HESI 799 RN EXIT EXAM 100 QUESTIONS WITH
100% VERIFIED SOLUTIONS AND EXPLANATIONS |
RATED A+ (GUARANTEED SUCCESS).
An adult patient is exhibit the manic stage of bipolar disorder is admitted to the psychiatric unit.
The patient has lost 10 pounds in the last two weeks and has no bathed in a week "I'm trying to
start a new business and "I'm too busy to eat". The patient is oriented to time, place, person
but not situation. Which nursing problem has the greatest priority?
a. Hygiene-self-care deficit
b. Imbalance nutrition
c. Disturbed sleep pattern
d. Self-neglect - CORRECT ANSWER Imbalance nutrition
Explanation: The patient's nutritional status has the highest priority at this time, and finger
foods are often provided, so the patient who is on the maniac phase of bipolar disease can
receive adequate nutrition. Other options are nursing problems that should also be addresses
with the patient's plan of care, but at this stage in the patient's treatment, adequate nutrition is
a priority
A patient who had a percutaneous transluminal coronary angioplasty (PTCA) two weeks ago
returns to the clinic for a follow up visit. The patient has a postoperative ejection fraction
ejection fraction of 30%. Today the patient has lungs which are clear, +1 pedal edema, and a
5pound weight gain. Which intervention the carer implement?
a. Arrange transport for admission to the hospital.
b. Insert saline lock for IV diuretic therapy.
c. Assess compliance with routine prescriptions.
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d. Instruct the patient to monitor daily caloric intake. - CORRECT ANSWER Assess compliance
with routine prescriptions.
Explanation: Fluid retention may be a sign that the patient is not taking the medication as
prescribed or that the prescriptions may need adjustment to manage cardiac function post
PTCA (normal ejection fraction range is 50 to 75%)
The carer is assessing a patient's nailbeds. Witch appearance indicates further follow-up is
needed for problems associated with chronic hypoxia?
Clubbing FLIP for photo!!! - CORRECT ANSWER clubbing
The RN is assigned to care for four surgical patients. After receiving report, which patient
should the carer see first? The patient who is:
a. Two days postoperative bladder surgery with continuous bladder irrigation infusing.
b. One day postoperative laparoscopic cholecystectomy requesting pain medication.
c. Three days postoperative colon resection receiving transfusion of packed RBCs.
d. Preoperative, in buck's traction, and scheduled for hip arthroplasty within the next 12 hours.
- CORRECT ANSWER Three days postoperative colon resection receiving transfusion of
packed RBCs.
The carer is preparing an older patient for discharge following cataract extraction. Which
instruction should be include in the discharge teaching?
a. Do not read without direct lighting for 6 weeks.
b. Avoid straining at stool, bending, or lifting heavy objects.
c. Irrigate conjunctiva with ophthalmic saline prior to installing antibiotic ointment.
d. Limit exposure to sunlight during the first 2 weeks when the cornea is healing. - CORRECT
ANSWER Avoid straining at stool, bending, or lifting heavy objects
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Explanation: after cataract surgery, the patient should avoid activities which increase pressure
and place strain on the suture line.
The healthcare provider prescribes potassium chloride 25 mEq in 500 ml D_5W to infuse over 6
hours. The available 20 ml vial of potassium chloride is labeled, "10 mEq/5ml." how many ml of
potassium chloride should the carer add the IV fluid? (Enter numeric value only. If is rounding is
required, round to the nearest tenth.)
12.5 - CORRECT ANSWER 12.5
Explanation: Using the formula D / H X Q: 25 mEq / 10 mEq x 5ml ꞊12.5ml
At 40 week gestation, a laboring patient who is lying is a supine position tells the carer that she
has finally found a comfortable position. What action should the carer take?
a. Encourage the patient to turn on her left side.
b. Place a pillow under the patient's head and knees.
c. Explain to the patient that her position is not safe.
d. Place a wedge under the patient's right hip. - CORRECT ANSWER Place a wedge under the
patient's right hip
Explanation: Hypotension from pressure on the vena cava is a risk for the full-term patient.
Placing a wedge under the right hip will relieve pressure on the vena cava. Other options will
either not relieve pressure on the vena cava or would not allow the patient the remaining her
position of choice.
The carer is preparing a 4-day-old I infant with a serum bilirubin level of 19 mg/dl (325
micromol/L) for discharge from the hospital. When teaching the parents about home
phototherapy, which instruction should the carer include in the discharge teaching plan?
a. Reposition the infant every 2 hours.
b. Perform diaper changes under the light.
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c. Feed the infant every 4 hours.
d. Cover with a receiving blanket. - CORRECT ANSWER Reposition the infant every 2 hours.
Explanation: An infant, who is receiving phototherapy for hyperbilirubinemia, should be
repositioned every two hours. The position changes ensure that the phototherapy lights reach
all of the body surface areas. Bathing, feedings, and diaper changes are ways for the parents to
bond with the infant and can occur away from the treatment. Feedings need to occur more
frequently than every 4 hours to prevent dehydration. The infant should wear only a diaper so
that the skin is exposed to the phototherapy.
A patient with a history of diabetes and coronary artery disease is admitted with shortness of
breath, anxiety, and confusion. The patient's blood pressure is 80/60 mmHg, heart rate 120
beats/minute with audible third and fourth heart sounds, and bibasilar crackles. The patient's
average urinary output is 5 ml/hour. Normal saline is infusing at 124 ml/hour with a secondary
infusion of dopamine at mcg/kg/minute per infusion pump. With intervention should the carer
implement?
a. Irrigate the indwelling urinary catheter.
b. Prepare the patient for external pacing.
c. Obtain capillary blood glucose measurement.
d. Titrate the dopamine infusion to raise the BP. - CORRECT ANSWER Titrate the dopamine
infusion to raise the BP.
Explanation: the patient is experiencing cardiogenic shock and requires titration per protocol of
the vasoactive secondary infusion, dopamine, to increase the blood pressure. Low hourly urine
output is due to shock and does not indicate a need for catheter irrigation. Pacing is not
indicated based on the patient's capillary blood glucose should be monitored but is not directly
indicated at this time.
The carer ends the assessment of a patient by performing a mental status exam. Which
statement correctly describes the purpose of the mental status exam?
a. Determine the patient's level of emotional functioning'