HESI COMPREHENSIVE EXAM B(100 Percent CORRECT QUESTION AND ANSWER)NEW!!! UPDATE

HESI COMPREHENSIVE EXAM B(100% CORRECT QUESTION AND ANSWER)NEW!!! UPDATE The nurse assesses a client who is taking indomethacin (Indocin) for arthritic pain. Which finding is most important to report to the primary health care provider? A. Takes medication with milk. B. Blood pressure, 104/64 mm Hg. C. Elevated liver enzyme levels. D. Hemoglobin level, 13 g/dL. - ANSWERS-C Rationale:Indomethacin is an antiinflammatory drug and can cause liver damage. Elevated liver enzyme levels indicate a complication with the drug. This medication should be taken with food or milk to reduce gastrointestinal (GI) side effects. Options B and D are normal findings. The nurse is caring for a client with a cerebrovascular accident (CVA) who is receiving enteral tube feedings. Which task performed by the UAP requires immediate intervention by the nurse? A. Suctions oral secretions from mouth B. Positions head of bed flat when changing sheets C. Takes temperature using the axillary method D. Keeps head of bed elevated at 30 degrees - ANSWERS-B Rationale:Positioning the head of the bed flat when enteral feedings are in progress puts the client at risk for aspiration. Options A, C, and D are all acceptable tasks performed by the UAP. When assessing safety for the older adult, which finding is the nurse's highest priority? A. The client has a cataract in the right eye. B. The client is not married and lives alone. C. The client lives in a two-story building. D. The client reports a history of repeated falls. - ANSWERS-D Rationale:Risk assessment for falls is a critical element in caring for the older adult. Options A, B, and C are important components in assessing client risk, but a history of prior falls puts the older client at very high risk for falling again.