a client with asthma receives a prescription for h
hcp discontinued drug but measures to prevent rebo
the nurse is preparing to administer atropine an
an 80 year old client is given mor
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HESI comp exam 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? - ANSMetoprolol tartrate (Lopressor)
Best antihypertensive med for asthmatics. Beta2 blocking agent -- also a cardioselective and
less likely to cause bronchoconstriction.
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 3 months. Which instruction should the nurse provide? - ANSAsk the healthcare
provider about tapering the drug dose over the next week.
HCP discontinued drug BUT measures to prevent rebound cardiac excitation, such as
progressively reducing the dose over 1 or 2 weeks, should be recommended to prevent rebound
tachycardia, hypertension, and ventricular dysrhythmias.
A client who is taking clonidine ( Catapres, Duraclon) reports drowsiness. Which additional
assessment should the nurse make? - ANSHow 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 provides
information to direct additional instruction.
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? - ANSDecrease 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 during surgical anesthesia.
An 80-year old client is given morphine sulfate for post-op pain. Which concomitant med should
the nurse question that poses a potential development of urinary retention in this geriatric client?
- ANSTricyclic antidepressants
Drugs with anticholinergic properties can exacerbate urinary retention associated with opioids in
the older client.
A client with osteoarthritis is given a new script for a NSAID. The client asks the nurse, "How is
this med different from the acetaminophen I have been taking?" Which information about the
,therapeutic action of NSAIDs should the nurse provide? - ANSProvide anti-inflammatory
response
NSAIDs relieve pain associated with osteoarthritis and differs from acetaminophen(a
non-narcotic & antipyretic). Also potentially hepatotoxic.
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? - ANSLiver
Acetaminophen & alcohol both metabolized in the liver. Pt at risk of hepatotoxicity & potentially
fatal liver damage.
The nurse obtains a heart rate of 92 and a BP of 110/76 prior to administering a scheduled does
of verapamil (Calan) for a client with atrial flutter. Which action should the nurse implement? -
ANSAdminister the dose as prescribed.
Verapamil slows SA nodal automaticity, delays AV nodal conduction, slowing ventricular rate &
treats atrial flutter. HR is above 60 and BP is WNL.
A client is admitted to the hospital with a diagnosis of Type 2 diabetes mellitus and influenza.
Which categories of illness should the nurse develop goals for the client's plan of care? -
ANSOne chronic and one acute illness
Adult onset DM is life-long chronic disease. Influenza is acute illness with short term duration.
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? - ANSStimulate contraction of the uterus
Infant suckling breast releases oxytocin by the posterior pituitary and stimulates the "letdown"
reflex. Causing release of colostrum & contracts the uterus to prevent uterine hemorrhage.
Which intervention should the nurse include in the plan of care for a female client with severe
postpartum depression who is admitted to the inpatient psychiatric unit? - ANSSupervised and
guided visits with infant.
Structured visits provide an opportunity for the mother and infant to bond and should be
facilitated and encouraged according to the client's pace of progress.
A 16-year-old male client is admitted to the hospital after falling off a bike and sustaining a
fractured bone. The HCP explains the surgery needed to immobilize the fracture. Which action
should be implemented to obtain a valid informed consent? - ANSObtain the permission of the
custodial parent for the surgery.
, Pt is a minor and cannot legally sign his own consent unless he is an emancipated minor.
Consent should be obtained from the guardian, custodial parent.
During a client assessment, the client says, "I can't walk very well." Which action should the
nurse implement first? - ANSIdentify the problem
Sequential problem solving steps: 1) Identify the problem, 2) consider alternatives, 3) consider
outcomes of the alternatives, 4) predict the likelihood of the outcomes occurring and choose
best chance of success.
The nurse identifies a client's needs and formulates the nursing problem of, "Imbalanced
nutrition: less than body requirements, related to mental impairment and decreased intake, as
evidenced by increasing confusion and weight loss of more than 30 lbs over the last 6 months."
Which short term goal is best for this pt? - ANSEat 50% of six small meals each day by the end
of one week
Short term goals: realistic & attainable, time frame 7-10 days before discharge
A male client is angry and is leaving the hospital AMA. The client demands to take his chart with
him and states it's "his" and doesn't want contact with the hospital anymore. How should the
nurse respond? - ANSThe chart is the property of the hospital but I will see that a cope is made
for you.
Pt has legal right to the information in it even if leaving AMA
The nurse manager is assisting a nurse with improving organizational skills and time
management. Which nursing activity is the priority in pre-planning a schedule for selected
nursing activities in the daily assignment? - ANSMedication administration
Med admin is based on a prescribed schedule that is time-sensitive in the delivery of nursing
care and should be priority in scheduling nursing activities in a daily assignment.
What nursing delivery of care provides the nurse to plan and direct care of a group of clients
over a 24-hour period? - ANSPrimary nursing
is a model of delivery of care where a nurse us accountable for planning care for clients around
the clock.
Two unlicensed assistive personnel (UAP) are arguing on the unit about who deserves to take a
break first. What is the most important basic guideline that the nurse should follow in resolving
the conflict? - ANSDeal with the issues and not personalities
Issues are concrete and is 1 of 7 important key behaviors in managing conflict. Personalities
include emotional reactions (not concrete).
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