Question 1
Purchase the whole exam here
Hesi PN Exit V1 (2022: 160 Questions and Answers)
A school-age client with diabetes is placed on an intermediate acting insulin and regular insulin before breakfast and before dinner. She will receive a snack of milk and cereal at bedtime. What does the nurse tell the client the snack is intended to do?
You Selected: • Prevent late night hypoglycemia. Correct response:
• Prevent late night hypoglycemia.
Question 2
A well-known public official of a small community is admitted to the emergency department following an episode of chest pain. Several nurses from the medical unit are aware of the admission and access the official’s electronic medical record to obtain a status update. What is the best response for the nurse manager to make to the nurses regarding this situation?
You Selected:
• “Assessing the official’s medical record is a breach of confidentiality.” Correct response:
• “Assessing the official’s medical record is a breach of confidentiality.”
Question 3
A four-year-old child is diagnosed as having acute lymphocytic leukemia. The white blood cell (WBC) count, especially the neutrophil count, is low. What is the most important intervention the
nurse should teach the parents?
You Selected:
• Protect your child from infections because his resistance to infection is decreased Correct response:
• Protect your child from infections because his resistance to infection is decreased
Question 4
The nurse is caring for a client with influenza. The most effective way to decrease the spread of microorganisms is:
You Selected:
• placing the client in isolation.
Correct response:
• washing the hands frequently.
Question 5
A client with a history of hypertension has been prescribed a new antihypertensive medication and is reporting dizziness. Which is the best way for the nurse to assess blood pressure?
You Selected:
• in the supine, sitting, and standing positions Correct response:
• in the supine, sitting, and standing positions
6. The client with infective endocarditis must be assessed frequently by the home health nurse. Which finding suggests that antibiotic therapy is not effective, and must be reported by the nurse immediately to the healthcare provider?: Fever of 103 degrees Fahrenheit (39.5 degrees Celsius)
7. A client who had a vasectomy is in the post recovery unit at an outpatient clinic. Which of these points is most important to be reinforced by the nurse?: Until the health care provider has determined that your ejaculate doesn't contain
8. A client who is to have antineoplastic chemotherapy tells the nurses of a fear of being sick all the time and wishes to try acupuncture. Which of these beliefs stated by the client would be incorrect about acupuncture?: The flow of life is believed to flow through major pathways or nerve clusters in your body.
9. The nurse is discussing with a group of students the disease Kawasaki. What statement made by a student about Kawasaki disease is incorrect?-
: Kawasaki disease occurs most often in boys, children younger than age 5 and children of Hispanic descent
10. A client has viral pneumonia affecting 2/3 of the right lung. What would be the best position to teach the client to lie in every other hour during first 12 hours after admission?: Side-lying on the left with the head elevated 10 degrees
11. A client has an indwelling catheter with continuous bladder irrigation af- ter undergoing a transurethral resection of the prostate (TURP) 12 hours ago. Which finding at this time should be reported to the health care provider?: -
minimal drainage into the urinary collection bag
12. A nurse is performing CPR on an adult who went into cardiopulmonary arrest. Another nurse enters the room in response to the call. After checking the client's pulse and respirations, what should be the function of the second nurse?: Participate with the compressions or breathing
13. . The nurse assesses a 72 year-old client who was admitted for right sided congestive heart failure. Which of the following would the nurse anticipate finding?: Jugular vein distention
14. A client with heart failure has a prescription for digoxin. The nurse is aware that sufficient potassium should be included in the diet because hypokalemia in combination with this medication?: Can predispose to dys- rhythmias
15. A nurse assesses a young adult in the emergency room following a motor vehicle accident. Which of the following neurological signs is of most concern?: Pupils fixed and dilated
16. A 14 year-old with a history of sickle cell disease is admitted to the hospital with a diagnosis of vaso-occlusive crisis. Which statements by the client would be most indicative of the etiology of this crisis: "I went to the health care provider last week for a cold and I have gotten worse."
17. Which these findings would the nurse more closely associate with ane- mia in a 10
month-old infant?: Pale mucosa of the eyelids and lips
18. The nurse is caring for a client in hypertensive crisis in an intensive care unit. The priority assessment in the first hour of care is: Pupil responses
19. Which of these clients who are all in the terminal stage of cancer is least appropriate to suggest the use of patient controlled analgesia (PCA) with a pump?: A preschooler with intermittent episodes of alertness
20. The nurse is about to assess a 6 month-old child with nonorganic fail- ure-to thrive (NOFTT). Upon entering the room, the nurse would expect the baby to be: Pale, thin arms and legs, uninterested in surroundings
21. As the nurse is speaking with a group of teens which of these side effects of chemotherapy for cancer would the nurse expect this group to be more interested in during the discussion?: Hair loss
22. While caring for a client who was admitted with myocardial infarction (MI)
2 days ago, the nurse notes today's temperature is 101.1 degrees Fahrenheit (38.5 degrees Celsius). The appropriate nursing intervention is to: Administer acetaminophen as ordered as this is normal at this time
23. . A client is admitted for first and second degree burns on the face, neck, anterior chest and hands. The nurse's priority should be: Assess for dyspnea or stridor
24. Which of these clients who call the community health clinic would the nurse ask to come in that day to be seen by the health care provider?: I went to the bathroom and my urine looked very red and it didn't hurt when I went.
25. A middle aged woman talks to the nurse in the health care provider's office about uterine fibroids also called leiomyomas or myomas. What state- ment by the woman indicates more education is needed?: Fibroids that cause no problems still need to be taken out.
26. An elderly client admitted after a fall begins to seize and loses conscious- ness. What action by the nurse is appropriate to do next?: Stay with client and observe for airway obstruction
27. A nurse is providing care to a primigravida whose membranes sponta- neously ruptured (ROM) 4 hours ago. Labor is to be induced. At the time
of the ROM the vital signs were T-99.8 degrees F, P-84, R-20, BP-130/78, and fetal heart tones (FHT) 148 beats/min. Which assessment findings taken now may be an early indication that the client is developing a complication of labor?: FHT 168 beats/min
28. A client with pneumococcal pneumonia had been started on antibiotics
16 hours ago. During the nurse's initial evening rounds the nurse notices a foul smell in the room. The client makes all of these statements during their conversation. Which statement would
alert the nurse to a complication?: "I have been coughing up foul-tasting, brown, thick sputum."
29. The nurse is performing an assessment on a client in congestive heart failure. Auscultation of the heart is most likely to reveal: S3 ventricular gallop
30. Which of these observations made by the nurse during an excretory urogram indicate a complicaton?: The client's entire body turns a bright red color
31. A client is diagnosed with a spontaneous pneumothorax necessitating the insertion of a chest tube. What is the best explanation for the nurse to provide this client?: "The tube will remove excess air from your chest."
32. The nurse is reviewing laboratory results on a client with acute renal failure. Which one of the following should be reported immediately?: Serum potassium 6 mEq/L
33. The nurse is caring for a client undergoing the placement of a central venous catheter line. Which of the following would require the nurse's im- mediate attention?: Dyspnea
34. The nurse is performing a physical assessment on a client who just had an endotracheal tube inserted. Which finding would call for immediate action by the nurse?: Pulse oximetry of 88
35. A nurse checks a client who is on a volume-cycled ventilator. Which finding indicates that the client may need suctioning?: Restlessness
36. The most effective nursing intervention to prevent atelectasis from de- veloping in a post operative client is to: Assist client to turn, deep breathe, and cough
37. When caring for a client with a post right thoracotomy who has un- dergone an upper lobectomy, the nurse focuses on pain management to promote: Deep breathing and coughing
38. A nurse is to collect a sputum specimen for acid-fast bacillus (AFB) from a client. Which action should the nurse take first?: Assist with oral hygiene
39. The nurse is caring for a child immediately after surgical correction of a ventricular septal defect.Which of the following nursing assessments should be a priority?: Assess for post operative arrhythmias
40. . A client has a history of chronic obstructive pulmonary disease (COPD). As the nurse enters the client's room, his oxygen is running at 6 liters per minute, his color is flushed and his respirations are 8 per minute. What should the nurse do first?: Lower the oxygen rate
0
1148