Module 5 HESI Management of Care
Latest Edition.
** A client with leukemia is being considered for a bone marrow
transplant. The healthcare team is discussing the risks and benefits of
this treatment and other possible treatments with the goal of inflicting
the least possible harm on the client. Which principle of healthcare
ethics is the team practicing?
Nonmaleficence
Autonomy
Justice
Fidelity - ✔✔Nonmaleficence
** A nurse educator describes the standards of care formulated by the
American Nurses Association to a group of new nursing graduates hired
by the hospital. Which of the following options are accurate
descriptions of these standards of care? Select all that apply.
Have some similarity to policies and procedures
Are statements that relate only to the agency in which the nurse is
employed
Are specific guidelines
Describe an acceptable level of client care
,Define professional practice
Are authoritative statements that describe a common level of
performance - ✔✔Define professional practice
Have some similarity to policies and procedures
Are authoritative statements that describe a common or acceptable
level of client care or performance
** A nurse is performing suctioning through an adult client's
tracheostomy tube. The nurse notes that the client's oxygen saturation
is 89% and terminates the procedure. Which action would the nurse
take next?
Rechecking the pulse oximetry reading
Oxygenating the client with 100% oxygen
Calling the respiratory therapist
Calling the primary health care provider - ✔✔Oxygenating the client
with 100% oxygen
** A nurse is reading the nurse practice act for the state in which she is
employed. The nurse uses the information in this act to:
Identify healthcare policies in her state
,Be aware of hospital and long-term care facilities policies
Be aware of the role of the professional nurse
Know how to perform certain procedures - ✔✔Be aware of the role of
the professional nurse
** A nurse monitoring a client with a chest tube notes that there is no
tidaling of fluid in the water seal chamber. After further assessment,
the nurse suspects that the client's lung has reexpanded and notifies
the physician. The physician verifies with the use of a chest x-ray that
the lung has reexpanded, then calls the nurse to asks that the chest
tube be removed. The nurse should first:
Explain the procedure to the client, then remove the chest tube
Obtain petrolatum-impregnated gauze and ask another nurse to assist
in removing the chest tube
Call the nursing supervisor
Inform the primary health care provider that removal of a chest tube is
not a nursing procedure - ✔✔Inform the physician that removal of a
chest tube is not a nursing procedure
** A nurse on the night shift is making client rounds. When the nurse
checks a client who is 97 years old and has successfully been treated for
heart failure, he notes that the client is not breathing. If the client does
not have a do-not-resuscitate (DNR) order, the nurse should:
, Administer cardiopulmonary resuscitation (CPR)
Call the client's primary health care provider
Contact the nursing supervisor for directions
Contact the client's next-of-kin - ✔✔Administer cardiopulmonary
resuscitation (CPR)
** A nurse preparing a client to go to the radiology department for a
chest x-ray notes that the client is wearing a religious medal on a chain
around the neck. The client, a Catholic, expresses a concern about
removing the medal. What is the most appropriate action for the nurse
to take?
Asking the client to remove the medal until the x-ray has been
completed
Asking the client to place the medal in the top drawer of the bedside
stand just before leaving for the radiology department
Assisting the client in pinning the medal and chain to the waistband of
the client's pajama bottoms
Telling the client that the medal and chain will be kept at the nurses'
station for safekeeping while the client is undergoing the x-ray -
✔✔Assisting the client in pinning the medal and chain to the waistband
of the client's pajama bottoms
** A nurse working the 7 am-to-3 pm shift is reviewing the records of
her assigned clients. Which client should the nurse assess first?
Latest Edition.
** A client with leukemia is being considered for a bone marrow
transplant. The healthcare team is discussing the risks and benefits of
this treatment and other possible treatments with the goal of inflicting
the least possible harm on the client. Which principle of healthcare
ethics is the team practicing?
Nonmaleficence
Autonomy
Justice
Fidelity - ✔✔Nonmaleficence
** A nurse educator describes the standards of care formulated by the
American Nurses Association to a group of new nursing graduates hired
by the hospital. Which of the following options are accurate
descriptions of these standards of care? Select all that apply.
Have some similarity to policies and procedures
Are statements that relate only to the agency in which the nurse is
employed
Are specific guidelines
Describe an acceptable level of client care
,Define professional practice
Are authoritative statements that describe a common level of
performance - ✔✔Define professional practice
Have some similarity to policies and procedures
Are authoritative statements that describe a common or acceptable
level of client care or performance
** A nurse is performing suctioning through an adult client's
tracheostomy tube. The nurse notes that the client's oxygen saturation
is 89% and terminates the procedure. Which action would the nurse
take next?
Rechecking the pulse oximetry reading
Oxygenating the client with 100% oxygen
Calling the respiratory therapist
Calling the primary health care provider - ✔✔Oxygenating the client
with 100% oxygen
** A nurse is reading the nurse practice act for the state in which she is
employed. The nurse uses the information in this act to:
Identify healthcare policies in her state
,Be aware of hospital and long-term care facilities policies
Be aware of the role of the professional nurse
Know how to perform certain procedures - ✔✔Be aware of the role of
the professional nurse
** A nurse monitoring a client with a chest tube notes that there is no
tidaling of fluid in the water seal chamber. After further assessment,
the nurse suspects that the client's lung has reexpanded and notifies
the physician. The physician verifies with the use of a chest x-ray that
the lung has reexpanded, then calls the nurse to asks that the chest
tube be removed. The nurse should first:
Explain the procedure to the client, then remove the chest tube
Obtain petrolatum-impregnated gauze and ask another nurse to assist
in removing the chest tube
Call the nursing supervisor
Inform the primary health care provider that removal of a chest tube is
not a nursing procedure - ✔✔Inform the physician that removal of a
chest tube is not a nursing procedure
** A nurse on the night shift is making client rounds. When the nurse
checks a client who is 97 years old and has successfully been treated for
heart failure, he notes that the client is not breathing. If the client does
not have a do-not-resuscitate (DNR) order, the nurse should:
, Administer cardiopulmonary resuscitation (CPR)
Call the client's primary health care provider
Contact the nursing supervisor for directions
Contact the client's next-of-kin - ✔✔Administer cardiopulmonary
resuscitation (CPR)
** A nurse preparing a client to go to the radiology department for a
chest x-ray notes that the client is wearing a religious medal on a chain
around the neck. The client, a Catholic, expresses a concern about
removing the medal. What is the most appropriate action for the nurse
to take?
Asking the client to remove the medal until the x-ray has been
completed
Asking the client to place the medal in the top drawer of the bedside
stand just before leaving for the radiology department
Assisting the client in pinning the medal and chain to the waistband of
the client's pajama bottoms
Telling the client that the medal and chain will be kept at the nurses'
station for safekeeping while the client is undergoing the x-ray -
✔✔Assisting the client in pinning the medal and chain to the waistband
of the client's pajama bottoms
** A nurse working the 7 am-to-3 pm shift is reviewing the records of
her assigned clients. Which client should the nurse assess first?
