HESI Comprehensive Exam
,Enalapril maleate is prescribed for a hospitalized client. Which assessment does the nurse perform as a
priority before administering the medication?
Checking the client's blood pressure Checking the
client's peripheral pulses Checking the most recent
potassium level
Checking the client's intake-and-output record for the last 24 hours - Answer Checking the client's blood
pressure
Rationale: Enalapril maleate is an angiotensin-converting enzyme (ACE) inhibitor used to treat
hypertension. One common side effect is postural hypotension. Therefore the nurse would check the
client's blood pressure immediately before administering each dose. Checking the client's peripheral
pulses, the results of the most recent potassium level, and the intake and output for the previous 24
hours are not specifically associated with this mediation.
A client is scheduled to undergo an upper gastrointestinal (GI) series, and the nurse provides
instructions to the client about the test. Which statement by the client indicates a need for further
instruction?
"The test will take about 30 minutes."
"I need to fast for 8 hours before the test."
"I need to drink citrate of magnesia the night before the test and give myself a Fleet enema on the
morning of the test."
"I need to take a laxative after the test is completed, because the liquid that I'll have to drink for the test
can be constipating." - Answer "I need to drink citrate of magnesia the night before the test and give
myself a Fleet enema on the morning of the test."
Rationale: No special preparation is necessary before a GI series, except that NPO (nothing by mouth)
status must be maintained for 8 hours before the test. An upper GI series involves visualization of the
esophagus, duodenum, and upper jejunum by means of the use of a contrast medium. It involves
swallowing a contrast medium (usually barium), which is administered in a flavored milkshake. Films
are taken at intervals during the test, which takes about 30 minutes. After an upper GI series, the client is
prescribed a laxative to hasten elimination of the barium. Barium that remains in the colon may become
hard and difficult to expel, leading to fecal impaction.
A nurse on the evening shift checks a primary health care provider's prescriptions and notes that the
dose of a prescribed medication is higher than the normal dose. The nurse calls the primary health care
provider's answering service and is told that the primary health care provider is off for the night and
will be available in the morning.
What should the nurse do next?
Call the nursing supervisor
,Ask the answering service to contact the on-call primary health care provider
, Withhold the medication until the primary health care provider can be reached in the morning
Administer the medication but consult the primary health care provider when he becomes available -
Answer Ask the answering service to contact the on-call primary health care provider
Rationale: The nurse has a duty to protect the client from harm. A nurse who believes that a primary
health care provider's prescription may be in error is responsible for clarifying the prescription before
carrying it out. Therefore the nurse would not administer the medication; instead, the nurse would
withhold the medication until the dose can be clarified. The nurse would not wait until the next
morning to obtain clarification. It is premature to call the nursing supervisor.
An emergency department (ED) nurse is monitoring a client with suspected acute myocardial infarction
(MI) who is awaiting transfer to the coronary intensive care unit. The nurse notes the sudden onset of
premature ventricular contractions (PVCs) on the monitor, checks the client's carotid pulse, and
determines that the PVCs are not perfusing. What is the nurse's most appropriate action?
Document the findings
Ask the ED primary health care provider to check the client Continue
to monitor the client's cardiac status
Inform the client that PVCs are expected after an MI - Answer Ask the ED primary health care provider
to check the client
Rationale: The most appropriate action by the nurse would be to ask the ED health care provider to
check the client. PVCs are a result of increased irritability of ventricular cells. Peripheral pulses may be
absent or diminished with the PVCs themselves because the decreased stroke volume of the premature
beats may in turn decrease peripheral perfusion. Because other rhythms also cause widened QRS
complexes, it is essential that the nurse determine whether the premature beats are resulting in perfusion
of the extremities. This is done by palpating the carotid, brachial, or femoral artery while observing the
monitor for widened complexes or by auscultating for apical heart sounds. In the situation of acute MI,
PVCs may be considered warning dysrhythmias, possibly heralding the onset of ventricular tachycardia
or ventricular fibrillation. Therefore, the nurse would not tell the client that the PVCs are expected.
Although the nurse will continue to monitor the client and document the findings, these are not the
most appropriate actions of those provided.
NPO status is imposed 8 hours before the procedure on a client scheduled to undergo electroconvulsive
therapy (ECT) at 1 p.m. On the morning of the procedure, the nurse checks the client's record and notes
that the client routinely takes an oral antihypertensive medication each morning. What action should
the nurse take?
Administer the antihypertensive with a small sip of water Withhold
the antihypertensive and administer it at bedtime
,Enalapril maleate is prescribed for a hospitalized client. Which assessment does the nurse perform as a
priority before administering the medication?
Checking the client's blood pressure Checking the
client's peripheral pulses Checking the most recent
potassium level
Checking the client's intake-and-output record for the last 24 hours - Answer Checking the client's blood
pressure
Rationale: Enalapril maleate is an angiotensin-converting enzyme (ACE) inhibitor used to treat
hypertension. One common side effect is postural hypotension. Therefore the nurse would check the
client's blood pressure immediately before administering each dose. Checking the client's peripheral
pulses, the results of the most recent potassium level, and the intake and output for the previous 24
hours are not specifically associated with this mediation.
A client is scheduled to undergo an upper gastrointestinal (GI) series, and the nurse provides
instructions to the client about the test. Which statement by the client indicates a need for further
instruction?
"The test will take about 30 minutes."
"I need to fast for 8 hours before the test."
"I need to drink citrate of magnesia the night before the test and give myself a Fleet enema on the
morning of the test."
"I need to take a laxative after the test is completed, because the liquid that I'll have to drink for the test
can be constipating." - Answer "I need to drink citrate of magnesia the night before the test and give
myself a Fleet enema on the morning of the test."
Rationale: No special preparation is necessary before a GI series, except that NPO (nothing by mouth)
status must be maintained for 8 hours before the test. An upper GI series involves visualization of the
esophagus, duodenum, and upper jejunum by means of the use of a contrast medium. It involves
swallowing a contrast medium (usually barium), which is administered in a flavored milkshake. Films
are taken at intervals during the test, which takes about 30 minutes. After an upper GI series, the client is
prescribed a laxative to hasten elimination of the barium. Barium that remains in the colon may become
hard and difficult to expel, leading to fecal impaction.
A nurse on the evening shift checks a primary health care provider's prescriptions and notes that the
dose of a prescribed medication is higher than the normal dose. The nurse calls the primary health care
provider's answering service and is told that the primary health care provider is off for the night and
will be available in the morning.
What should the nurse do next?
Call the nursing supervisor
,Ask the answering service to contact the on-call primary health care provider
, Withhold the medication until the primary health care provider can be reached in the morning
Administer the medication but consult the primary health care provider when he becomes available -
Answer Ask the answering service to contact the on-call primary health care provider
Rationale: The nurse has a duty to protect the client from harm. A nurse who believes that a primary
health care provider's prescription may be in error is responsible for clarifying the prescription before
carrying it out. Therefore the nurse would not administer the medication; instead, the nurse would
withhold the medication until the dose can be clarified. The nurse would not wait until the next
morning to obtain clarification. It is premature to call the nursing supervisor.
An emergency department (ED) nurse is monitoring a client with suspected acute myocardial infarction
(MI) who is awaiting transfer to the coronary intensive care unit. The nurse notes the sudden onset of
premature ventricular contractions (PVCs) on the monitor, checks the client's carotid pulse, and
determines that the PVCs are not perfusing. What is the nurse's most appropriate action?
Document the findings
Ask the ED primary health care provider to check the client Continue
to monitor the client's cardiac status
Inform the client that PVCs are expected after an MI - Answer Ask the ED primary health care provider
to check the client
Rationale: The most appropriate action by the nurse would be to ask the ED health care provider to
check the client. PVCs are a result of increased irritability of ventricular cells. Peripheral pulses may be
absent or diminished with the PVCs themselves because the decreased stroke volume of the premature
beats may in turn decrease peripheral perfusion. Because other rhythms also cause widened QRS
complexes, it is essential that the nurse determine whether the premature beats are resulting in perfusion
of the extremities. This is done by palpating the carotid, brachial, or femoral artery while observing the
monitor for widened complexes or by auscultating for apical heart sounds. In the situation of acute MI,
PVCs may be considered warning dysrhythmias, possibly heralding the onset of ventricular tachycardia
or ventricular fibrillation. Therefore, the nurse would not tell the client that the PVCs are expected.
Although the nurse will continue to monitor the client and document the findings, these are not the
most appropriate actions of those provided.
NPO status is imposed 8 hours before the procedure on a client scheduled to undergo electroconvulsive
therapy (ECT) at 1 p.m. On the morning of the procedure, the nurse checks the client's record and notes
that the client routinely takes an oral antihypertensive medication each morning. What action should
the nurse take?
Administer the antihypertensive with a small sip of water Withhold
the antihypertensive and administer it at bedtime
