Evolve Comprehensive Exam (Hesi) 2022 with well
explained answers
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.
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.
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.
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.
,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).
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.
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.
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.
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.
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.
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.
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.
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?
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.
explained answers
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.
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.
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.
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.
,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).
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.
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.
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.
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.
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.
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.
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.
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?
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.
