HESI EXIT EXAM REVIEW
Evolve Comprehensive Exam (Hesi) 1
With 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 at least likely to exacerbate asthma
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.
2. 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?
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.
3. A client who is taking clonidine ( Catapres, Duraclon) reports drowsiness. Which additional assessment should
the nurse make?
How long has the client been taking the medication
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. 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?
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.
5. 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. ?
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).
6. 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?
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.
7. 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?
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 in the immediate period after the emergency delivery. Although maternal-newborn bonding
(D) is facilitated by early breastfeeding, the priority is uterine contraction stimulation.
8. The nurse identifies a clients needs and formulates th nursing problem of " Imbalancee nutrition: Less than
body requirements, related to mental impairment and decreased intkae, as evidence by increasing confusion
and weight loss of more than 30 pounds over the last 6 months. " which short-term goal is best for this client?
Eat 50% of six small meals each day by the end of the week
Short-term goals should be realistic and attainable and should have a timeline of 7 to 10 days before discharge. (A)
meets those criteria. (B) is nurse-oriented. (C) may be beyond the capabilities of a confused client. (D) is a long-term
goal.
, 9. the nursie is caring for a client who is unable to void. The plan of care establishes an objective for the client to
ingest at least 1000 mL of fluid between 7:00 am and 3:30pm. Which client response should the nurse
document that indicates a successful outcome?
Drinks 240 mL of fluid five times during the shift.
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.
10. a client who has active tuberculosis ( TB) is admitted to the medical unit. What action is most important for the
nurse to implement?
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.
11. 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?
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.
12. 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?
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.
Evolve Comprehensive Exam (Hesi) 1
With 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 at least likely to exacerbate asthma
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.
2. 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?
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.
3. A client who is taking clonidine ( Catapres, Duraclon) reports drowsiness. Which additional assessment should
the nurse make?
How long has the client been taking the medication
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. 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?
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.
5. 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. ?
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).
6. 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?
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.
7. 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?
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 in the immediate period after the emergency delivery. Although maternal-newborn bonding
(D) is facilitated by early breastfeeding, the priority is uterine contraction stimulation.
8. The nurse identifies a clients needs and formulates th nursing problem of " Imbalancee nutrition: Less than
body requirements, related to mental impairment and decreased intkae, as evidence by increasing confusion
and weight loss of more than 30 pounds over the last 6 months. " which short-term goal is best for this client?
Eat 50% of six small meals each day by the end of the week
Short-term goals should be realistic and attainable and should have a timeline of 7 to 10 days before discharge. (A)
meets those criteria. (B) is nurse-oriented. (C) may be beyond the capabilities of a confused client. (D) is a long-term
goal.
, 9. the nursie is caring for a client who is unable to void. The plan of care establishes an objective for the client to
ingest at least 1000 mL of fluid between 7:00 am and 3:30pm. Which client response should the nurse
document that indicates a successful outcome?
Drinks 240 mL of fluid five times during the shift.
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.
10. a client who has active tuberculosis ( TB) is admitted to the medical unit. What action is most important for the
nurse to implement?
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.
11. 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?
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.
12. 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?
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.
