BSN HESI 266 Questions With Complete Solutions
A client arrives to the emergency department
reporting an intermittent fever
and night sweats for the past 3 weeks and has developed a
productive cough
containing small amounts of blood.
Which intervention should the nurse
prioritize?
a. Move into airborne isolation
b. Collect specimens for
blood cultures.
c. Arrange transport for radiographic imaging.
d. Obtain a sputum sample Correct Answer a. Move into
airborne isolation
A client arrives to the medical-surgical unit 4 hours after a
transurethral resection of the prostate. A triple-lumen catheter
for the continuous bladder
irrigation with normal saline is infused and the nurse observes
dark-pink tinged outflow with blood clots in the tubing
collection bag.
Which action should the nurse take?
a. Monitoring catheter drainage (pic one says this)
b. irrigation the catheter manually.
,c. Decreasing the flow rate.
d. Discounting infusing solution. Correct Answer a. Monitoring
catheter drainage (pic one says this)
A client experiences an AOB incompatibility reaction after
multiple blood transfusions. Which finding should the nurse
report immediately to the health care provider?
a. low back pain and hypotension
b. rhinitis and nasal stuffiness
c. delayed painful rash with urticarial
d. arthritic joint changes and chronic pain Correct Answer a.
low back pain and hypotension
ANSWER: (A) LOW BACK PAIN AND HYPOTENSTION
A client is diagnosed with chronic kidney disease and needs to
begin dialysis.
Which condition entered on the client's medical record should
the nurse recognize as a contraindication for peritoneal dialysis?
a. Nephrotic syndrome history.
b. Latent hepatitis C.
,c. Crohn's disease with colectomy.
d. Type 2 diabetes mellitus Correct Answer c. Crohn's disease
with colectomy.
A client presents to the emergency department reporting chest
pain that is radiation to the left arm, shortness of breath, and
diaphoresis.
Which medication should the nurse anticipate being prescribed
by the healthcare provider?
a. Fentanyl.
b. Hydromorphone.
c. Oxycodone.
d. Morphine Correct Answer d. Morphine
A client receives a prescription for 1 liter of Ringer's
intravenously to be infused over 6 hours.
How many mL/hr should the nurse program the infusion pump
to deliver?
(Enter numerical value only. If rounding is required, round to
the nearest whole number.) Correct Answer 167 mL
1000mL/6(hours) =166.6=167mL
A client who had colon surgery 3 days ago is anxious and
requesting
, assistance to reposition. While the nurse is turning the client, the
wound dehiscence's and eviscerates. The nurse moistens an a
available sterile dressing
and places over the wound.
Which intervention should the nurse implement
next?
a. Prepare the client to return to the operating room.
b. Auscultate the abdomen for bowel sound activity.
c. Obtain a sample fo the drainage to send to the lab.
d. Bring additional sterile dressing supplies to the room Correct
Answer d. Bring additional sterile dressing supplies to the room
A client who has a history of hypothyroidism was initially with
lethargy and confusion.
Which additional finishing warrants finding warrants the most
immediate action by the nurse?
a. Facial puffiness and periorbital edema.
b. Further decline in level consciousness.
c. Hematocrit of 30% (0.30).
d. Cold and dry skin. Correct Answer b. Further decline in
level consciousness.
A client arrives to the emergency department
reporting an intermittent fever
and night sweats for the past 3 weeks and has developed a
productive cough
containing small amounts of blood.
Which intervention should the nurse
prioritize?
a. Move into airborne isolation
b. Collect specimens for
blood cultures.
c. Arrange transport for radiographic imaging.
d. Obtain a sputum sample Correct Answer a. Move into
airborne isolation
A client arrives to the medical-surgical unit 4 hours after a
transurethral resection of the prostate. A triple-lumen catheter
for the continuous bladder
irrigation with normal saline is infused and the nurse observes
dark-pink tinged outflow with blood clots in the tubing
collection bag.
Which action should the nurse take?
a. Monitoring catheter drainage (pic one says this)
b. irrigation the catheter manually.
,c. Decreasing the flow rate.
d. Discounting infusing solution. Correct Answer a. Monitoring
catheter drainage (pic one says this)
A client experiences an AOB incompatibility reaction after
multiple blood transfusions. Which finding should the nurse
report immediately to the health care provider?
a. low back pain and hypotension
b. rhinitis and nasal stuffiness
c. delayed painful rash with urticarial
d. arthritic joint changes and chronic pain Correct Answer a.
low back pain and hypotension
ANSWER: (A) LOW BACK PAIN AND HYPOTENSTION
A client is diagnosed with chronic kidney disease and needs to
begin dialysis.
Which condition entered on the client's medical record should
the nurse recognize as a contraindication for peritoneal dialysis?
a. Nephrotic syndrome history.
b. Latent hepatitis C.
,c. Crohn's disease with colectomy.
d. Type 2 diabetes mellitus Correct Answer c. Crohn's disease
with colectomy.
A client presents to the emergency department reporting chest
pain that is radiation to the left arm, shortness of breath, and
diaphoresis.
Which medication should the nurse anticipate being prescribed
by the healthcare provider?
a. Fentanyl.
b. Hydromorphone.
c. Oxycodone.
d. Morphine Correct Answer d. Morphine
A client receives a prescription for 1 liter of Ringer's
intravenously to be infused over 6 hours.
How many mL/hr should the nurse program the infusion pump
to deliver?
(Enter numerical value only. If rounding is required, round to
the nearest whole number.) Correct Answer 167 mL
1000mL/6(hours) =166.6=167mL
A client who had colon surgery 3 days ago is anxious and
requesting
, assistance to reposition. While the nurse is turning the client, the
wound dehiscence's and eviscerates. The nurse moistens an a
available sterile dressing
and places over the wound.
Which intervention should the nurse implement
next?
a. Prepare the client to return to the operating room.
b. Auscultate the abdomen for bowel sound activity.
c. Obtain a sample fo the drainage to send to the lab.
d. Bring additional sterile dressing supplies to the room Correct
Answer d. Bring additional sterile dressing supplies to the room
A client who has a history of hypothyroidism was initially with
lethargy and confusion.
Which additional finishing warrants finding warrants the most
immediate action by the nurse?
a. Facial puffiness and periorbital edema.
b. Further decline in level consciousness.
c. Hematocrit of 30% (0.30).
d. Cold and dry skin. Correct Answer b. Further decline in
level consciousness.
