atropine use perioperatively.
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. ? - Answer--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 bleeding, but do not increase urinary retention with opioids
(D).
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? - Answer--Admister the dose as prescribed
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.
following an emergency Cesarean delivery the nurse encourages the new mother to
breastfed her newborn . the client asks why she should breastfeed now. Which info
should the nurse provide? - Answer--Stimulate contraction of the uterus
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
