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EXIT HESI - Comprehensive PN Exam A Practice Questions 1. A nurse who has recently completed orientation is beginning work in the labor and delivery unit for the first time. When making assignments, which client should the charge nurse assign to this new $10.49
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EXIT HESI - Comprehensive PN Exam A Practice Questions 1. A nurse who has recently completed orientation is beginning work in the labor and delivery unit for the first time. When making assignments, which client should the charge nurse assign to this new
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Course
HESI NURSING
Institution
HESI NURSING
EXIT HESI - Comprehensive PN Exam A Practice Questions
1. A nurse who has recently completed orientation is beginning work in the
labor and delivery unit for the first time. When making assignments, which
client should the charge nurse assign to this new nurse?: A multiparous client
who is dila...
EXIT HESI - Comprehensive PN Exam A Practice Questions
1. A nurse who has recently completed orientation is beginning work in the labor and delivery unit for the first time. When making
assignments, which client should the charge nurse assign to this new nurse?
ANSW A multiparous clientwho is dilated 5 cm and 50% effaced
2. A client with human immunodeficiency virus (HIV) infection has white lesions in the oral cavity that resemble milk curds. Nystatin
(Mycostatin) preparation is prescribed as a swish and swallow. Which information is mostimportant for the nurse to provide the client?
ANSW Oral hygiene should be performedbefore the medication.
3. A client who is admitted with emphysema is having difficulty breathing. Inwhich position should the nurse place the client?
ANSW Sitting upright and forward with both arms supported on an over the bed table
4. A client with chronic renal insufficiency (CRI) is taking 25 mg of hy- drochlorothiazide (HCTZ) PO and 40 mg of furosemide (Lasix
PO daily.Today,at a routine clinic visit, the client's serum potassium level is 4 mEq/L. What isthe most likely cause of this client's
potassium level?
ANSW The client's renal functionhas affected his potassium level.
5. A registered nurse (RN) delivers telehealth services to clients via electroniccommunication.Which nursing action creates the greatest
risk for profession-al liability and has the potential for a malpractice lawsuit?
ANSW Sending medical records to health care providers via the Internet
6. Which pathophysiologic response supports the contraindication for opi- oids, 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 Pco2 and contributes to anelevated ICP.
ANSW D
The greatest risk associated with opioids such as morphine (D) is respiratory depression that causes an increase in Pco2, which
increases ICP and masks theearly signs of intracranial bleeding in head injury. (A, B, and C) do not support therisks associated with
opioid use in a client with increased ICP.
7. The charge nurse of a medical surgical unit is alerted to an impending disaster requiring implementation of the hospital's
disaster plan. Specific facts about the nature of this disaster are not yet known. Which instruction
, EXIT HESI - Comprehensive PN Exam A Practice Questions
should the charge nurse give to the other staff members at this time?
A. Prepare to evacuate the unit, starting with the bedridden clients. B.UAPs should report to the emergency center to
handle transports.
C.The licensed staff should begin counting wheelchairs and IV poles on theunit.
D.Continue with current assignments until more instructions are received.
ANSW DWhen faced with an impending disaster, hospital personnel may be alerted but should continue with current client care
assignments until further instructions are received (D). Evacuation is typically a response of last resort that begins with clientswho are
most able to ambulate (A). (B) is premature and is likely to increase the chaos if incoming casualties are anticipated. (C) is poor
utilization of personnel.
8. The nurse assesses a client while the UAP measures the client's vital signs. The client's vital signs change suddenly, and the
nurse determines that the client's condition is worsening. The nurse is unsure of the client'sresuscitative status and needs to check
the client's medical record for anyadvanced directives. Which action should the nurse implement?
A. Ask the UAP to check for the advanced directive while the nurse completesthe assessment.
B. Assign the UAP to complete the assessment while the nurse checks for theadvanced directive.
C. Check the medical record for the advanced directive and then complete theclient assessment.
D. Call for the charge nurse to check the advanced directive while continuingto assess the client.
ANSW D
Because the client's condition is worsening, the nurse should remain with the client and continue the assessment while calling for
help from the charge nurse to determine the client's resuscitative status (D). (A and B) are tasks that must becompleted by a nurse
and cannot be delegated to the UAP. (C) is contraindicated.
9. The nurse is preparing a client for surgery scheduled in 2 hours. A UAP ishelping the nurse.Which task is important for the nurse to
perform, rather thanthe UAP?
A. Remove the client's nail polish and dentures.
B. Assist the client to the restroom to void.
C. Obtain the client's height and weight.
D. Offer the client emotional support.
ANSW D
By using therapeutic techniques to offer support (D), the nurse can determine any
, EXIT HESI - Comprehensive PN Exam A Practice Questions
client concerns that need to be addressed. (A, B, and C) are all actions that can beperformed by the UAP under the supervision of the
nurse.
10. Until the census on the obstetrics (OB) unit increases, an unlicensed assistive personnel (UAP) who usually works in labor and
delivery and the newborn nursery is assigned to work on the postoperative unit. Which clientwould be best for the charge nurse to
assign to this UAP?
A.An adolescent who was readmitted to the hospital because of a postoper-ative infection
B.A woman with a new colostomy who requires discharge teaching
C.A woman who had a hip replacement and may be transferred to the homecare unit
D.A man who had a cholecystectomy and currently has a nasogastric tube setto intermittent suction
ANSW C
The charge nurse will be responsible for providing a report to the home care unit ifthe transfer occurs (A). The client is infected and an
employee who works on an OBunit should be assigned to clean cases in case the employee is required to return tothe OB unit (B). This
requires the skills of a registered nurse (RN) to do discharge teaching and provide emotional support (D). This may require skills beyond
the levelof this UAP.
11. A male client is admitted for observation after being hit on the head with a baseball bat. Six hours after admission, the clien
attempts to crawl out of bed and asks the nurse why there are so many bugs in his bed. His vital signs are stable, and the pulse oximeter
reading is 98% on room air. Which interventionshould the nurse perform first?
A.Administer oxygen per nasal cannula at 2 L/min.B.Plan to check his vital signs again in
30 minutes.
C.Notify the health care provider of the change in mental status.
D.Ask the client why he thinks there are bugs in the bed.
ANSW C
One of the earliest signs of increased intracranial pressure (ICP) is a change in mental status (C). It is important to act early and
quickly when symptoms of
increased ICP occur. Because his oxygen saturation is normal, the administration ofoxygen (A) is not the top priority. Vital signs should be
monitored frequently (B), butthe client's confusion should be reported immediately. (D) is not a useful intervention.
12. The nurse is monitoring a client who is receiving bedside conscious sedation with midazolam hydrochloride (Versed). In
assessing the client, thenurse determines that the client has slurred speech with diplopia. Based onthis finding, what action should the
nurse take?
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