HESI COMPREHENSIVE EXAM REVIEW (A Grade), Questions and Answers, All Correct Study Guide, Download to Score A 1. A client with hepatic failure tells the nurse about recent use of acetaminophen. How should the nurse respond to this client's statement? A. Bleeding precautions should be implemented. B. Tylenol is indicated for minor aches and pains. C. Acetaminophen reduces inflammation. D. The drug is hepatotoxic and contraindicated. Rationale: Acetaminophen is hepatotoxic and can cause further complications for a client with impaired liver function, so its use is contraindicated. Although bleeding is a risk in clients with liver disease caused by decreased production of clotting components, this drug significantly increases this risk and is contraindicated. Although option B is an indicated use for this drug, it remains contraindicated in clients with hepatic failure. Option C is inaccurate. 2. Which physiologic finding in an older adult contributes to an adverse drug reaction? A. Reduced renal excretion B. Reduced gastrointestinal motility C. Increased hepatic metabolism D. Increased risk of autoimmune disorders Rationale: During the aging process, reduced renal function is common and contributes to drug accumulation that contributes to adverse reactions. Reduced hepatic function, not option C, predisposes an older adult to an increase in adverse drug reactions. Option B may occur frequently in an older client but does not impact the bioavailability of drugs. Although an older adult may have a decreased immune response, the aging client's risk for autoimmune disorders is not increased, nor does it affect drug pharmacotherapeutics. 3. The nurse is providing care to a client with head trauma with the most recent intracranial pressure reading of 22 mm Hg. The health care provider has prescribed morphine for pain control. Which pathophysiologic response supports the contraindication for opioids, such as morphine, in clients with increased intracranial pressure (ICP)? A. Sedation produced by opioids is a result of a prolonged half-life when theICP is elevated. B. Higher doses of opioids are required when cerebral blood flow is reducedby an elevated ICP. C. Dysphoria from opioids contributes to altered levels of consciousness withan elevated ICP. D. Opioids suppress respirations, which increases PCO2and contributes toan elevated ICP. Rationale: The greatest risk associated with opioids such as morphine is respiratory depression that causes an increase in PCO2, which increases ICP and masks the early signs of intracranial bleeding in head injury. Options A, B, and C do not support the risks associated with opioid use in a client with increased ICP. 4. A client who is admitted with emphysema is having difficulty breathing. In which position should the nurse place theclient? A. High Fowler position without a pillow behind the head B. Semi-Fowler position with a single pillow behind the head C. Right side-lying position with the head of the bed elevated 45 degrees D. Sitting upright and forward with both arms supported on an over the bedtable Rationale: Adequate lung expansion is dependent on deep breaths that allow the respiratory muscles to increase the longitudinal and anterior-posterior size of the thoracic cage. Sitting upright and leaning forward with the arms supported on an over the bed table allows the thoracic cage to expand in all four directions and reduces dyspnea. A high Fowler position does not allow maximum expansion of the posterior lobes of the lungs. A semi-Fowler position restricts the expansion of the anterior- posterior diameter of the thoracic cage. Positioning a client on the right side with the head of the bed elevated does not facilitate lung expansion. 5. An older client who resides in a long-term care facility is hearing-impaired. How should the nurse modifyinterventions for this client? A. Turn off the client's television and speak very loudly. B. Communicate in writing whenever it is possible. C. Speak very slowly while exaggerating each word. D. Face the client and speak in a normal tone of voice. Rationale: A hearing-impaired client frequently relies on lip reading and body language to determine what is being said, so option D should be implemented. Options A and C may distort the sounds and facial expressions, which alters the client's ability to interpret the verbal message. Communicating in writing is another option that could be used if verbal or body language is