Q&A: HESI Comprehensive Exam 263 Prep Quiz 2026

• Question: Enalapril maleate is prescribed for a hospitalized client. Which assessment does the nurse perform as a priority before administering the medication?

  • 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 medication.

     

• Question: 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?

   

  • 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 bowel preparation is necessary before an upper 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 using a contrast medium (usually barium) administered in a flavored milkshake. Films are taken at intervals during the test, which takes about 30 minutes. After completion, a laxative is prescribed to hasten elimination of the barium, as remaining barium in the colon may become hard and cause fecal impaction.

• Question: 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?

   

  • 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 withhold the medication until the dose can be clarified. The nurse would not wait until the next morning to obtain clarification, and it is premature to call the nursing supervisor before trying to reach the on-call provider.

     

• Question: 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?

   

  • Answer: Ask the ED primary health care provider to check the client

  • Rationale: PVCs result from increased irritability of ventricular cells, and peripheral pulses may be absent or diminished because the decreased stroke volume of premature beats decreases peripheral perfusion. In an acute MI scenario, PVCs are considered warning dysrhythmias that can herald the onset of lethal ventricular tachycardia or ventricular fibrillation. It is essential to have the provider assess the client immediately. Telling the client PVCs are expected is incorrect, and while documenting and monitoring are necessary, they are not the priority over direct medical evaluation.

• Question: 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?

  • Answer: Administer the antihypertensive with a small sip of water

  • Rationale: General anesthesia is required for ECT, so NPO status is enforced for 6 to 8 hours before treatment to prevent aspiration. Exceptions include clients who routinely receive cardiac medications, antihypertensive agents, or histamine (H2) blockers, which should be given several hours before treatment with a small sip of water. Withholding the dose risks rebound hypertension, and a nurse cannot alter the route of administration to IV without a specific provider order.

• Question: 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?

   

  • Answer: "Tell me more about what you're feeling."

  • Rationale: When a client expresses feelings of depression, it is crucial for the nurse to explore these feelings further. Responses such as "This is a normal response," "It will take time," or "Every client feels the same way" offer false reassurance, minimize the client's unique psychological experience, and avoid addressing their immediate emotional needs.