HESI Fundamentals Exam/ HESI Fundamentals Practice Test | 200 Questions and Verified Answers (2023/2024)
Q: A client with Raynaud's disease asks the nurse about using biofeedback for self- management of symptoms. What response is best for the nurse to provide?
Answer:
Biofeedback allows t...
HESI Fundamentals Exam/ HESI Fundamentals Practice Test | 200 Questions and Verified A nswers (2023/2024) Q: A client with Raynaud's disease asks the nurse about using biofeedback for self - management of symptoms. What response is best for the nurse to provide? Answer: Biofeedback al lows the client to control involuntary responses to promote peripheral vasodilation. Biofeedback involves the use of various monitoring devices that help people become more aware and able to control their own physiologic responses, such as heart rate, bo dy temperature, muscle tension, and brain waves. Q: When the nurse enters a client's room to do an initial assessment, the client shouts, "Get out of my room! I'm tired of being bothered!" How should the nurse respond? Answer: "What is concerning you this morning?" open -ended question that encourages the client to discuss personal feelings. Q: The nurse notes that a client consistently coughs while eating and drinking. Which nursing diagnosis is most important for the nurse to include in this client's plan of care? Answer: Risk for aspiration. Coughing during or after meals is a manifest ation of dysphagia, or difficulty swallowing, which places the client at risk for aspiration Q: A female nurse who sometimes tries to save time by putting medications in her uniform pocket to deliver to clients, confides that after arriving home she fou nd a hydrocodone (Vicodin) tablet in her pocket. Which possible outcome of this situation should be the nurse's greatest concern? Answer: Accused of diversion. Even if this is only one incident, the nurse may be suspected of taking medications on a reg ular basis and the incident could be interpreted as diversion Q: A client is admitted to the hospital with intractable pain. What instruction should the nurse provide the unlicensed assistive personnel (UAP) who is preparing to assist this client with a bed bath? Answer: Take measures to promote as much comfort as possible. Intractable pain is highly resistant to pain relief measures, so it is important to promote comfort client Q: What client statement indicates to the nurse that the client requires assistance with bathing? Answer: "I don't understand why I'm so weak and tired." Bathing often makes a client feel weak, and if a client is already feeling weak Q: The nurse en counters resistance when inserting the tubing into a client's rectum for a tap water enema. What action should the nurse implement? Answer: Ask the client to relax and run a small amount of fluid into the rectum. If resistance is encountered during the initial insertion of an enema tube, the client should be instructed to relax while a small amount of solution runs through the tube into the rectum Q: The nurse removes the dressing on a client's heel that is covering a pressure sore one -inch in diamet er and finds that there is straw -colored drainage seeping from the wound. What description of this finding should the nurse include in the client's record? Answer: One-inch pressure sore draining serous fluid. Serous drainage is clear watery plasma Q: When preparing to administer an intravenous medication through a central venous catheter, the nurse aspirates a blood return in one of the lumens of the triple lumen catheter. Which action should the nurse implement? Answer: Flush the lumen with the saline solution and administer the medication through the lumen. Aspiration of a blood return in the lumen of a central venous catheter indicates that the catheter is in place and the medication can be administered. The nurse should flush the tubing with the saline solution, administer the medication Q: Before administering a client's medication, the nurse assesses a change in the client's condition and decides to withhold the medication until consulting with the healthcare provider. After consultation with the healthcare provider, the dose of the medication is changed and the nurse administers the newly prescribed dose an hour later than the originally scheduled time. What action should the nurse implement in response to this situation? Answer: Docum ent the events that occurred in the nurses' notes. The nurse took the correct action and should document the events that occurred in the nurses' notes Q: When making the bed of a client who needs a bed cradle which action should the nurse include? Answer: Drape the top sheet and covers loosely over the bed cradle. A bed cradle is used to keep the top bedclothes off the client, so the nurse should drape the top sheet and covers loosely over the cradle Q: How should the nurse handle linens that are soiled with incontinent feces? Answer: Place the soiled linens in a pillow case and deposit them in the dirty linen hamper. The nurse should be careful to keep the soiled linens from contaminating the fresh linens, and should handle the soiled linens like any other dirty linen Q: The daughter of an older woman who became depressed following the death of her husband asks "My mother was always well -adjusted until my father died. Will she tend to be sick from now on?" Which response is best for the nurse to provide? Answer: "It's highly likely that she will recover a nd return to her pre -illness state." Analysis of behavior patterns using Erikson's framework can identify age -appropriate or arrested development of normal interpersonal skills. Erikson describes the successful resolution of a developmental crisis in th e later years (older than 65 -years) to include the achievement of a sense of integrity and fulfillment, wisdom, and a willingness to face one's own mortality and accept the death of others Q: The nurse working in the emergency department is assessing fo ur clients' ability to tolerate pain. Which client is likely to tolerate a higher level of pain? Answer:
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