EVOLVE MED SURG HESI EXAM QUESTIONS WITH CORRECT ANSWERS

EVOLVE MED SURG HESI EXAM QUESTIONS WITH CORRECT ANSWERS Rationale:By circling the existing stain upon admission to the unit, the nurse can then assess any increase, though subtle, in the amount of drainage over time. The size of the stain will need to be noted in the chart, but it is not the first action. The nurse removes the dressing under the prescription of the health care provider or in an emergency. Neither of those conditions exist in the question. The dressing in place is an absorbent dressing. There is no need for a further dressing until the existing dressing becomes saturated. While at a home game, the mother of a 6-year-old is heard screaming, "My child is having an asthma attack! Can anyone help?" The nurse arrives and finds the child gasping for breath with circumoral cyanosis. What are the nurse's next actions? (Select all that apply.) A. Yell, "Call 911." B. Ask the mother if she has the child's bronchodilator. C. Start cardiopulmonary respirations. D. Ask the mother if the child is allergic to bee stings. E. Stay with the child and mother until the ambulance arrives. F. Sit the child straight up in Fowler's position. - Answer-Correct Answer: A,B,E,F Rationale: CPR is not needed at this time as the child is still moving air. An allergy to bee stings is related to anaphylactic shock, which is not the situation here. The remaining actions are correct for asthma. The nurse is providing care to a client after a percutaneous transluminal coronary angioplasty (PTCA). What actions will the nurse include in the client's plan of care? (Select all that apply.) A. Frequent vital signs. B. Determine if the client is allergic to aspirin. C. Assist out of bed 2 hours after return from the procedure. D. Offer fluids of choice. E. Assess distal pulses on the side of the procedure. F. Monitor infusion of IV nitroglycerine. - Answer-Correct Answer: A,B,D,F Rationale: The client's incisional leg needs to stay straight for 6 to 8 hours to decrease the risk of hemorrhage from the incision site. Pulses must be assessed bilaterally for a point of comparison. The remaining actions are included in the care plan for the client after a PTCA