Comprehensive HESI Module Exam WITH ACTUAL
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A primary health care provider prescribes a dose of morphine sulfate 2.5 mg stat
to be administered intravenously to a client in pain. The nurse preparing the
medication notes that the label on the vial of morphine sulfate solution for
injection reads "4 mg/mL." How many milliliters (mL) must the nurse draw into a
syringe for administration to the client? - {ASNWER}->0.625 mL
Rationale: Use the medication calculation formula:
Desired amt/available x mL = mL per dose;A nurse is monitoring a hospitalized
client who is being treated for preeclampsia. Which finding elicited during the
assessment indicates that the condition has not yet resolved?
Nursing Progress Notes:
1. Hyperreflexia is present.
2. Urinary protein is not detectable.
3. Urine output is 45 mL/hr.
4. Blood pressure is 128/78 mm Hg. - {ASNWER}->1. Hyperreflexia is present.
,Rationale: In a client with preeclampsia, deep tendon reflexes may be very brisk
(hyperreflexia) and clonus (series of involuntary, rhythmic, muscular contractions
and relaxations)may be present, suggesting cerebral irritability resulting from
decreased brain circulation and edema. Hypertension, generalized edema, and
proteinuria are the three classic signs of preeclampsia. Decreased urinary output
(less than 30 mL/hr) indicates poor perfusion of the kidneys and may precede
acute renal failure.
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?
1. Withhold the medication until the primary health care provider can be reached
in the morning
2. Administer the medication but consult the primary health care provider when
he becomes available
3. Ask the answering service to contact the on-call primary health care provider
4. Call the nursing supervisor - {ASNWER}->3. 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?
1. Inform the client that PVCs are expected after an MI
2. Ask the ED primary health care provider to check the client
3. Document the findings
4. Continue to monitor the client's cardiac status - {ASNWER}->2. 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?
Withhold the antihypertensive and administer it at bedtime
Administer the antihypertensive with a small sip of water
Administer the medication by way of the intravenous (IV) route
Hold the antihypertensive and resume its administration on the day after the ECT -
{ASNWER}->Administer the antihypertensive with a small sip of water
Rationale: The nurse should administer the antihypertensive with a small sip of
water. General anesthesia is required for ECT, so NPO status is imposed for 6 to 8
hours before treatment to help prevent aspiration. Exceptions include clients who
routinely receive cardiac medications, antihypertensive agents, or histamine (H2)
blockers, which should be administered several hours before treatment with a
small sip of water. Withholding the antihypertensive and administering it at
bedtime and withholding the antihypertensive and resuming administration on
the day after the ECT are incorrect actions, because antihypertensives must be
administered on time; otherwise, the risk for rebound hypertension exists. The
nurse would not administer a medication by way of a route that has not been
prescribed.;A client who recently underwent coronary artery bypass graft surgery
comes to the primary health care provider's office for a follow-up visit. On
assessment, the client tells the nurse that he is feeling depressed. Which response
by the nurse is therapeutic?
"Tell me more about what you're feeling."
"It will take time, but I promise you, you will get over this depression."
"That's a normal response after this type of surgery."
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