HESI Critical Care Exam Questions with Answers and Rationales
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
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
