( 2024-2025) EXIT HESI -PN Exam A
PRACTICE QUESTIONS And Answers
Ap2-
dayppostpartumpmotherpwhopispbreastfeedingpasks,p"WhypdopIpfeelpthisptinglingpinpmypbreas
tspafterpthepbabypsuckspforpapfewpminutes?"pWhichpinformationpshouldpthepnursepprovide?
A.Thispfeelingpoccurspduringpfeedingpwithpapbreastpinfection.
B.Thispsensationpoccurspaspbreastpmilkpmovesptopthepnipple.
C.Thepbabypdoespnotphavepgoodplatch-on.
D.Thepinfantpispnotppositionedpcorrectly.p-pCORRECTppANSWER-B
Whenpthepmother'spmilkpcomespin,pusuallyp2ptop3pdayspafterpdelivery,pwomenpoftenpreportpt
heypfeelpaptinglingpsensationpinptheirpnipplesp(B)pwhenplet-
downpoccurs.p(A,pC,pandpD)pprovidepinaccuratepinformation.
Ap40-year-
oldpofficepworkerpwhopispatp36pweeks'pgestationppresentsptopthepoccupationalphealthpclinicpc
omplainingpofpappoundingpheadache,pblurrypvision,pandpswollenpankles.pWhichpinterventio
npshouldpthepnursepimplementpfirst?
A.Checkpthepclient'spbloodppressure.
pB.Teachpherptopelevatepherpfeetpwhenpsitting.
pC.Obtainpap24-hourpdietphistoryptopevaluatepforpthepintakepofpsaltypfoods.
pD.Assesspthepfetalpheartprate.p-pCORRECTppANSWER-A
Thepbloodppressurep(A)pshouldpbepassessedpfirst.pPreeclampsiapispapmultisystempdisorder,
pandpwomenpolderpthanp35pyearspandphavepchronicphypertensionparepatpincreasedprisk.pCla
ssicpsignspincludepheadache,pvisualpchanges,pedema,precentprapidpweightpgain,pandpeleva
tedpbloodppressure.p(B,pC,pandpD)pcanpbepdonepifpthepbloodppressurepispnormal.
Ap50-year-
oldpmanparrivespatpthepclinicpwithpcomplaintspofppainponpejaculation.pWhichpactionpshouldpth
epnursepimplement?
A.Teachpthepclientptesticularpself-examinationp(TSE).
B.Assesspforptheppresencepofpbloodpinpthepurine.
C.Askpaboutpscrotalppainporpbloodpinpthepsemen.
D.Inquirepaboutpaphistorypofpkidneypstones.p-pCORRECTppANSWER-C
Orchitispispanpacuteptesticularpinflammationpresultingpfromprecurrentpurinaryptractpinfection,p
recurrentpsexuallyptransmittedpdiseasep(STD),porpanpindwellingpurethralpurinarypcatheterpc
ausingppainponpejaculation,pscrotalppain,pbloodpinpthepsemen,pandppenilepdischarge,psopthep
nursepshouldpdetermineptheppresencepofpotherpsymptomsp(C).pAlthoughpallpmenpshouldppr
acticepTSE,pthepclient'spsymptomsparepsuggestivepofpanpinflammatorypsyndromepratherptha
,nptesticularpcancerp(A).pAlthoughphematuriap(B)pispassociatedpwithprenalpdiseaseporpcalculip
(D),pthepclient'sppainpispassociatedpwithpejaculate,pnotpurine.
Ap77-year-
oldpfemalepclientpstatespthatpshephaspneverpbeenpsoplargeparoundpthepwaistpandpthatpsheph
aspfrequentpperiodspofpconstipation.pColonpdiseasephaspbeenpruledpoutpwithpapflexiblepsigm
oidoscopy.pWhichpinformationpshouldpthepnursepprovideptopthispclient?
A.Aspwomenpage,ptheypoftenpbecomeprounderpinpthepmiddlepbecauseptheypdopnotpexercisep
properly.
pB.Furtherpassessmentpispindicatedpbecauseplosspofpabdominalpmuscleptonepandpconstipat
ionpdopnotpoccurpwithpaging.
pC.Withpage,pmorepfattyptissuepdevelopspinpthepabdomenpandpdecreasedpintestinalpmovem
entpcanpcausepconstipation.
pD.Becauseptherepispnopevidencepofpapdiseasedpcolon,ptherepispnopneedptopworrypaboutpabd
ominalpsizep-pCORRECTppANSWER-C
Withpaging,pthepabdominalpmusclespweakenpaspfattyptissuepispdepositedparoundptheptrunkpa
ndpwaist.pSlowingpperistalsispalsopaffectspthepemptyingpofpthepcolon,presultingpinpconstipati
onp(C).p(A)pispnotpthepprimarypreasonpforpthepchangespinpbodypstructure.p(B)pispnotpindicated
pbecauseplosspofpmuscleptonepandpconstipationparepage-
relatedpchanges.p(D)pdismissespthepclient'spconcernspandpdoespnotphelppherpunderstandpth
epchangespthatpshepispexperiencing.
Apchildpisphavingpapgeneralizedptonic-clonicpseizure.pWhichpactionpshouldpthepnurseptake?
pA.Movepobjectspoutpofpthepchild'spimmediateparea.
pB.Quicklypslippsoftprestraintsponpthepchild'spwrists.
pC.Insertpappaddedptonguepbladepbetweenpthepteeth.
pD.Placepinptheprecoveryppositionpbeforepgoingpforphelp.p-pCORRECTppANSWER-A
Thepfirstpprioritypduringpapseizurepisptopprovidepapsafepenvironment,psopthepnursepshouldpcle
arpthepareap(A)ptopreducepthepriskpofptrauma.pThepchildpshouldpnotpbeprestrainedp(B)pbecaus
epthispmaypcausepmoreptrauma.pObjectspshouldpnotpbepplacedpinpthepchild'spmouthp(C)pbec
ausepitpmaypposepapchokingphazard.pAlthoughp(D)pshouldpbepimplementedpafterpthepseizur
e,pthepnursepshouldpnotpleavepthepchildpduringpapseizureptopgetphelp.
Apchildpwithpnephroticpsyndromepispreceivingpprednisonep(Deltasone).pWhichpchoicepofpbre
akfastpfoodspatpapfastpfoodprestaurantpindicatespthatpthepmotherpunderstandspthepdietarypgu
idelinespnecessarypforpherpchild?
A.Frenchptoastpstickspandporangepjuice
pB.Sausagepeggpmuffinpandpgrapepjuice
pC.Canadianpbaconpslicespandphotpchocolate
pD.Toastedpoatpcerealpandplow-fatpmilkp-pCORRECTppANSWER-D
Apchildpreceivingpapcorticosteroidpforpnephroticpsyndromepshouldpfollowpaplow-sodium,plow-
fat,pandplow-
,sugarpdiet.pBasedponpthesepguidelines,pthepbestpbreakfastpchoicepisp(D).p(A)pisphighpinpfatpa
ndpsugar.p(BpandpC)parephighpinpfatpandpsodium.
Apclientphaspbeenponpapmechanicalpventilatorpforpseveralpdays.pWhatpshouldpthepnursepusep
topdocumentpandprecordpthispclient'sprespirations?
A.Theprespiratorypsettingsponpthepventilator
pB.Onlypthepclient'spspontaneousprespirations
pC.Thepventilator-assistedprespirationspminuspthepclient'spindependentpbreaths
pD.Thepventilatorpsettingpforprespiratorypratepandpthepclient-initiatedprespirationsp-
pCORRECTppANSWER-D
Thepnursepshouldpcountpthepclient'sprespirations,pandpdocumentpbothptheprespiratoryprateps
etpbypthepventilatorpandpthepclient'spindependentprespiratorypratep(D).pNeverprelypstrictlyponp
(A).pAlthoughpthepclient'spspontaneouspbreathspwillpbepshallowpandpmachine-
assistedpbreathspwillpbepdeep,pitpispimportantptoprecordpmachine-
assistedpbreathspaspwellpaspthepclient'spspontaneouspbreathsptopgetpanpoverallprespiratoryp
picturepofpthepclientp(BpandpC).
Apclientphaspbeenpreceivingplevofloxacinp(Levaquin),p500pmgpIVppiggybackpq24hpforp7pdays
.pThepUAPpreportsptopthepnursepthatpthepclientphasphadpthreeploosepfoul-
smellingpstoolspthispmorning.pWhichpinterventionpispmostpimportantpforpthepnurseptopimplem
ent?
pA.Performpapdigitalpevaluationpforpfecalpimpaction.
pB.AdministerpapPRNpdosepofppsylliump(Metamucil).
pC.Obtainpapstoolpspecimenpforpculturepandpsensitivity.
pD.InstructpthepUAPptopobtainpincontinentppadspforpthepclient.p-pCORRECTppANSWER-C
Long-termpusepofplevofloxacinp(Levaquin)pcanpcausepfoul-
smellingpdiarrheapbecausepofpClostridiumpdifficilepinfectionporpassociatedpcolitis,psopitpispmo
stpimportantptopobtainpapstoolpspecimenp(C).pImpactionpispunlikely,psop(A)pispofplessppriorityp
andpmaypnotpbepnecessary.p(B)pispapbulk-
formingpagentpthatpmaypbepusedpforpconstipationporpdiarrhea.pTreatmentpofpthepdiarrheapan
dpclientpcomfortp(D)parepimportantpinterventionspbutpofplesspprioritypthanpdeterminingpthepca
usepofpthepclient'spdiarrhea.
Apclientphospitalizedpforpmeningitispispdemonstratingpnuchalprigidity.pWhichpsymptompispthi
spclientplikelyptopbepexhibiting?
A.Hyperexcitabilitypofpreflexes
pB.Hyperextensionpofpthepheadpandpback
pC.Inabilityptopflexpthepchinptopthepchest
pD.Lateralpfacialpparalysisp-pCORRECTppANSWER-C
Nuchalprigidityp(neckpstiffness)pispapcharacteristicpofpmeningealpirritationpandpispelicitedpbypa
ttemptingptopflexpthepneckpandpplacepthepchinptopthepchestp(C).pAlthoughp(A,pB,pandpD)pmayp
occurpinpmeningitis,p(A)pdescribespexaggeratedpspinalpnervepreflexpresponses,p(B)pdescrib
, espopisthotonus,pandp(D)pmaypbeprelatedptopcranialpnerveppathologypofptheptrigeminalpnerv
e.
Apclientpispadmittedptopthepmentalphealthpunitpwithpapchiefpcomplaintpofpcrying,pdepressedpm
ood,pandpsleepingpdifficulties.pWhileptalkingpaboutpthepdeathpofpapfriend,pthepclientpstates,p"Ip
can'tpbelievepthisphappened."pWhichpstatementpbypthepnursepispmostptherapeutic?
A."Itpsoundsplikepyou'repfeelingpverypsad."
pB."Tellpmepmorepaboutphowpyou'repfeeling."
pC."Howpoftenpdopyouphavepcryingpspells?"
pD."Dopyoupwantptoptalkpaboutpthesepfeelings?"p-pCORRECTppANSWER-B
Itpispmostptherapeuticptopaskpanpopen-
endedpquestionpandpencouragepthepclientptopexplorephisporpherpfeelingsp(B).p(A)pispapleadin
gpresponse,pandpthepclientpmaypnotpbepfeelingpsad.p(CpandpD)parepclose-
endedpquestionspthatpdopnotpfacilitatepcommunication.
Apclientpreportspexperiencingpdysuriapandpurinarypfrequency.pWhichpclientpteachingpshould
pthepnursepprovide?
A.Savepthepnextpurinepsample.
pB.Restrictporalpfluidpintake.
pC.Strainpallpvoidedpurine.
pD.Reducepphysicalpactivity.p-pCORRECTppANSWER-A
Thepnursepshouldpinstructpthepclientptopsavepthepnextpurinepsamplep(A)pforpobservationpofpit
spappearancepandpforppossiblepurinalysis.pThepclientpispreportingpsymptomspthatpmaypindic
ateptheponsetpofpapurinaryptractpinfection.pIncreasedpfluidpintakepshouldpbepencouraged,punl
esspcontraindicatedp(B).p(C)pisponlypnecessarypifpapcalculusp(stone)pispsuspected.p(D)pispnotp
indicatedpbypthispclient'spsymptoms.
Apclientptellspthepnursepthatphepispsufferingpfrompinsomnia.pWhichpinformationpispmostpimpor
tantpforpthepnurseptopobtain?
A.Thepclient'spusualpsleepingppattern
pB.Whetherpthepclientpsmokes
pC.Howpmuchpliquidpthepclientpconsumespbeforepbedtime
pD.Thepamountpofpcaffeinepthatpthepclientpconsumespduringpthepdayp-
pCORRECTppANSWER-A
Thepfirstpthingptopdeterminepispthepclient'spusualpsleepingppatternpandphowpitphaspchangedpt
opbecomepwhatpthepclientpdescribespaspinsomniap(A).p(B,pC,pandpD)pprovidepadditionalpinfor
mationpafterp(A)pispascertained.
Apclientpwhopispadmittedpwithpemphysemapisphavingpdifficultypbreathing.pInpwhichppositionps
houldpthepnursepplacepthepclient?
A.HighpFowler'sppositionpwithoutpappillowpbehindpthephead
pB.Semi-Fowler'sppositionpwithpapsingleppillowpbehindpthephead
PRACTICE QUESTIONS And Answers
Ap2-
dayppostpartumpmotherpwhopispbreastfeedingpasks,p"WhypdopIpfeelpthisptinglingpinpmypbreas
tspafterpthepbabypsuckspforpapfewpminutes?"pWhichpinformationpshouldpthepnursepprovide?
A.Thispfeelingpoccurspduringpfeedingpwithpapbreastpinfection.
B.Thispsensationpoccurspaspbreastpmilkpmovesptopthepnipple.
C.Thepbabypdoespnotphavepgoodplatch-on.
D.Thepinfantpispnotppositionedpcorrectly.p-pCORRECTppANSWER-B
Whenpthepmother'spmilkpcomespin,pusuallyp2ptop3pdayspafterpdelivery,pwomenpoftenpreportpt
heypfeelpaptinglingpsensationpinptheirpnipplesp(B)pwhenplet-
downpoccurs.p(A,pC,pandpD)pprovidepinaccuratepinformation.
Ap40-year-
oldpofficepworkerpwhopispatp36pweeks'pgestationppresentsptopthepoccupationalphealthpclinicpc
omplainingpofpappoundingpheadache,pblurrypvision,pandpswollenpankles.pWhichpinterventio
npshouldpthepnursepimplementpfirst?
A.Checkpthepclient'spbloodppressure.
pB.Teachpherptopelevatepherpfeetpwhenpsitting.
pC.Obtainpap24-hourpdietphistoryptopevaluatepforpthepintakepofpsaltypfoods.
pD.Assesspthepfetalpheartprate.p-pCORRECTppANSWER-A
Thepbloodppressurep(A)pshouldpbepassessedpfirst.pPreeclampsiapispapmultisystempdisorder,
pandpwomenpolderpthanp35pyearspandphavepchronicphypertensionparepatpincreasedprisk.pCla
ssicpsignspincludepheadache,pvisualpchanges,pedema,precentprapidpweightpgain,pandpeleva
tedpbloodppressure.p(B,pC,pandpD)pcanpbepdonepifpthepbloodppressurepispnormal.
Ap50-year-
oldpmanparrivespatpthepclinicpwithpcomplaintspofppainponpejaculation.pWhichpactionpshouldpth
epnursepimplement?
A.Teachpthepclientptesticularpself-examinationp(TSE).
B.Assesspforptheppresencepofpbloodpinpthepurine.
C.Askpaboutpscrotalppainporpbloodpinpthepsemen.
D.Inquirepaboutpaphistorypofpkidneypstones.p-pCORRECTppANSWER-C
Orchitispispanpacuteptesticularpinflammationpresultingpfromprecurrentpurinaryptractpinfection,p
recurrentpsexuallyptransmittedpdiseasep(STD),porpanpindwellingpurethralpurinarypcatheterpc
ausingppainponpejaculation,pscrotalppain,pbloodpinpthepsemen,pandppenilepdischarge,psopthep
nursepshouldpdetermineptheppresencepofpotherpsymptomsp(C).pAlthoughpallpmenpshouldppr
acticepTSE,pthepclient'spsymptomsparepsuggestivepofpanpinflammatorypsyndromepratherptha
,nptesticularpcancerp(A).pAlthoughphematuriap(B)pispassociatedpwithprenalpdiseaseporpcalculip
(D),pthepclient'sppainpispassociatedpwithpejaculate,pnotpurine.
Ap77-year-
oldpfemalepclientpstatespthatpshephaspneverpbeenpsoplargeparoundpthepwaistpandpthatpsheph
aspfrequentpperiodspofpconstipation.pColonpdiseasephaspbeenpruledpoutpwithpapflexiblepsigm
oidoscopy.pWhichpinformationpshouldpthepnursepprovideptopthispclient?
A.Aspwomenpage,ptheypoftenpbecomeprounderpinpthepmiddlepbecauseptheypdopnotpexercisep
properly.
pB.Furtherpassessmentpispindicatedpbecauseplosspofpabdominalpmuscleptonepandpconstipat
ionpdopnotpoccurpwithpaging.
pC.Withpage,pmorepfattyptissuepdevelopspinpthepabdomenpandpdecreasedpintestinalpmovem
entpcanpcausepconstipation.
pD.Becauseptherepispnopevidencepofpapdiseasedpcolon,ptherepispnopneedptopworrypaboutpabd
ominalpsizep-pCORRECTppANSWER-C
Withpaging,pthepabdominalpmusclespweakenpaspfattyptissuepispdepositedparoundptheptrunkpa
ndpwaist.pSlowingpperistalsispalsopaffectspthepemptyingpofpthepcolon,presultingpinpconstipati
onp(C).p(A)pispnotpthepprimarypreasonpforpthepchangespinpbodypstructure.p(B)pispnotpindicated
pbecauseplosspofpmuscleptonepandpconstipationparepage-
relatedpchanges.p(D)pdismissespthepclient'spconcernspandpdoespnotphelppherpunderstandpth
epchangespthatpshepispexperiencing.
Apchildpisphavingpapgeneralizedptonic-clonicpseizure.pWhichpactionpshouldpthepnurseptake?
pA.Movepobjectspoutpofpthepchild'spimmediateparea.
pB.Quicklypslippsoftprestraintsponpthepchild'spwrists.
pC.Insertpappaddedptonguepbladepbetweenpthepteeth.
pD.Placepinptheprecoveryppositionpbeforepgoingpforphelp.p-pCORRECTppANSWER-A
Thepfirstpprioritypduringpapseizurepisptopprovidepapsafepenvironment,psopthepnursepshouldpcle
arpthepareap(A)ptopreducepthepriskpofptrauma.pThepchildpshouldpnotpbeprestrainedp(B)pbecaus
epthispmaypcausepmoreptrauma.pObjectspshouldpnotpbepplacedpinpthepchild'spmouthp(C)pbec
ausepitpmaypposepapchokingphazard.pAlthoughp(D)pshouldpbepimplementedpafterpthepseizur
e,pthepnursepshouldpnotpleavepthepchildpduringpapseizureptopgetphelp.
Apchildpwithpnephroticpsyndromepispreceivingpprednisonep(Deltasone).pWhichpchoicepofpbre
akfastpfoodspatpapfastpfoodprestaurantpindicatespthatpthepmotherpunderstandspthepdietarypgu
idelinespnecessarypforpherpchild?
A.Frenchptoastpstickspandporangepjuice
pB.Sausagepeggpmuffinpandpgrapepjuice
pC.Canadianpbaconpslicespandphotpchocolate
pD.Toastedpoatpcerealpandplow-fatpmilkp-pCORRECTppANSWER-D
Apchildpreceivingpapcorticosteroidpforpnephroticpsyndromepshouldpfollowpaplow-sodium,plow-
fat,pandplow-
,sugarpdiet.pBasedponpthesepguidelines,pthepbestpbreakfastpchoicepisp(D).p(A)pisphighpinpfatpa
ndpsugar.p(BpandpC)parephighpinpfatpandpsodium.
Apclientphaspbeenponpapmechanicalpventilatorpforpseveralpdays.pWhatpshouldpthepnursepusep
topdocumentpandprecordpthispclient'sprespirations?
A.Theprespiratorypsettingsponpthepventilator
pB.Onlypthepclient'spspontaneousprespirations
pC.Thepventilator-assistedprespirationspminuspthepclient'spindependentpbreaths
pD.Thepventilatorpsettingpforprespiratorypratepandpthepclient-initiatedprespirationsp-
pCORRECTppANSWER-D
Thepnursepshouldpcountpthepclient'sprespirations,pandpdocumentpbothptheprespiratoryprateps
etpbypthepventilatorpandpthepclient'spindependentprespiratorypratep(D).pNeverprelypstrictlyponp
(A).pAlthoughpthepclient'spspontaneouspbreathspwillpbepshallowpandpmachine-
assistedpbreathspwillpbepdeep,pitpispimportantptoprecordpmachine-
assistedpbreathspaspwellpaspthepclient'spspontaneouspbreathsptopgetpanpoverallprespiratoryp
picturepofpthepclientp(BpandpC).
Apclientphaspbeenpreceivingplevofloxacinp(Levaquin),p500pmgpIVppiggybackpq24hpforp7pdays
.pThepUAPpreportsptopthepnursepthatpthepclientphasphadpthreeploosepfoul-
smellingpstoolspthispmorning.pWhichpinterventionpispmostpimportantpforpthepnurseptopimplem
ent?
pA.Performpapdigitalpevaluationpforpfecalpimpaction.
pB.AdministerpapPRNpdosepofppsylliump(Metamucil).
pC.Obtainpapstoolpspecimenpforpculturepandpsensitivity.
pD.InstructpthepUAPptopobtainpincontinentppadspforpthepclient.p-pCORRECTppANSWER-C
Long-termpusepofplevofloxacinp(Levaquin)pcanpcausepfoul-
smellingpdiarrheapbecausepofpClostridiumpdifficilepinfectionporpassociatedpcolitis,psopitpispmo
stpimportantptopobtainpapstoolpspecimenp(C).pImpactionpispunlikely,psop(A)pispofplessppriorityp
andpmaypnotpbepnecessary.p(B)pispapbulk-
formingpagentpthatpmaypbepusedpforpconstipationporpdiarrhea.pTreatmentpofpthepdiarrheapan
dpclientpcomfortp(D)parepimportantpinterventionspbutpofplesspprioritypthanpdeterminingpthepca
usepofpthepclient'spdiarrhea.
Apclientphospitalizedpforpmeningitispispdemonstratingpnuchalprigidity.pWhichpsymptompispthi
spclientplikelyptopbepexhibiting?
A.Hyperexcitabilitypofpreflexes
pB.Hyperextensionpofpthepheadpandpback
pC.Inabilityptopflexpthepchinptopthepchest
pD.Lateralpfacialpparalysisp-pCORRECTppANSWER-C
Nuchalprigidityp(neckpstiffness)pispapcharacteristicpofpmeningealpirritationpandpispelicitedpbypa
ttemptingptopflexpthepneckpandpplacepthepchinptopthepchestp(C).pAlthoughp(A,pB,pandpD)pmayp
occurpinpmeningitis,p(A)pdescribespexaggeratedpspinalpnervepreflexpresponses,p(B)pdescrib
, espopisthotonus,pandp(D)pmaypbeprelatedptopcranialpnerveppathologypofptheptrigeminalpnerv
e.
Apclientpispadmittedptopthepmentalphealthpunitpwithpapchiefpcomplaintpofpcrying,pdepressedpm
ood,pandpsleepingpdifficulties.pWhileptalkingpaboutpthepdeathpofpapfriend,pthepclientpstates,p"Ip
can'tpbelievepthisphappened."pWhichpstatementpbypthepnursepispmostptherapeutic?
A."Itpsoundsplikepyou'repfeelingpverypsad."
pB."Tellpmepmorepaboutphowpyou'repfeeling."
pC."Howpoftenpdopyouphavepcryingpspells?"
pD."Dopyoupwantptoptalkpaboutpthesepfeelings?"p-pCORRECTppANSWER-B
Itpispmostptherapeuticptopaskpanpopen-
endedpquestionpandpencouragepthepclientptopexplorephisporpherpfeelingsp(B).p(A)pispapleadin
gpresponse,pandpthepclientpmaypnotpbepfeelingpsad.p(CpandpD)parepclose-
endedpquestionspthatpdopnotpfacilitatepcommunication.
Apclientpreportspexperiencingpdysuriapandpurinarypfrequency.pWhichpclientpteachingpshould
pthepnursepprovide?
A.Savepthepnextpurinepsample.
pB.Restrictporalpfluidpintake.
pC.Strainpallpvoidedpurine.
pD.Reducepphysicalpactivity.p-pCORRECTppANSWER-A
Thepnursepshouldpinstructpthepclientptopsavepthepnextpurinepsamplep(A)pforpobservationpofpit
spappearancepandpforppossiblepurinalysis.pThepclientpispreportingpsymptomspthatpmaypindic
ateptheponsetpofpapurinaryptractpinfection.pIncreasedpfluidpintakepshouldpbepencouraged,punl
esspcontraindicatedp(B).p(C)pisponlypnecessarypifpapcalculusp(stone)pispsuspected.p(D)pispnotp
indicatedpbypthispclient'spsymptoms.
Apclientptellspthepnursepthatphepispsufferingpfrompinsomnia.pWhichpinformationpispmostpimpor
tantpforpthepnurseptopobtain?
A.Thepclient'spusualpsleepingppattern
pB.Whetherpthepclientpsmokes
pC.Howpmuchpliquidpthepclientpconsumespbeforepbedtime
pD.Thepamountpofpcaffeinepthatpthepclientpconsumespduringpthepdayp-
pCORRECTppANSWER-A
Thepfirstpthingptopdeterminepispthepclient'spusualpsleepingppatternpandphowpitphaspchangedpt
opbecomepwhatpthepclientpdescribespaspinsomniap(A).p(B,pC,pandpD)pprovidepadditionalpinfor
mationpafterp(A)pispascertained.
Apclientpwhopispadmittedpwithpemphysemapisphavingpdifficultypbreathing.pInpwhichppositionps
houldpthepnursepplacepthepclient?
A.HighpFowler'sppositionpwithoutpappillowpbehindpthephead
pB.Semi-Fowler'sppositionpwithpapsingleppillowpbehindpthephead
