HESI REVIEW NURS 310 EXAM WITH ACTUAL QUESTIONS
AND CORRECT VERIFIED ANSWERS
A 75-year-old client who has a history of end stage renal failure and advanced
| | | | | | | | | | | | |
lung cancer, recently had a stroke. Two days ago the healthcare provider
| | | | | | | | | | | |
discontinued the client's dialysis treatments, stating that death is inevitable,
| | | | | | | | | |
but the client is disoriented and will not sign a DNR directive. What is the
| | | | | | | | | | | | | | |
priority nursing intervention?
| | |
Review the client's most recent laboratory reports.
| | | | | |
Refer the client and family members for hospice care.
| | | | | | | |
Notify the hospital ethics committee of the client situation.
| | | | | | | |
Determine who is legally empowered to make decisions. - ANSWER-Determine
| | | | | | | | |
who is legally empowered to make decisions.
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A male client with an infected wound tells the nurse that he follows a
| | | | | | | | | | | | |
macrobiotic diet. Which type of foods should the nurse recommend that the
| | | | | | | | | | |
client select from the hospital menu?
| | | | | |
,Low fat and low sodium foods.
| | | | |
Combination of plant proteins to provide essential amino acids.
| | | | | | | |
Limited complex carbohydrates and fiber.
| | | |
Increased amount of vitamin C and beta carotene rich foods. - ANSWER-
| | | | | | | | | | |
|Combination of plant proteins to provide essential amino acids.
| | | | | | | |
A macrobiotic diet is high in whole-grain cereals, vegetables, sea vegetables,
| | | | | | | | | |
beans, and vegetarian soups, and the client needs essential amino acids to
| | | | | | | | | | | |
provide complete proteins to heal the infected wound. Although a macrobiotic
| | | | | | | | | | |
diet contains no source of animal protein, essential amino acids should be
| | | | | | | | | | | |
obtained by combining plant (incomplete) proteins to provide complete (all
| | | | | | | | |
essential amino acids) proteins (B) for anabolic processes. (A, C, and D) do not
| | | | | | | | | | | | | |
provide the client with food choices consistent with a macrobiotic diet and
| | | | | | | | | | | |
protein needs.
| |
The nurse is administering an intermittent infusion of an antibiotic to a client
| | | | | | | | | | | |
|whose intravenous (IV) access is an antecubital saline lock. After the nurse
| | | | | | | | | | |
|opens the roller clamp on the IV tubing, the alarm on the infusion pump
| | | | | | | | | | | | |
indicates an obstruction. What action should the nurse take first?
| | | | | | | | |
Check for a blood return.
| | | |
Reposition the client's arm. | | |
Remove the IV site dressing.| | | |
, Flush the lock with saline. - ANSWER-Reposition the client's arm.
| | | | | | | | |
If the client's elbow is bent, the IV may be unable to infuse, resulting in an
| | | | | | | | | | | | | | |
|obstruction alarm, so the nurse should first attempt to reposition the client's
| | | | | | | | | | |
|arm to alleviate any obstruction
| | | |
What action should the nurse implement to prevent the formation of a sacral
| | | | | | | | | | | |
ulcer for a client who is immobile?
| | | | | | |
Maintain in a lateral position using protective wrist and vest devices.
| | | | | | | | | |
Position prone with a small pillow below the diaphragm.
| | | | | | | |
Raise the head and knee gatch when lying in a supine position.
| | | | | | | | | | |
Transfer into a wheelchair close to the nurse's station for observation. -
| | | | | | | | | | |
ANSWER-Position prone with a small pillow below the diaphragm.
| | | | | | | | |
What intervention should the nurse include in the plan of care for a client who
| | | | | | | | | | | | | |
is being treated with an Unna's paste boot for leg ulcers due to chronic venous
| | | | | | | | | | | | | | |
insufficiency?
|
Check capillary refill of toes on lower extremity with Unna's paste boot.
| | | | | | | | | | |
Apply dressing to wound area before applying the Unna's paste boot.
| | | | | | | | | |
Wrap the leg from the knee down towards the foot.
| | | | | | | | |
AND CORRECT VERIFIED ANSWERS
A 75-year-old client who has a history of end stage renal failure and advanced
| | | | | | | | | | | | |
lung cancer, recently had a stroke. Two days ago the healthcare provider
| | | | | | | | | | | |
discontinued the client's dialysis treatments, stating that death is inevitable,
| | | | | | | | | |
but the client is disoriented and will not sign a DNR directive. What is the
| | | | | | | | | | | | | | |
priority nursing intervention?
| | |
Review the client's most recent laboratory reports.
| | | | | |
Refer the client and family members for hospice care.
| | | | | | | |
Notify the hospital ethics committee of the client situation.
| | | | | | | |
Determine who is legally empowered to make decisions. - ANSWER-Determine
| | | | | | | | |
who is legally empowered to make decisions.
| | | | | | |
A male client with an infected wound tells the nurse that he follows a
| | | | | | | | | | | | |
macrobiotic diet. Which type of foods should the nurse recommend that the
| | | | | | | | | | |
client select from the hospital menu?
| | | | | |
,Low fat and low sodium foods.
| | | | |
Combination of plant proteins to provide essential amino acids.
| | | | | | | |
Limited complex carbohydrates and fiber.
| | | |
Increased amount of vitamin C and beta carotene rich foods. - ANSWER-
| | | | | | | | | | |
|Combination of plant proteins to provide essential amino acids.
| | | | | | | |
A macrobiotic diet is high in whole-grain cereals, vegetables, sea vegetables,
| | | | | | | | | |
beans, and vegetarian soups, and the client needs essential amino acids to
| | | | | | | | | | | |
provide complete proteins to heal the infected wound. Although a macrobiotic
| | | | | | | | | | |
diet contains no source of animal protein, essential amino acids should be
| | | | | | | | | | | |
obtained by combining plant (incomplete) proteins to provide complete (all
| | | | | | | | |
essential amino acids) proteins (B) for anabolic processes. (A, C, and D) do not
| | | | | | | | | | | | | |
provide the client with food choices consistent with a macrobiotic diet and
| | | | | | | | | | | |
protein needs.
| |
The nurse is administering an intermittent infusion of an antibiotic to a client
| | | | | | | | | | | |
|whose intravenous (IV) access is an antecubital saline lock. After the nurse
| | | | | | | | | | |
|opens the roller clamp on the IV tubing, the alarm on the infusion pump
| | | | | | | | | | | | |
indicates an obstruction. What action should the nurse take first?
| | | | | | | | |
Check for a blood return.
| | | |
Reposition the client's arm. | | |
Remove the IV site dressing.| | | |
, Flush the lock with saline. - ANSWER-Reposition the client's arm.
| | | | | | | | |
If the client's elbow is bent, the IV may be unable to infuse, resulting in an
| | | | | | | | | | | | | | |
|obstruction alarm, so the nurse should first attempt to reposition the client's
| | | | | | | | | | |
|arm to alleviate any obstruction
| | | |
What action should the nurse implement to prevent the formation of a sacral
| | | | | | | | | | | |
ulcer for a client who is immobile?
| | | | | | |
Maintain in a lateral position using protective wrist and vest devices.
| | | | | | | | | |
Position prone with a small pillow below the diaphragm.
| | | | | | | |
Raise the head and knee gatch when lying in a supine position.
| | | | | | | | | | |
Transfer into a wheelchair close to the nurse's station for observation. -
| | | | | | | | | | |
ANSWER-Position prone with a small pillow below the diaphragm.
| | | | | | | | |
What intervention should the nurse include in the plan of care for a client who
| | | | | | | | | | | | | |
is being treated with an Unna's paste boot for leg ulcers due to chronic venous
| | | | | | | | | | | | | | |
insufficiency?
|
Check capillary refill of toes on lower extremity with Unna's paste boot.
| | | | | | | | | | |
Apply dressing to wound area before applying the Unna's paste boot.
| | | | | | | | | |
Wrap the leg from the knee down towards the foot.
| | | | | | | | |
