HESI MILESTONE 2 EXAM | QUESTIONS & ANSWERS (VERIFIED) | LATEST UPDATE | GRADED A+

1 HESI MILESTONE 2 EXAM | QUESTIONS & ANSWERS (VERIFIED) | LATEST UPDATE | GRADED A+ What's the Broca's Area control? Correct Answer: Speech located in a convolution adjoining the middle cerebral artery. for control of the combinations of muscular movements needed to speak each word. What are the Chemo Side Effects? Correct Answer: Nausea Vomiting Myelosuppression SIADH Cardiac Toxicity sterility. Chemotherapy-induced neurotoxicity Chemo Brain Fatigue What is Expressive Aphasia? 2 Correct Answer: Inability to express oneself What's the first step of a pt is Dx with Meningitis? Correct Answer: Broad Spectrum Antibiotics What are the sx of Correct Answer: (may not seek health care until he or she experiences blurred vision or "halos") Blurred vision Halos difficulty focusing difficulty adjusting eyes in low lighting loss of peripheral vision aching or discomfort around the eyes headache. What Assessments should an RN conduct for Guillain Barre syndrome? Correct Answer: monitored for life-threatening complications (respiratory failure, cardiac dysrhythmias, VTE [including DVT or PE]) assess the patient's and family's ability to cope Maintain respiratory function Enhancing physical mobility Promote adequate nutrition 3 Improving communication Decreasing fear and anxiety Managing potential complications How does Multiple Sclerosis relate to Urinary Retention? Correct Answer: A neurogenic bladder results in urinary retention or leakage. The patient may describe a sensation of bladder fullness or incomplete bladder emptying. The pharmacological treatment of urinary retention is administration of a cholinergic agonist Traction & Assessment (Blueprint- Fractured Femer Dim Pulses) Correct Answer: After skin traction is applied, the nurse assesses circulation of the foot within 15 to 30 minutes and then every 1 to 2 hours. Circulatory assessment consists of: Peripheral pulses, color, capillary refill, and temperature of the fingers or toes. Manifestations of deep vein thrombosis (DVT), which include unilateral calf tenderness, warmth, redness, and swelling. How is Compartment Syndrome diagnosed Correct Answer: 6 P's pain poikilothermia pallor 4 paresthesia pulselessness paralysis Describe a Normal Sinus Rhythm Correct Answer: begins in the SA node · rate: 60 to 100 bpm · rhythm: Regular · QRS shape and duration: Usually normal, but may be regularly abnormal · P wave: Normal and consistent shape; always in front of the QRS · PR interval: Consistent interval between 0.12 and 0.20 seconds · P:QRS ratio: 1:1 What should an rn teach a pt who is undergoing a Valve Replacement? Correct Answer: VS are assessed every 5 to 15 minutes / PRN After the patient has recovered from anesthesia and sedation, is hemodynamically stable without IV medications, and has stable physical assessment parameters, he or she usually is transferred to a telemetry unit, typically within 24 to 72 hours of surgery. educates the patient about anticoagulant therapy, explaining the need for frequent follow-up appointments and blood laboratory studies. What teaching should a nurse conduct to a mother who was just diagnosed w Engorgement? 5 Correct Answer: sandwich technique :grasp her breast by making a "C" with her thumb and index finger. The thumb stabilizes the top of the breast while the remaining four fingers support her breast from below. Massage or pumping the breast may soften and extend the nipple for easier infant latchon. What should a nurse do if her patient Refuses RhoGam? Correct Answer: Consider culture Nurses need to respect whatever the mother's decision is. What is 24 Hour Jaundice? What should be taught to mothers who baby's have jaundice? Correct Answer: Physiologic jaundice is very common in newborns, with the majority demonstrating yellowish skin, mucous membranes, and sclera within the first 3 days of life. Advise mothers to nurse their infants at least eight to 12 times per day for the first several days What are Variable Decelerations? What does it mean? How do we resolve it? Correct Answer: visually apparent abrupt decreases in FHR below baseline and have an unpredictable shape on the FHR baseline, possibly demonstrating no consistent relationship to uterine contractions. Variable decelerations are associated with cord compression 6 Turn the client on her left or right lateral, knee-chest, or hands and knees to increase placental perfusion or relieve cord compression. What is the Normal Fetal Heart Rate? Correct Answer: 110-160 bpm What is IUGR? & What are NST Results? Correct Answer: intrauterine growth restriction Currently, an NST is recommended twice weekly (after 28 weeks' gestation) for clients with diabetes and other high-risk conditions, A nonreactive test has been correlated with a higher incidence of fetal distress during labor, fetal mortality, and IUGR. Additional testing, such as a biophysical profile, should be considered What's the class of Methadone? What's methadone for? Correct Answer: opioid Symptoms of opioid withdrawal Onset could be 2 to 4 days, and the symptoms may take 2 weeks to subside. treat addiction & withdrawl 7 Methadone can be used as a replacement for opioids, and the dosage is then decreased over 2 weeks. Substitution of methadone during detoxification reduces symptoms to no worse than a mild case of flu What are the signs a Client is in their Termination Phase? Correct Answer: Abandons old needs Aspires to new goals Becomes independent of helping person Applies new problem-solving skills Maintains changes in style of communication and interaction Shows positive changes in view of self Integrates illness Exhibits ability to stand alone What's the role of a Nurse during Termination Phase? Correct Answer: Sustains relationship as long as client feels necessary Promotes family interaction to assist with goal planning Teaches preventive measures Uses community agencies Teaches self-care Terminates nurse-client relationship Maslow 8 Correct Answer: The most basic needs— met first. safety and security needs - 2nd level Love and belonging needs - 3rd esteem needs - 4th self-actualization - 5th highest level Why are Gout patients prescribed Allupurinol Correct Answer: Allopurinol is used to decrease the about of serum uric acid levels It is necessary to administer allopurinol after meals to ensure absorption. What's the overall goal of Osteoarthritis pts? How does this relate to Exercise? Correct Answer: decrease pain and stiffness and to maintain or, mprove joint mobility. Exercise, especially in the form of cardiovascular aerobic exercise and lower extremity strength training, has been found to prevent OA progression and decrease symptoms of OA Hypertonic Fluids Correct Answer: When normal saline solution or lactated Ringer solution contains 5% dextrose, the total osmolality exceeds that of the ECF Saline 3% or 5% 9 What should the Rn suspect to be prescribed for Treatment of Rheumatoid Arthritis Pain? Correct Answer: NSAIDs (ibuprofen (Motrin) and naproxen (Naprosyn)) COX-2 . What is important to know about Hypothyroidism? Correct Answer: Levothyroxine (Synthroid): Used to treat hypothyroidism. People should take levothyroxine in the morning on an empty stomach. pulse rate prior to administering the drug is more than 100 beats/min =notify the prescriber What's the Theraputic effect of synthroid Correct Answer: Increased energy Decreased fatigue What is a Lithotripsy? Correct Answer: Electrohydraulic lithotripsy is a similar method in which an electrical discharge is used to create a hydraulic shock wave to break up the stone. A probe is passed through the cystoscope, and the tip of the lithotriptor is placed near the stone. This procedure is performed under topical anesthesic What are the Symptoms of BPH? 10 Correct Answer: urinary frequency urgency nocturia hesitancy in starting urination, decreased and intermittent force of stream sensation of incomplete bladder emptying abdominal straining with urination a decrease in the volume and force of the urinary stream dribbling complications of acute urinary retention recurrent UTIs. What are the risks of BPH? Correct Answer: Estrogens levels = sensitive prostate tissue and less responsive to DHT. Smoking heavy alcohol consumption obesity reduced activity level hypertension heart disease diabetes Western diet (high in animal fat and protein and refined carbohydrates, low in fiber) 11 What's the Relation between PAD & Diabetes? Correct Answer: Peripheral Arterial Occlusion Diabetes is a risk factor of PAD - specifically speeds it up Thrombocytopenia Labs Correct Answer: greater than 50,000/mm3 = excessive bleeding can follow surgery. less than 20,000/mm3 = petechiae, nasal and gingival bleeding, excessive menstrual bleeding, and excessive bleeding after surgery or dental extractions. less than 5000/mm3 = spontaneous, potentially fatal central nervous system or GI hemorrhage can occur What's Thrombocytopenia Correct Answer: Low playlet count What are the Clinical Manifestations of Digoxin Toxicity? Correct Answer: anorexia nausea visual disturbances confusion bradycardia. serum potassium level is monitored bc could = hypokalemia which can = digoxin toxicity 12 When is a patients serum digoxin levels monitored? Correct Answer: renal function changes symptoms of toxicity. What is the main concern of patients taking Digoxin?? Correct Answer: Pt w/ renal dysfunction and older patients should receive smaller doses of digoxin, as it is excreted through the kidneys. A key concern associated with digoxin therapy is digitalis toxicity. What is digoxin used for Correct Answer: increase heart contractility in HF Pt Decreased sx of Hf What are the Sx of Congestion HF? Correct Answer: Dyspnea Orthopnea Paroxysmal nocturnal dyspnea Cough (recumbent or exertional) Pulmonary crackles that do not clear with cough Weight gain (rapid) Dependent edema Abdominal bloating or discomfort 13 Ascites Jugular venous distention Sleep disturbance (anxiety or air hunger) Fatigue What are the Sx of Poor Perfusion/Low Cardiac Output HF? Correct Answer: Decreased exercise tolerance Muscle wasting or weakness Anorexia or nausea Unexplained weight loss Lightheadedness or dizziness Unexplained confusion or altered mental status Resting tachycardia Daytime oliguria with recumbent nocturia Cool or vasoconstricted extremities Pallor or cyanosis What is the Diet like in a Diverticulitis pt? Correct Answer: Initially, a clear liquid diet until the inflammation subsides; then, a high-fiber, low-fat diet HIGH FIBER LOW FAT . 14 Stage 2-4 Diverticulitis on Hinchey Staging: Withholding oral intake, administering IV fluids, and instituting nasogastric (NG) suctioning if vomiting or distention occurs are used to rest the bowel What's the 3 main components of treatment in diverticulitis patients? Correct Answer: Rest oral fluids analgesic medications are recommended. What are the Symptoms of Diverticulitis? Correct Answer: Most commonly, no problematic symptoms occur bowel irregularity with intervals of alternating constipation and diarrhea w/ nausea anorexia Bloating Abdominal distention. What percentage of diverticulitis patients report an acute onset of mile to severe pain in the LLQ? Correct Answer: 70% What's the purpose of an NG tube in PUD patients? Correct Answer: , during surgery and postop the stomach contents are drained by NG tube. 15 monitor fluid and electrolyte balance and assesses the patient for localized infection or peritonitis. Antibiotic therapy as prescribed. What's are the Sx of peritonitis? Correct Answer: increased temperature abdominal pain paralytic ileus increased or absent bowel sounds abdominal distention What is the nursing management in a pt who has a small Bowel Obstruction? Correct Answer: Decompress the bowel via NG tube- can be tried for 3 days for partial obstruction. Goal- rest bowel. does not require surgery = maintain function of the NG, assessing and measuring the NG output, assessing for fluid and electrolyte imbalance, monitoring nutritional status, and assessing for manifestations consistent with resolution . NPO bc high risk of fluid imbalance Nursing care post surg repair of a small bowel obstruction is similar to that for other abdominal surgeries What should the nurse report to the provider in a pt w/ a SBO? 16 Correct Answer: discrepancies in I&O worsening pain or abdominal distention increased NG output. If condition does not improve = prepares for surgery. What are signs that a SBO (small bowel obstruction) has resolved? Correct Answer: return of normal bowel sounds decreased abdominal distention subjective improvement in abdominal pain and tenderness passage of flatus or stool What should an RN teach a pt w/ GERD? Correct Answer: avoid situations that decrease lower esophageal sphincter pressure or cause esophageal irritation. eat a low-fat diet avoid caffeine, tobacco, beer, milk, foods containing peppermint or spearmint, and carbonated beverages avoid eating or drinking 2 hours before bedtime ; maintain normal body weight avoid tight-fitting clothes elevate the head of the bed by at least 30 degrees What should the rn monitor for Ulcerative Colitis w/ Diarrhea 17 Correct Answer: Identifying precipitating factors the frequency of bowel movements & character, consistency amount of stool passed is important. What's the nursing management of a or w ulcerative colitis pt w/ diarrhea Correct Answer: provides ready access to a bathroom, commode, or bedpan keeps the environment clean . Administer antidiarrheal medications as prescribed. Loperamide may be prescribed 30 minutes before meals The nurse should record the frequency and consistency of stools after therapy is initiated. What medication may be prescribed 30 mins before a meal to an ulcerative colitis pt w diarrhea Correct Answer: Loperamide What's the oxygen goal of a COPD pt? Correct Answer: increase the baseline resting PaO2 to at least 60 mm Hg Increase SaO2 to at least 90% What's the purpose of oxygen in COPD pts? Correct Answer: improve quality of life reduce pulmonary arterial pressure 18 Reduce dyspnea improve survival. When is long term oxygen therapy introduced in COPD pts? Correct Answer: usually introduced in very severe COPD indications : PaO2 of 55 mm Hg or less or evidence of tissue hypoxia and organ damage such as cor pulmonale, secondary polycythemia, edema from right-sided heart failure, or impaired mental status. Although the hypoxic drive is often cited as a concern in administering supplemental oxygen to patients with COPD, in actuality it is a very small part of the overall stimulus driving the respiratory What's the treatment management of COPD Correct Answer: promoting smoking cessation prescribing medications that typically include bronchodilators and may include corticosteroids managing exacerbations providing oxygen therapy as indicated What is COPD Exacerbation Treatment Correct Answer: FIRST LINE: supplemental oxygen therapy and rapid assessment to determine if the exacerbation is life-threatening. 19 A short-acting IN bronchodilator may be used to assess response to treatment. PO or IV corticosteroids, in addition to bronchodilators Antibiotics also benefit patients with COPD because bacterial infections often follow viral infections. How can IBD (inflammatory bowel disease) lead to Peritonitis Correct Answer: Long-term inflammation and colon ulcers = weakened intestinal wall. Over time, developes into a perforation = bacteria and leakage into abdomen . = peritonitis. What are the Sx of Alcohol Withdrawl Correct Answer: coarse hand tremors sweating elevated pulse and BP insomnia anxiety N/V Severe or untreated withdrawal may cause transient hallucinations, seizures, or delirium, called delirium tremens. When do sx of Alcohol Withdrawl usually begins, peaks and ends? Correct Answer: 4 to 12 hours after cessation or marked reduction of alcohol peaks on the day 2, ends day 5. 20 may take 1 to 2 weeks. What are common Alcohol Withdrawl Medications Correct Answer: benzodiazepines: lorazepam (Ativan), chlordiazepoxide (Librium), or diazepam (Valium), What is Placenta Abruption Correct Answer: Separation of the placenta from the uterine wall What emergency measures should be take on an pt w placenta abruption Correct Answer: starting two large-bore IV lines with normal saline or LR solution - for hypovolemia obtaining blood specimens for evaluating hemodynamic status values, typing and crossmatching frequently monitoring fetal and maternal well-being What are the Cm of placental abruption Correct Answer: painful, dark-red vaginal bleeding "knife-like" abdominal pain uterine tenderness contractions decreased fetal movement. 21 A woman presents to the ER w/ placental abruption but is also in active labor. How will the provider decide between a vaginal vs c section? Correct Answer: Depending on severity the women can be monitored through a vaginal birth but if it is a risk they will do c-section What should the Rn do if a fetus has Shoulder Dystocia during labor? Correct Answer: McRoberts Manuver and Superpubic Pressure What is a Umbilical Cord Prolaspe? Correct Answer: Rare obstetric emergency that occurs when the cord precedes the fetus out Nursing management of an umbilical cord prolapse? Correct Answer: examiner places a sterile gloved hand into the vagina and holds the presenting part off the umbilical cord until delivery. Change position to a modified Sims, Trendelenburg, or knee-chest position also helps relieve cord pressure. Do not attempt to replace the cord in the uterus. Monitor FHR maintain bed rest administer oxygen if ordered. What should of the RN do if the uterus is Boggy on palpation? 22 Correct Answer: Massage the boggy uterus to stimulate contractions and expression of any accumulated blood clots while supporting the lower uterine segment What's the therapeutic response of Cystic Fibrosis treatment Management? Correct Answer: minimizing pulmonary complications maximizing lung function preventing infection facilitating growth. Nursing Management of a CF pt? Correct Answer: Provide CPT use of the vest airway clearance system use of the flutter-valve devise, and/or positive expiratory pressure therapy in order to clear secretions and maintain airway patency. For children with cystic fibrosis, CPT is a critical intervention. Administer pancreatic enzyme supplements (pancrelipase [Creon, Pancreaze, Zenpep]) must be administered with all meals and snacks to promote adequate digestion and absorption of nutrients Prevent Infection What are the Complications of Tetralogy of Fallot Correct Answer: Blood clots (which may be in the brain causing stroke) bacterial endocarditis 23 arrhythmias HF Death. What are the Symptoms of Plyoric Stenosis Correct Answer: Forceful, non bilious vomiting, unrelated to feeding position Hunger soon after vomiting episode Weight loss d/t vomiting Progressive dehydration with subsequent lethargy What is Intussusception Correct Answer: a process that occurs when a proximal segment of bowel "telescopes" into a more distal segment causing edema, vascular compromise, partial or total bowel obstruction. barium enema is successful at reducing a large percentage of intussusception cases; other cases are reduced surgically. What's the diet of a pt w/ Diarrhea? Correct Answer: Avoid fluids high in glucose (fruit juice, gelatin, and soda) Chronic diarrhea is often a result of excessive intake of formula, water, or fruit juice, so teach the parents about appropriate fluid intake. What should be taught to a mom w diarrhea 24 Correct Answer: eat the BRAT diet: bananas, rice (white), applesauce and toast. When your health is good usually recommend whole-grain, high-fiber foods. But highfiber foods could spell trouble when you have diarrhea What's the First Sign of a Sickle Cell Crisis Correct Answer: swelling of the hands and feet in the infant or toddler What are the triggers of a sickle cell crisis Correct Answer: any stress or traumatic event, such as infection, fever, dehydration, physical exertion, excessive cold exposure, or hypoxia Hemophilia Safety Correct Answer: The primary goal =prevent bleeding. best accomplished by instructing the child to avoid activities with a high potential for injury Muscular Dystrophy: What is it Correct Answer: a group of inherited conditions that result in progressive muscle weakness and wasting. The muscles affected are primarily the skeletal (voluntary) muscles Duchenne muscular dystrophy, the most common neuromuscular disorder of childhood, results in a shortened life expectancy. 25 Nursing Management Muscular Dystrophy Correct Answer: no cure use of corticosteroids slow the progression of the disease. Calcium supplements and vitamin D are prescribed to prevent osteoporosis antidepressants may be helpful when depression occurs related to the chronicity of the disease and/or as an effect of corticosteroid use. Beat blockers or ACE inhibitors to decrease the workload of the heart Nursing focus on promoting mobility and cardiopulmonary function What to teach a pt after SCFE Surgery Correct Answer: Surgical intervention may include in situ pinning (pin or screw is inserted percutaneously into the femoral head to hold it in place). After in situ pinning, assist the child with crutch walking. Teach the family that weight bearing is usually resumed about a week after the surgery and that the pin will be removed later What is Slipped femoral capital epiphysis (SCFE) Correct Answer: Femoral head dislocates at the epiphyseal plate. The epiphysis slips downward and backward. The left hip is more often affected In acute SCFE, the pain is usually sudden in onset and results in inability to bear weight. Chronic SCFE may present with an insidious onset of pain and limp. 26 !!!!Do not attempt to perform passive range of motion to determine the extent of limitation in the child with SCFE =worsening condition. What should a rn enforce in a or who had a SCFE Correct Answer: Enforce bed rest and activity restriction. Febrile Seizure Teaching Correct Answer: Counsel parents on controlling fever discuss how to keep a child safe during a seizure provide instruction and demonstration in the administration of rectal diazepam at the onset of a seizure Instruct parents when to call their physician when to take their child to the emergency room. Reinforce that any recurrent seizure activity will require prompt medical attention. What is Hydrocephalus: Correct Answer: Hydrocephalus results when there is an obstruction in the ventricular system or obliteration or malfunction of the arachnoid villi. Hydrocephalus Treatment Correct Answer: identified early Treatment needs to be initiated in order to prevent brain tissue damage that can result from the increased ICP that hydrocephalus creates 27 . Specific treatment will depend on the underlying etiology. Assessment of Cardiomyopathy Correct Answer: Vital signs Calculation of pulse pressure and identification of pulsus paradoxus Weight gain/ loss Detection by palpation of the point of maximal impulse, often shifted to the left Cardiac auscultation for a systolic murmur and S3 and S4 heart sounds Pulmonary auscultation for crackles Measurement of jugular vein distention Assessment of edema and its severity Improve cardiac output & peripheral blood flow Increase activity tolerance and improve gas exchange What's the clinical magemnt of a pt w Pulmonary Edema Action Correct Answer: oxygen and ventilatory support IV medication nursing assessment and interventions. Nonrebreather mask What's the goal in pts w pulmonary edema Correct Answer: reducing volume overload improving ventricular function 28 increasing oxygenation. Respiratory Acidosis Correct Answer: pH less than 7.35 PaCo2 over 45 Low pH and High CO2 Chronic respiratory acidosis occurs with pulmonary diseases such as chronic emphysema and bronchitis, obstructive sleep apnea, and obesity. ARDS Symptoms Correct Answer: rapid onset of severe dyspnea that usually occurs less than 72 hours after the precipitating event. Arterial hypoxemia that does not respond to supplemental oxygen. Acute Pancreatitis Symptoms Correct Answer: Severe midepigastric pain afrequently acute in onset, occurring 24 to 48 hours after a very heavy meal or alcohol ingestion may be diffuse and difficult to localize. generally more severe after meals and is unrelieved by antacids. Alcoholic Hepatitis Teaching Correct Answer: Stop drinking alcohol Sodium restriction 29 What drug is used to treat ascites in cirrhosis? Correct Answer: Spirolactone Acute Renal Failure Priority Correct Answer: Fluid & Electrolyte Imbalances Why does metabolic acidosis occur in Chronic kidney disease ? Correct Answer: kidneys are unable to excrete increased loads of acid. = inability of the kidney tubules to excrete ammonia and to reabsorb sodium bicarbonate There is also decreased excretion of phosphates and other organic acids. When is acute Dialysis indicated Correct Answer: high and increasing level of serum potassium fluid overload impending pulmonary edema increasing acidosis pericarditis advanced uremia. It may also be used to remove medications or toxins (poisoning or medication overdose) from the blood edema that does not respond to other treatment , hepatic coma hyperkalemia 30 hypercalcemia hypertension uremia. How does Addison's Disease effect Blood Sugar Correct Answer: Hypoglycemia What causes Cushing's syndrome Correct Answer: Taking lifelong steroids (prednisone) Pituitary Tumor Symptoms of Cushing's syndrome Correct Answer: Moon Face & Buffalo Hump Central Obesity Thin Fragile Skin, Easily Bruised, Abdominal Stretch Marks Acne Hirsutism Hypertension & Hyperglycemia Infertility What is cushings disease Correct Answer: Elevated cortisol 31 Symptoms of Diabetes Insipidus Correct Answer: Peeing non-stop, crystal clear, cannot have concentrated urine Low urine osmolarity (concentration) Serum Osmolality High Hypokalemia & Hypernatremia Polyuria & Polydipsia 1.001-1.005 Urine Specific Gravity (normal for them) What causes diabetes insipidus? Correct Answer: Insufficiency of ADH or loss of sensitivity in nephrons circulating ADH Head Trauma, Brain Tumor, Brain Surgery, CNS Infection What's the treatment of diabetes insipidus Correct Answer: Desmopressin (replaces ADH) Testing: Fluid Deprivation Test (withhold fluid for