PN Hesi Exit V1.pdf

Question 61 An agitated, confused client arrives in the emergency department. The client's history includes type 1 diabetes, hypertension, and angina pectoris. Assessment reveals pallor, diaphoresis, headache, and intense hunger. A stat blood glucose sample measures 42 mg/dl, (2.3 mmol/L) and the client is treated for an acute hypoglycemic reaction. After recovery, the nurse teaches the client to treat hypoglycemia by ingesting You Selected: • 18 to 20 g of a simple carbohydrate. Correct response: • 15 g of a simple carbohydrate. Question 62 A competent client in a long-term care facility refuses to take oral diuretic medication. The nurse informs the client that if the medication isn’t taken, restraints will be applied, and the medication will be given by injection. Which legal tort best describes this nurse’s statement? You Selected: • negligence Correct response: • assault Question 63 A client with weakness and tingling in both legs is admitted to the medical-surgical unit with a tentative diagnosis of Guillain-Barré syndrome. On admission, which assessment is most important for this client? You Selected: • lung auscultation and measurement of vital capacity and tidal volume Correct response: • lung auscultation and measurement of vital capacity and tidal volume Question 64 Which client should the nurse assess first? You Selected: • a client with chronic hypertension whose blood pressure today is 182/98 mm Hg Correct response: • a client being treated for chronic stable angina who reports a recent increase in chest pain frequency Question 65 A nurse is caring for a client during the first postpartum day. The client asks the nurse how to relieve pain from her episiotomy. What should the nurse instruct the woman to do? You Selected: • Take a sitz bath. Correct response: • Apply an ice pack to her perineum. Question 66 The nurse is admitting a hospital client who does not speak English and who is accompanied by the client's school-aged child. The client appears to be in pain, but the nurse is unable to assess the character or history of the client's pain. How should the nurse best communicate with the client? You Selected: • Have a hospital interpreter come to the assessment; defer the assessment if none is available. Correct response: • Enlist the help of a hospital interpreter; ask the son to translate if none is readily available.