BSN 366 HESI RN Exit Test Questions & Answers (Latest Update 2024 / 2025) | 100% Correct | Grade A - Nightingale
Question:
Duplex scanning confirms the presence of a deep venous thrombosis for a client with swelling and pain of the lower leg. While the client is receiving continuous heparin...
BSN 366 HESI RN Exit Test
Questions & Answers (Latest Update
) | 100% Correct | Grade
A - Nightingale
Question:
Duplex scanning confirms the presence of a deep venous thrombosis for a
client with swelling and pain of the lower leg. While the client is receiving
continuous heparin infusion, what actions should the nurse implement?
1. Avoid any intramuscular medications to prevent localized bleeding.
2. Have vitamin K available in the event the client begins to bleed.
3. Notify the healthcare provider if the partial thromboplastin time is greater
than 50 seconds.
4. Start instruction for self-administered SC heparin injections for long-term
home therapy.
Answer:
1. Avoid any intramuscular medications to prevent localized bleeding.
Question:
During a home visit, the nurse notes that a female client with degenerative
joint disease is taking 3 grams of aspirin PO daily. The client complains of
,tinnitus, and seems confused. Which intervention should the nurse
implement?
1. Prepare a written schedule to remind the client when to take each dose of
aspirin.
2. Observe the client place each dose in the correct boxes of her pill container.
3. Contact the client's healthcare provider to report the assessment findings.
4. Ask a family member to ensure that the client takes the medication as
prescribed.
Answer:
3. Contact the client's healthcare provider to report the assessment findings.
Question:
When examining the wound of a client who had abdominal surgery yesterday,
the nurse finds that the wound edges are close together, there is no sign of
redness, and there is a slight amount of bright red blood oozing from the
incision. What action should the nurse take?
1. Record these findings in the client's record.
2. Observe closely for possible dehiscence.
3. Notify the healthcare provider that the client's wound is producing a
sanguineous drainage.
4. Increase the IV fluid rate and encourage the client to eat more ice chips.
Answer:
1. Record these findings in the client's record.
,Question:
Current assessment findings for a client who is withdrawing from barbiturates
are: blood pressure 135/90, temperature 97.6 F, pulse rate of 98 beats/minute,
and respiratory rate 22 breaths/minute. The client is also experiencing
insomnia, restlessness, confusion, and pronounced muscle twitching. What
action should the nurse take?
1. Notify the healthcare provider of the client's status.
2. Assess vital signs q15 minutes until stable.
3. Place the client in a vest-type restraining jacket.
4. Encourage the client to take a warm bath to help relax.
Answer:
1. Notify the healthcare provider of the client's status.
Question:
To treat cystitis, a 14-day course of treatment with cephalexin (Ceclor) is
prescribed for a client residing in a long-term care facility. Which action is
most important for the nurse to take prior to administering the first dose of
this medication?
1. Review the client's fasting blood glucose levels for a hyperglycemic trend.
2. Determine if the client has ever had a hypersensitivity reaction to
penicillins.
3. Restrict the use of dairy products in the client's diet for the next 3 weeks.
4. Take the client's vital signs prior to the first dose and once daily for 14 days.
Answer:
2. Determine if the client has ever had a hypersensitivity reaction to
penicillins.
, Question:
A young adult female is brought to the emergency room by family members
who report that she ingested a large quantity of acetaminophen (Tylenol). The
nurse should prepare for which treatment to be implemented?
1. IV administration of Narcan.
2. Syrup of ipecac per nasogastric tube.
3. Acetylcysteine (Mucomyst) 140 mg/kg.
4. Gastric lavage with normal saline.
Answer:
3. Acetylcysteine (Mucomyst) 140 mg/kg
Question:
While auscultating the lungs of a client who is being mechanically ventilated,
the nurse hears coarse, snoring sounds over the upper anterior chest with
clear sounds over the other lung fields. Based on these assessment findings,
which action should the nurse take?
1. Notify respiratory therapy immediately for a PRN bronchodilator treatment.
2. Obtain a prescription to increase the tidal volume setting on the ventilator.
3. Stop mechanical ventilation and re-assess the client's lung sounds
bilaterally.
4. Suction the client's endotracheal tube and auscultate following suctioning.
Answer:
4. Suction the client's endotracheal tube and auscultate following suctioning.
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