HESI Clinical Analysis Practice Exam With Answers (248 Solved Questions)

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1) A nurse is caring for a client with hyperparathyroidism and notes that the client's serumcalcium level is 13 mg/dL. Which medication should the nurse prepare to administer asprescribed to the client?1. Calcium chloride2. Calcium gluconate3. Calcitonin (Miacalcin)4. Large doses of vitamin D3. Calcitonin (Miacalcin)Rationale:The normal serum calcium level is 8.6 to 10.0 mg/dL. This client is experiencing hypercalcemia.Calcium gluconate and calcium chloride are medications used for the treatment of tetany, whichoccurs as a result of acute hypocalcemia. In hypercalcemia, large doses of vitamin D need to beavoided. Calcitonin, a thyroid hormone, decreases the plasma calcium level by inhibiting boneresorption and lowering the serum calcium concentration.10.) The clinic nurse is performing an admission assessment on a client. The nurse notes that theclient is taking azelaic acid (Azelex). Because of the medication prescription, the nurse wouldsuspect that the client is being treated for:1. Acne2. Eczema3. Hair loss4. Herpes simplex1. AcneRationale:Azelaic acid is a topical medication used to treat mild to moderate acne. The acid appears towork by suppressing the growth of Propionibacterium acnes and decreasing the proliferation ofkeratinocytes. Options 2, 3, and 4 are incorrect.100.) Saquinavir (Invirase) is prescribed for the client who is human immunodeficiency virusseropositive. The nurse reinforces medication instructions and tells the client to:1. Avoid sun exposure.2. Eat low-calorie foods.3. Eat foods that are low in fat.4. Take the medication on an empty stomach.1. Avoid sun exposure.

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Rationale:Saquinavir (Invirase) is an antiretroviral (protease inhibitor) used with other antiretroviralmedications to manage human immunodeficiency virus infection. Saquinavir is administeredwith meals and is best absorbed if the client consumes high-calorie, high-fat meals. Saquinavircan cause photosensitivity, and the nurse should instruct the client to avoid sun exposure.101.) Ketoconazole is prescribed for a client with a diagnosis of candidiasis. Select theinterventions that the nurse includes when administering this medication. Select all that apply.1. Restrict fluid intake.2. Instruct the client to avoid alcohol.3. Monitor hepatic and liver function studies.4. Administer the medication with an antacid.5. Instruct the client to avoid exposure to the sun.6. Administer the medication on an empty stomach.2. Instruct the client to avoid alcohol.3. Monitor hepatic and liver function studies.5. Instruct the client to avoid exposure to the sun.Rationale:Ketoconazole is an antifungal medication. It is administered with food (not on an emptystomach) and antacids are avoided for 2 hours after taking the medication to ensure absorption.The medication is hepatotoxic and the nurse monitors liver function studies. The client isinstructed to avoid exposure to the sun because the medication increases photosensitivity. Theclient is also instructed to avoid alcohol. There is no reason for the client to restrict fluid intake.In fact, this could be harmful to the client.102.) A client with human immunodeficiency virus is taking nevirapine (Viramune). The nurseshould monitor for which adverse effects of the medication? Select all that apply.1. Rash2. Hepatotoxicity3. Hyperglycemia4. Peripheral neuropathy5. Reduced bone mineral density1. Rash

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2. HepatotoxicityRationale:Nevirapine (Viramune) is a non-nucleoside reverse transcriptase inhibitors (NRTI) that is used totreat HIV infection. It is used in combination with other antiretroviral medications to treat HIV.Adverse effects include rash, Stevens-Johnson syndrome, hepatitis, and increased transaminaselevels. Hyperglycemia, peripheral neuropathy, and reduced bone density are not adverse effectsof this medication.103.) A nurse is caring for a hospitalized client who has been taking clozapine (Clozaril) for thetreatment of a schizophrenic disorder. Which laboratory study prescribed for the client will thenurse specifically review to monitor for an adverse effect associated with the use of thismedication?1. Platelet count2. Cholesterol level3. White blood cell count4. Blood urea nitrogen level3. White blood cell countRationale:Hematological reactions can occur in the client taking clozapine and include agranulocytosis andmild leukopenia. The white blood cell count should be checked before initiating treatment andshould be monitored closely during the use of this medication. The client should also bemonitored for signs indicating agranulocytosis, which may include sore throat, malaise, andfever. Options 1, 2, and 4 are unrelated to this medication.104.) Disulfiram (Antabuse) is prescribed for a client who is seen in the psychiatric health careclinic. The nurse is collecting data on the client and is providing instructions regarding the use ofthis medication. Which is most important for the nurse to determine before administration ofthis medication?1. A history of hyperthyroidism2. A history of diabetes insipidus3. When the last full meal was consumed4. When the last alcoholic drink was consumed 4. When the last alcoholic drink was consumedRationale:Disulfiram is used as an adjunct treatment for selected clients with chronic alcoholism who want

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to remain in a state of enforced sobriety. Clients must abstain from alcohol intake for at least 12hours before the initial dose of the medication is administered. The most important data are todetermine when the last alcoholic drink was consumed. The medication is used with caution inclients with diabetes mellitus, hypothyroidism, epilepsy, cerebral damage, nephritis, and hepaticdisease. It is also contraindicated in severe heart disease, psychosis, or hypersensitivity related tothe medication.105.) A nurse is collecting data from a client and the client's spouse reports that the client istaking donepezil hydrochloride (Aricept). Which disorder would the nurse suspect that this clientmay have based on the use of this medication?1. Dementia2. Schizophrenia3. Seizure disorder4. Obsessive-compulsive disorder1. DementiaRationale:Donepezil hydrochloride is a cholinergic agent used in the treatment of mild to moderatedementia of the Alzheimer type. It enhances cholinergic functions by increasing theconcentration of acetylcholine. It slows the progression of Alzheimer's disease. Options 2, 3, and4 are incorrect.106.) Fluoxetine (Prozac) is prescribed for the client. The nurse reinforces instructions to theclient regarding the administration of the medication. Which statement by the client indicates anunderstanding about administration of the medication?1. "I should take the medication with my evening meal."2. "I should take the medication at noon with an antacid."3. "I should take the medication in the morning when I first arise."4. "I should take the medication right before bedtime with a snack."3. "I should take themedication in the morning when I first arise."Rationale:Fluoxetine hydrochloride is administered in the early morning without consideration to meals.**Eliminate options 1, 2, and 4 because they are comparable or alike and indicate taking themedication with an antacid or food.**107.) A client receiving a tricyclic antidepressant arrives at the mental health clinic. Which

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observation indicates that the client is correctly following the medication plan?1. Reports not going to work for this past week2. Complains of not being able to "do anything" anymore3. Arrives at the clinic neat and appropriate in appearance4. Reports sleeping 12 hours per night and 3 to 4 hours during the day3. Arrives at the clinicneat and appropriate in appearanceRationale:Depressed individuals will sleep for long periods, are not able to go to work, and feel as if theycannot "do anything." Once they have had some therapeutic effect from their medication, theywill report resolution of many of these complaints as well as demonstrate an improvement intheir appearance.108.) A nurse is performing a follow-up teaching session with a client discharged 1 month agowho is taking fluoxetine (Prozac). What information would be important for the nurse to gatherregarding the adverse effects related to the medication?1. Cardiovascular symptoms2. Gastrointestinal dysfunctions3. Problems with mouth dryness4. Problems with excessive sweating2. Gastrointestinal dysfunctionsRationale:The most common adverse effects related to fluoxetine include central nervous system (CNS)and gastrointestinal (GI) system dysfunction. This medication affects the GI system by causingnausea and vomiting, cramping, and diarrhea. Options 1, 3, and 4 are not adverse effects of thismedication.109.) A client taking buspirone (BuSpar) for 1 month returns to the clinic for a follow-up visit.Which of the following would indicate medication effectiveness?1. No rapid heartbeats or anxiety2. No paranoid thought processes3. No thought broadcasting or delusions4. No reports of alcohol withdrawal symptoms1. No rapid heartbeats or anxiety

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Rationale:Buspirone hydrochloride is not recommended for the treatment of drug or alcohol withdrawal,paranoid thought disorders, or schizophrenia (thought broadcasting or delusions). Buspironehydrochloride is most often indicated for the treatment of anxiety and aggression.11.) The health care provider has prescribed silver sulfadiazine (Silvadene) for the client with apartial-thickness burn, which has cultured positive for gram-negative bacteria. The nurse isreinforcing information to the client about the medication. Which statement made by the clientindicates a lack of understanding about the treatments?1. "The medication is an antibacterial."2. "The medication will help heal the burn."3. "The medication will permanently stain my skin."4. "The medication should be applied directly to the wound."3. "The medication willpermanently stain my skin."Rationale:Silver sulfadiazine (Silvadene) is an antibacterial that has a broad spectrum of activity againstgram-negative bacteria, gram-positive bacteria, and yeast. It is applied directly to the wound toassist in healing. It does not stain the skin.110.) A client taking lithium carbonate (Lithobid) reports vomiting, abdominal pain, diarrhea,blurred vision, tinnitus, and tremors. The lithium level is checked as a part of the routine follow-up and the level is 3.0 mEq/L. The nurse knows that this level is:1. Toxic2. Normal3. Slightly above normal4. Excessively below normal1. ToxicRationale:The therapeutic serum level of lithium is 0.6 to 1.2 mEq/L. A level of 3 mEq/L indicates toxicity.111.) A client arrives at the health care clinic and tells the nurse that he has been doubling hisdaily dosage of bupropion hydrochloride (Wellbutrin) to help him get better faster. The nurseunderstands that the client is now at risk for which of the following?1. Insomnia

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2. Weight gain3. Seizure activity4. Orthostatic hypotension3. Seizure activityRationale:Bupropion does not cause significant orthostatic blood pressure changes. Seizure activity iscommon in dosages greater than 450 mg daily. Bupropion frequently causes a drop in bodyweight. Insomnia is a side effect, but seizure activity causes a greater client risk.112.) A hospitalized client is started on phenelzine sulfate (Nardil) for the treatment ofdepression. The nurse instructs the client to avoid consuming which foods while taking thismedication? Select all that apply.1. Figs2. Yogurt3. Crackers4. Aged cheese5 Tossed salad6. Oatmeal cookies1. Figs2. Yogurt4. Aged cheeseRationale:Phenelzine sulfate (Nardil) is a monoamine oxidase inhibitor(MAOI). The client should avoidtaking in foods that are high in tyramine. Use of these foods could trigger a potentially fatalhypertensive crisis. Some foods to avoid include yogurt, aged cheeses, smoked or processedmeats, red wines, and fruits such as avocados, raisins, and figs.113.) A nurse is reinforcing discharge instructions to a client receiving sulfisoxazole. Which of thefollowing would be included in the plan of care for instructions?1. Maintain a high fluid intake.2. Discontinue the medication when feeling better.3. If the urine turns dark brown, call the health care provider immediately.4. Decrease the dosage when symptoms are improving to prevent an allergic response.1.

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Maintain a high fluid intake.Rationale:Each dose of sulfisoxazole should be administered with a full glass of water, and the client shouldmaintain a high fluid intake. The medication is more soluble in alkaline urine. The client shouldnot be instructed to taper or discontinue the dose. Some forms of sulfisoxazole cause the urineto turn dark brown or red. This does not indicate the need to notify the health care provider.114.) A postoperative client requests medication for flatulence (gas pains). Which medicationfrom the following PRN list should the nurse administer to this client?1. Ondansetron (Zofran)2. Simethicone (Mylicon)3. Acetaminophen (Tylenol)4. Magnesium hydroxide (milk of magnesia, MOM)2. Simethicone (Mylicon)Rationale:Simethicone is an antiflatulent used in the relief of pain caused by excessive gas in thegastrointestinal tract. Ondansetron is used to treat postoperative nausea and vomiting.Acetaminophen is a nonopioid analgesic. Magnesium hydroxide is an antacid and laxative.115.) A client received 20 units of NPH insulin subcutaneously at 8:00 AM. The nurse shouldcheck the client for a potential hypoglycemic reaction at what time?1. 5:00 PM2. 10:00 AM3. 11:00 AM4. 11:00 PM1. 5:00 PMRationale:NPH is intermediate-acting insulin. Its onset of action is 1 to 2½ hours, it peaks in 4 to 12 hours,and its duration of action is 24 hours. Hypoglycemic reactions most likely occur during peak time.116.) A nurse administers a dose of scopolamine (Transderm-Scop) to a postoperative client. Thenurse tells the client to expect which of the following side effects of this medication?1. Dry mouth2. Diaphoresis

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3. Excessive urination4. Pupillary constriction1. Dry mouthRationale:Scopolamine is an anticholinergic medication for the prevention of nausea and vomiting thatcauses the frequent side effects of dry mouth, urinary retention, decreased sweating, anddilation of the pupils. The other options describe the opposite effects of cholinergic-blockingagents and therefore are incorrect.117.) A nurse has given the client taking ethambutol (Myambutol) information about themedication. The nurse determines that the client understands the instructions if the clientimmediately reports:1. Impaired sense of hearing2. Distressing gastrointestinal side effects3. Orange-red discoloration of body secretions4. Difficulty discriminating the color red from green4. Difficulty discriminating the color redfrom greenRationale:Ethambutol causes optic neuritis, which decreases visual acuity and the ability to discriminatebetween the colors red and green. This poses a potential safety hazard when driving a motorvehicle. The client is taught to report this symptom immediately. The client is also taught to takethe medication with food if gastrointestinal upset occurs. Impaired hearing results fromantitubercular therapy with streptomycin. Orange-red discoloration of secretions occurs withrifampin (Rifadin).118.) A nurse is caring for an older client with a diagnosis of myasthenia gravis and hasreinforced self-care instructions. Which statement by the client indicates that further teaching isnecessary?1. "I rest each afternoon after my walk."2. "I cough and deep breathe many times during the day."3. "If I get abdominal cramps and diarrhea, I should call my doctor."4. "I can change the time of my medication on the mornings that I feel strong."4. "I can changethe time of my medication on the mornings that I feel strong."Rationale:

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The client with myasthenia gravis should be taught that timing of anticholinesterase medicationis critical. It is important to instruct the client to administer the medication on time to maintain achemical balance at the neuromuscular junction. If not given on time, the client may become tooweak to swallow. Options 1, 2, and 3 include the necessary information that the client needs tounderstand to maintain health with this neurological degenerative disease.119.) A client with diabetes mellitus who has been controlled with daily insulin has been placedon atenolol (Tenormin) for the control of angina pectoris. Because of the effects of atenolol, thenurse determines that which of the following is the most reliable indicator of hypoglycemia?1. Sweating2. Tachycardia3. Nervousness4. Low blood glucose level4. Low blood glucose levelRationale:β-Adrenergic blocking agents, such as atenolol, inhibit the appearance of signs and symptoms ofacute hypoglycemia, which would include nervousness, increased heart rate, and sweating.Therefore, the client receiving this medication should adhere to the therapeutic regimen andmonitor blood glucose levels carefully. Option 4 is the most reliable indicator of hypoglycemia.12.) A nurse is caring for a client who is receiving an intravenous (IV) infusion of an antineoplasticmedication. During the infusion, the client complains of pain at the insertion site. During aninspection of the site, the nurse notes redness and swelling and that the rate of infusion of themedication has slowed. The nurse should take which appropriate action?1. Notify the registered nurse.2. Administer pain medication to reduce the discomfort.3. Apply ice and maintain the infusion rate, as prescribed.4. Elevate the extremity of the IV site, and slow the infusion.1. Notify the registered nurse.Rationale:When antineoplastic medications (Chemotheraputic Agents) are administered via IV, great caremust be taken to prevent the medication from escaping into the tissues surrounding theinjection site, because pain, tissue damage, and necrosis can result. The nurse monitors for signsof extravasation, such as redness or swelling at the insertion site and a decreased infusion rate. Ifextravasation occurs, the registered nurse needs to be notified; he or she will then contact thehealth care provider.

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120.) A client is taking lansoprazole (Prevacid) for the chronic management of Zollinger-Ellisonsyndrome. The nurse advises the client to take which of the following products if needed for aheadache?1. Naprosyn (Aleve)2. Ibuprofen (Advil)3. Acetaminophen (Tylenol)4. Acetylsalicylic acid (aspirin)3. Acetaminophen (Tylenol)Rationale:Zollinger-Ellison syndrome is a hypersecretory condition of the stomach. The client should avoidtaking medications that are irritating to the stomach lining. Irritants would include aspirin andnonsteroidal antiinflammatory drugs (ibuprofen). The client should be advised to takeacetaminophen for headache.**Remember that options that are comparable or alike are not likely to be correct. With this inmind, eliminate options 1 and 2 first.**121.) A client who is taking hydrochlorothiazide (HydroDIURIL, HCTZ) has been started ontriamterene (Dyrenium) as well. The client asks the nurse why both medications are required.The nurse formulates a response, based on the understanding that:1. Both are weak potassium-losing diuretics.2. The combination of these medications prevents renal toxicity.3. Hydrochlorothiazide is an expensive medication, so using a combination of diuretics is cost-effective.4. Triamterene is a potassium-sparing diuretic, whereas hydrochlorothiazide is a potassium-losing diuretic.4. Triamterene is a potassium-sparing diuretic, whereas hydrochlorothiazide is apotassium-losing diuretic.Rationale:Potassium-sparing diuretics include amiloride (Midamor), spironolactone (Aldactone), andtriamterene (Dyrenium). They are weak diuretics that are used in combination with potassium-losing diuretics. This combination is useful when medication and dietary supplement ofpotassium is not appropriate. The use of two different diuretics does not prevent renal toxicity.Hydrochlorothiazide is an effective and inexpensive generic form of the thiazide classification ofdiuretics.**It is especially helpful to remember that hydrochlorothiazide is a potassium-losing diuretic and

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triamterene is a potassium-sparing diuretic**122.) A client who has begun taking fosinopril (Monopril) is very distressed, telling the nurse thathe cannot taste food normally since beginning the medication 2 weeks ago. The nurse providesthe best support to the client by:1. Telling the client not to take the medication with food2. Suggesting that the client taper the dose until taste returns to normal3. Informing the client that impaired taste is expected and generally disappears in 2 to 3 months4. Requesting that the health care provider (HCP) change the prescription to another brand ofangiotensin-converting enzyme (ACE) inhibitor3. Informing the client that impaired taste isexpected and generally disappears in 2 to 3 monthsRationale:ACE inhibitors, such as fosinopril, cause temporary impairment of taste (dysgeusia). The nursecan tell the client that this effect usually disappears in 2 to 3 months, even with continuedtherapy, and provide nutritional counseling if appropriate to avoid weight loss. Options 1, 2, and4 are inappropriate actions. Taking this medication with or without food does not affectabsorption and action. The dosage should never be tapered without HCP approval and themedication should never be stopped abruptly.123.) A nurse is planning to administer amlodipine (Norvasc) to a client. The nurse plans to checkwhich of the following before giving the medication?1. Respiratory rate2. Blood pressure and heart rate3. Heart rate and respiratory rate4. Level of consciousness and blood pressure2. Blood pressure and heart rateRationale:Amlodipine is a calcium channel blocker. This medication decreases the rate and force of cardiaccontraction. Before administering a calcium channel blocking agent, the nurse should check theblood pressure and heart rate, which could both decrease in response to the action of thismedication. This action will help to prevent or identify early problems related to decreasedcardiac contractility, heart rate, and conduction.**amlodipine is a calcium channel blocker, and this group of medications decreases the rate andforce of cardiac contraction. This in turn lowers the pulse rate and blood pressure.**

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124.) A client with chronic renal failure is receiving ferrous sulfate (Feosol). The nurse monitorsthe client for which common side effect associated with this medication?1. Diarrhea2. Weakness3. Headache4. Constipation 4. ConstipationRationale:Feosol is an iron supplement used to treat anemia. Constipation is a frequent and uncomfortableside effect associated with the administration of oral iron supplements. Stool softeners are oftenprescribed to prevent constipation.**Focus on the name of the medication. Recalling that oral iron can cause constipation will easilydirect you to the correct option.**125.) A nurse is preparing to administer digoxin (Lanoxin), 0.125 mg orally, to a client with heartfailure. Which vital sign is most important for the nurse to check before administering themedication?1. Heart rate2. Temperature3. Respirations4. Blood pressure1. Heart rateRationale:Digoxin is a cardiac glycoside that is used to treat heart failure and acts by increasing the force ofmyocardial contraction. Because bradycardia may be a clinical sign of toxicity, the nurse countsthe apical heart rate for 1 full minute before administering the medication. If the pulse rate isless than 60 beats/minute in an adult client, the nurse would withhold the medication andreport the pulse rate to the registered nurse, who would then contact the health care provider.126.) A nurse is caring for a client who has been prescribed furosemide (Lasix) and is monitoringfor adverse effects associated with this medication. Which of the following should the nurserecognize as a potential adverse effect Select all that apply.1. Nausea2. Tinnitus

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3. Hypotension4. Hypokalemia5. Photosensitivity6. Increased urinary frequency 2. Tinnitus3. Hypotension4. HypokalemiaRationale:Furosemide is a loop diuretic; therefore, an expected effect is increased urinary frequency.Nausea is a frequent side effect, not an adverse effect. Photosensitivity is an occasional sideeffect. Adverse effects include tinnitus (ototoxicity), hypotension, and hypokalemia and occur asa result of sudden volume depletion.127.) The nurse provides medication instructions to an older hypertensive client who is taking 20mg of lisinopril (Prinivil, Zestril) orally daily. The nurse evaluates the need for further teachingwhen the client states which of the following?1. "I can skip a dose once a week."2. "I need to change my position slowly."3. "I take the pill after breakfast each day."4. "If I get a bad headache, I should call my doctor immediately."1. "I can skip a doseonce a week."Rationale:Lisinopril is an antihypertensive angiotensin-converting enzyme (ACE) inhibitor. The usual dosagerange is 20 to 40 mg per day. Adverse effects include headache, dizziness, fatigue, orthostatichypotension, tachycardia, and angioedema. Specific client teaching points include taking one pilla day, not stopping the medication without consulting the health care provider (HCP), andmonitoring for side effects and adverse reactions. The client should notify the HCP if side effectsoccur.128.) A nurse is providing instructions to an adolescent who has a history of seizures and istaking an anticonvulsant medication. Which of the following statements indicates that the clientunderstands the instructions?1. "I will never be able to drive a car."2. "My anticonvulsant medication will clear up my skin."

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3. "I can't drink alcohol while I am taking my medication."4. "If I forget my morning medication, I can take two pills at bedtime."3. "I can't drink alcoholwhile I am taking my medication."Rationale:Alcohol will lower the seizure threshold and should be avoided. Adolescents can obtain a driver'slicense in most states when they have been seizure free for 1 year. Anticonvulsants cause acneand oily skin; therefore a dermatologist may need to be consulted. If an anticonvulsantmedication is missed, the health care provider should be notified.129.) Megestrol acetate (Megace), an antineoplastic medication, is prescribed for the client withmetastatic endometrial carcinoma. The nurse reviews the client's history and contacts theregistered nurse if which diagnosis is documented in the client's history?1. Gout2. Asthma3. Thrombophlebitis4. Myocardial infarction3. ThrombophlebitisRationale:Megestrol acetate (Megace) suppresses the release of luteinizing hormone from the anteriorpituitary by inhibiting pituitary function and regressing tumor size. Megestrol is used withcaution if the client has a history of thrombophlebitis.**megestrol acetate is a hormonal antagonist enzyme and that a side effect is thromboticdisorders**13.) The client with squamous cell carcinoma of the larynx is receiving bleomycin intravenously.The nurse caring for the client anticipates that which diagnostic study will be prescribed?1. Echocardiography2. Electrocardiography3. Cervical radiography4. Pulmonary function studies4. Pulmonary function studiesRationale:Bleomycin is an antineoplastic medication (Chemotheraputic Agents) that can cause interstitialpneumonitis, which can progress to pulmonary fibrosis. Pulmonary function studies along with

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