HESI MED Surg Review Complete with Rationale
HESI MED SURG REVIEW
1. A client on telemetry has a pattern of uncontrolled atrial fibrillation with a rapid ventricular response. Based on this finding, the nurse anticipates assisting the physician with which treatment?
A. 	Administer lidocaine, 75 mg intravenous push.
B. 	Perform synchronized cardioversion.
C. 	Defibrillate the client as soon as possible.
D. 	Administer atropine, 0.4 mg intravenous push.
With uncontrolled atrial fibrillation, the treatment of choice is synchronized cardioversion to convert the cardiac rhythm back to normal sinus rhythm. Option A is a medication used for ventricular dysrhythmias. Option C is not for a client with atrial fibrillation; it is reserved for clients with life-threatening dysrhythmias, such as ventricular fibrillation and unstable ventricular tachycardia. Option D is the drug of choice in symptomatic sinus bradycardia, not atrial fibrillation.
2. A practical nurse (PN) tells the charge nurse in a long-term facility that she does not want to be assigned to one particular resident. She reports that the male client keeps insisting that she is his daughter and begs her to stay in his room. What is the best managerial decision?
A. 	Notify the family that the resident will have to be discharged if his behavior does not improve.
B. 	Notify administration of the PN’s insubordination and need for counseling about her statements.
C. 	Ask the PN what she has done to encourage the resident to believe that she is his daughter.
D. 	Reassign the PN until the resident can be assessed more completely for reality orientation.
Temporary reassignment is the best option until the resident can be examined and his medications reviewed. He may have worsening cerebral dysfunction from an infection or electrolyte imbalance. Option A is not the best option because the family cannot control the resident’s actions. The administration may need to know about the situation, but not as a case of insubordination. Implying that the PN is somehow creating the situation is inappropriate until a further evaluation has been conducted.
3. Client census is often used to determine staffing needs. Which method of obtaining census determination for a particular unit provides the best formula for determining long-range staffing patterns?
A. 	Midnight census
B. 	Oncoming shift census
C. 	Average daily census
D. 	Hourly census
An average daily census is determined by trend data and takes into account seasonal and daily fluctuations, so it is the best method for determining staffing needs. Options A and B provide data at a certain point in time, and that data could change quickly. It is unrealistic to expect to obtain an hourly census, and such data would only provide information about a certain point in time.
4. The nurse is counseling a healthy 30-year-old female client regarding osteoporosis prevention. Which activity would be most beneficial in achieving the client’s goal of osteoporosis prevention?
A. 	Cross-country skiing
B. 	Scuba diving
C. 	Horseback riding
Weight-bearing exercise is an important measure to reduce the risk of osteoporosis. Of the activities listed, cross-country skiing includes the most weight-bearing, whereas options B, C, and D involve less.
5. Which condition should the nurse anticipate as a potential problem in a female client with a neurogenic bladder?
A. 	Stress incontinence
C. 	Painless gross hematuria
Infection is the major complication resulting from stasis of urine and subsequent catheterization. Option A is the involuntary loss of urine through an intact urethra as a result of a sudden increase in intra-abdominal pressure. Option C is the most common symptom of bladder cancer. Option D is the most common and serious complication of peritoneal dialysis.
6. A client is being discharged following radioactive seed implantation for prostate cancer. What is the most important information that the nurse should provide to this client’s family?
A. 	Follow exposure precautions.
B. 	Encourage regular meals.
C. 	Collect all urine.
D. 	Avoid touching the client.
Clients being treated for prostate cancer with radioactive seed implants should be instructed regarding the amount of time and distance needed to prevent excessive exposure that would pose a hazard to others. Option B is a good suggestion to promote adequate nutrition but is not as important as option A. Option C is unnecessary. Contact with the client is permitted but should be brief to limit radiation exposure.
7. In assessing a client with an arteriovenous (AV) shunt who is scheduled for dialysis today, the nurse notes the absence of a thrill or bruit at the shunt site. What action should the nurse take?
A. 	Advise the client that the shunt is intact and ready for dialysis as scheduled.
B. 	Encourage the client to keep the shunt site elevated above the level of the heart.
C. 	Notify the health care provider of the findings immediately.
D. 	Flush the site at least once with a heparinized saline solution.
Absence of a thrill or bruit indicates that the shunt may be obstructed. The nurse should notify the health care provider so that intervention can be initiated to restore function of the shunt. Option A is incorrect. Option B will not resolve the obstruction. An AV shunt is internal and cannot be flushed without access using special needles.
8. The nurse is concerned about infection for a client after an esophagogastrostomy for esophageal cancer. Which actions should the nurse include in the client’s plan of care? (Select all that apply.)
A. 	Frequent oral care every 2 hours while awake.
B. 	Use incentive spirometer every 2 hours.
C. 	Empty contents from NG tube every 8 hours.
D. 	Ambulate within 1 hour of return from the PACU.
E. 	Limit visitors until postoperative day 2.
One hour post op is too soon to ambulate for this client. Visitors help support the patient and are encouraged to visit. Oral care is necessary as the client will be NPO. To decrease the risk of infection post operatively, implement routine pulmonary exercises. The client will have an NG tube in place, likely to intermittent suction, to decompress the stomach post surgery.
9. The nurse notes that the client’s drainage has decreased from 50 to 5 mL/hr 12 hours after chest tube insertion for hemothorax. What is the best initial action for the nurse to take?
A. 	Document this expected decrease in drainage.
B. 	Clamp the chest tube while assessing for air leaks.
C. 	Milk the tube to remove any excessive blood clot buildup.
D. 	Assess for kinks or dependent loops in the tubing.
The least invasive nursing action should be performed first to determine why the drainage has diminished. Option A is completed after assessing for any problems causing the decrease in drainage. Option B is no longer considered standard protocol because the increase in pressure may be harmful to the client. Option C is an appropriate nursing action after the tube has been assessed for kinks or dependent loops.
10. The nurse is assessing a 75-year-old client for symptoms of hyperglycemia. Which symptom of hyperglycemia is an older adult most likely to exhibit?
C. 	Weight loss
Signs and symptoms of hyperglycemia in older adults may include fatigue, infection, and evidence of neuropathy (e.g., sensory changes). The nurse needs to remember that classic signs and symptoms of hyperglycemia, such as options A, B, and C and polyphagia, may be absent in older adults.
11. Which abnormal laboratory finding indicates that a client with diabetes needs further evaluation for diabetic nephropathy?
C. 	Elevated serum lipid levels
Microalbuminuria is the earliest sign of diabetic nephropathy and indicates the need for follow-up evaluation. Hyperkalemia, not option A, is associated with end-stage renal disease caused by diabetic nephropathy. Option C may be elevated in end-stage renal disease. Option D may signal the onset of diabetic ketoacidosis (DKA).
12. Which change in laboratory values indicates to the nurse that a client with rheumatoid arthritis may be experiencing an adverse effect of methotrexate therapy?
A. 	Increase in rheumatoid factor
B. 	Decrease in hemoglobin level
C. 	Increase in blood glucose level
D. 	Decrease in erythrocyte sedimentation rate (ESR; sed rate)
Methotrexate is an immunosuppressant. A common side effect is bone marrow depression, which would be reflected by a decrease in the hemoglobin level. Option A indicates disease progression but is not a side effect of the medication. Option C is not related to methotrexate. Option D indicates that inflammation associated with the disease has diminished.
13. Which consideration is most important when the nurse is assigning a room for a client being admitted with progressive systemic sclerosis (scleroderma)?
A. 	Provide a room that can be kept warm.
B. 	Make sure that the room can be kept dark.
C. 	Keep the client close to the nursing unit.
D. 	Select a room that is visible from the nurses’ desk.
Abnormal blood flow in response to cold (Raynaud phenomenon) is precipitated in clients with scleroderma. Option B is not a significant factor. Stress can also precipitate the severe pain of Raynaud phenomenon, so a quiet environment is preferred to option C, which is often very noisy. Option D is not necessary.
14. The nurse is reviewing routine medications taken by a client with chronic angle-closure glaucoma. Which medication prescription should the nurse question?
A. 	Antianginal with a therapeutic effect of vasodilation
B. 	Anticholinergic with a side effect of pupillary dilation
C. 	Antihistamine with a side effect of sedation
D. 	Corticosteroid with a side effect of hyperglycemia
Clients with angle-closure glaucoma should not take medications that dilate the pupil because this can precipitate acute and severely increased intraocular pressure. Options A, C, and D do not cause increased intracranial pressure, which is the primary concern with angle-closure glaucoma.
15. The nurse is observing an unlicensed assistive personnel (UAP) performing care for a bedridden client with advanced Huntington disease. Which care measures are most important for the nurse to supervise? (Select all that apply.)
A. 	Oral care
C. 	Foot care
D. 	Catheter care
E. 	Enteral feeding
The client with Huntington disease experiences problems with motor skills such as swallowing and is at high risk for aspiration, so the highest priority for the nurse to observe is the UAP’s ability to perform oral care and feeding safely. Options B, C, and D do not necessarily require registered nurse (RN) supervision because they do not ordinarily pose life-threatening consequences.
16. During the change of shift report, the charge nurse reviews the infusions being received by clients on the oncology unit. The client receiving which infusion should be assessed first?
A. 	Continuous IV infusion of magnesium
B. 	One-time infusion of albumin
C. 	Continuous epidural infusion of morphine
D. 	Intermittent infusion of IV vancomycin
All four of these clients have the potential to have significant complications. The client with the morphine epidural infusion is at highest risk for respiratory depression and should be assessed first. Option A can cause hypotension. The client receiving option B is at lowest risk for serious complications. Although option D can cause nephrotoxicity and phlebitis, these problems are not as immediately life threatening as option C.
17. The nurse assesses a postoperative client whose skin is cool, pale, and moist. The client is very restless and has scant urine output. Oxygen is being administered at 2 L/min, and a saline lock is in place. Which action should the nurse take first?
A. 	Measure the urine specific gravity.
B. 	Obtain IV fluids for infusion per protocol.
C. 	Prepare for insertion of a central venous catheter.
D. 	Auscultate the client’s breath sounds.
The client is at risk for hypovolemic shock because of the postoperative status and is exhibiting early signs of shock. A priority intervention is the initiation of IV fluids to restore tissue perfusion. Options A, C, and D are all important interventions but are of lower priority than option B.
18. A client with type 2 diabetes takes metformin daily. The client is scheduled for major surgery requiring general anesthesia the next day. The nurse anticipates which approach to manage the client’s diabetes best while the client is NPO during the perioperative period?
A. 	NPO except for metformin and regular snacks
B. 	NPO except for oral antidiabetic agent
C. 	Novolin N insulin subcutaneously twice daily
D. 	Regular insulin subcutaneously per sliding scale
Regular insulin dosing based on the client’s blood glucose levels (sliding scale) is the best method to achieve control of the client’s blood glucose while the client is NPO and coping with the major stress of surgery. Option A increases the risk of vomiting and aspiration. Options B and C provide less precise control of the blood glucose level.
19. A client is diagnosed with an acute small bowel obstruction and suddenly spikes a temperature of 102°F/38.9°C. What other assessments should the nurse include in the client’s focused assessment? (Select all that apply.)
A. 	Nausea and vomiting
B. 	Loss of appetite
C. 	Abdominal cramping
D. 	Guarding with abdominal palpation
E. 	Low urine output
F. 	Cool, clammy skin
The client is showing signs of peritonitis with the sudden spike in temperature. Low urine output and cool clammy skin are not seen with peritonitis. Peritonitis is a medical emergency and the health care provider must be notified immediately.
20. The nurse witnesses a baseball player receive a blunt trauma to the back of the head with a softball. What assessment data should the nurse collect immediately? (Select all that apply.)
A. 	Reactivity of deep tendon reflexes
B. 	Heart rate and respiratory rate
C. 	Memory of recent events
D. 	Ability to open the eyes spontaneously
F. 	Ringing in the ears
The level of consciousness (LOC) should be established immediately when a head injury has occurred. Deep tendon reflexes are not an indicator of LOC or concussion. Spontaneous eye opening is a simple measure of alertness that indicates that arousal mechanisms are intact. The remaining assessments are included in the concussion protocol.
21. The nurse is preparing a teaching plan for a group of healthy adults. Which individual is most likely to maintain optimum health?
A. 	A teacher whose blood glucose levels average 126 mg/dL daily with oral antidiabetic drugs
B. 	An accountant whose blood pressure averages 140/96 mm Hg and who says he does not have time to exercise
C. 	A stock broker whose total serum cholesterol level dropped to 290 mg/dL with diet modifications
D. 	A recovering IV heroin user who contracted hepatitis more than 10 years ago
The diabetic teacher has assumed responsibility for self-care, so among those listed, he or she is the most likely to maintain optimum health. Option B has expressed a lack of interest in health promotion. Option C continues to demonstrate a high-risk cholesterol level despite a reported attempt at dietary modifications. Previous IV drug use and a history of hepatitis make this individual a health risk despite the fact that the individual is in recovery.
22. A client with hypertension has been receiving ramipril, 5 mg PO, daily for 2 weeks and is scheduled to receive a dose at 0900. At 0830, the client’s blood pressure is 120/70 mm Hg. Which action should the nurse take?
A. 	Administer the prescribed dose at the scheduled time.
B. 	Hold the dose and contact the health care provider.
C. 	Hold the dose and recheck the blood pressure in 1 hour.
D. 	Check the health care provider’s prescription to clarify the dose.
The client’s blood pressure is within normal limits, indicating that the ramipril, an antihypertensive, is having the desired effect and should be administered. Options B and C would be appropriate if the client’s blood pressure was excessively low (<100 mm Hg systolic) or if the client were exhibiting signs of hypotension such as dizziness. This prescribed dose is within the normal dosage range, as defined by the manufacturer; therefore, option D is not necessary.
23. When assigning clients on a medical-surgical floor to an RN and a PN, it is best for the charge nurse to assign which client to the PN?
A. 	A young adult with bacterial meningitis with recent seizures
B. 	An older adult client with pneumonia and viral meningitis
C. 	A female client in isolation with meningococcal meningitis
D. 	A male client 1 day postoperative after drainage of a brain abscess
The most stable client is option B. Options A, C, and D are all at high risk for increased intracranial pressure and require the expertise of the RN for assessment and management of care.
24. A resident in a long-term care facility is diagnosed with hepatitis B. Which action should the nurse take with the staff caring for this client?
A. 	Determine if all employees have had the hepatitis B vaccine series.
B. 	Explain that this type of hepatitis can be transmitted when feeding the client.
C. 	Assure the employees that they cannot contract hepatitis B when providing direct care.
D. 	Tell the employees that wearing gloves and a gown are required when providing all care.
Hepatitis B vaccine should be administered to all health care providers. Hepatitis A (not hepatitis B) can be transmitted by fecal–oral contamination. There is a chance that staff could contract hepatitis B if exposed to the client’s blood and/or body fluids; therefore, option C is incorrect. There is no need to wear gloves and gowns except with blood or body fluid contact.
25. During report, the nurse learns that a client with tumor lysis syndrome is receiving an IV infusion containing insulin. Which action should the nurse complete first?
A. 	Review the client’s history for diabetes mellitus.
B. 	Observe the extremity distal to the IV site.
C. 	Monitor the client’s serum potassium and blood glucose levels.
D. 	Evaluate the client’s oxygen saturation and breath sounds.
Clients with tumor lysis syndrome may experience hyperkalemia, requiring the addition of insulin to the IV solution to reduce the serum potassium level. It is most important for the nurse to monitor the client’s serum potassium and blood glucose levels to ensure that they are not at dangerous levels. Options A, B, and D provide valuable assessment data but are of less priority than option C.
26. A tornado warning alarm has been activated at the local hospital. Which action should the charge nurse working on a surgical unit take first?
A. 	Instruct the nursing staff to close all window blinds and curtains in clients’ rooms.
B. 	Move clients and visitors into the hallways and close all doors to clients’ rooms.
C. 	Visually confirm the location of the tornado by checking the windows on the unit.
D. 	Assist all visitors with evacuation down the stairs in a calm and orderly manner.
In the event of a tornado, all persons should be moved into the hallways, away from windows, to prevent flying debris from causing injury. Although option A may help decrease the amount of flying debris, it is not safe to leave clients in rooms with closed blinds; option B is a higher priority at this time. Hospital staff should stay away from windows to avoid injury and should focus on client evacuation into hallways rather than option C. Option D is not the first action that should be taken.
27. The nurse is assessing a client with acute pancreatitis. Which finding requires the most immediate intervention by the nurse?
A. 	The client’s amylase level is three times higher than the normal level.
B. 	The client has a carpal spasm when taking a blood pressure.
C. 	On a 1 to 10 scale, the client tells the nurse that her epigastric pain is at 7.
D. 	The client states that she will continue to drink alcohol after going home.
A positive Trousseau sign indicates hypocalcemia and always requires further assessment and intervention, regardless of the cause (40% to 75% of those with acute pancreatitis experience hypocalcemia, which can have serious, systemic effects). A key diagnostic finding of pancreatitis is serum amylase and lipase levels that are two to five times higher than the normal value. Severe boring pain is an expected symptom for this diagnosis, but dealing with the hypocalcemia is a priority over administering an analgesic. Long-term planning and teaching do not have the same immediate importance as a positive Trousseau sign.
28. The nurse is preparing a 45-year-old client for discharge from a cancer center following ileostomy surgery for colon cancer. Which discharge goal should the nurse include in this client’s discharge plan?
A. 	Reduce the daily intake of animal fat to 10% of the diet within 6 weeks.
B. 	Exhibit regular, soft-formed stool within 1 month.
C. 	Demonstrate the irrigation procedure correctly within 1 week.
D. 	Attend an ostomy support group within 2 weeks.
Attending a support group will be beneficial to the client and should be encouraged because adaptation to the ostomy can be difficult. This goal is attainable and is measurable. Option A is not specifically related to ileostomy care. The client with an ileostomy will not be able to accomplish option B. Option C is not necessary.
29. The nurse is assessing a client who presents with jaundice. Which assessment finding is most important for the nurse to follow up?
A. 	Urine specific gravity of 1.03
B. 	Frothy, tea-colored urine
C. 	Clay-colored stools
D. 	Elevated serum amylase and lipase levels
Obstructive cholelithiasis and alcoholism are the two major causes of pancreatitis, and elevated serum amylase and lipase levels indicate pancreatic injury. Option A is a normal finding. Options B and C are expected findings related to jaundice.
30. The nurse is performing hourly neurologic checks for a client with a head injury. Which new assessment finding warrants immediate action by the nurse?
A. 	A unilateral pupil that is dilated and nonreactive to light
B. 	Client cries out when awakened by a verbal stimulus.
C. 	Client demonstrates a loss of memory of the events leading up to the injury.
D. 	Onset of nausea, headache, and vertigo
Any change in pupil size and reactivity is an indication of increasing intracranial pressure and should be reported to the health care provider immediately. Option B is a normal response to being awakened. Options C and D are common manifestations of head injury and are of less immediacy than option A.
31. The nurse is caring for a client who is one day post-acute myocardial infarction. The client is receiving oxygen at 2 L/min via nasal cannula and has a peripheral saline lock. The nurse notes that the client is having eight premature ventricular contractions (PVCs) per minute. Which action should the nurse take first?
A. 	Obtain an IV pump for antiarrhythmic infusion.
B. 	Increase the client’s oxygen flow rate.
C. 	Prepare for immediate countershock.
D. 	Gather equipment for endotracheal intubation.
Increasing the oxygen flow rate provides more oxygen to the client’s myocardium and may decrease myocardial irritability as manifested by the frequent PVCs. Option A can be delegated and is a lower priority action than option B. Defibrillation may eventually be necessary, but option C is not the immediate treatment for frequent PVCs. Option D may become necessary if the client stops breathing but is not indicated at this time.
32. After attending a class on reducing cancer risk factors, a client selects bran flakes with 2% milk and orange slices from a breakfast menu. In evaluating the client’s learning, the nurse affirms that the client has made good choices and makes what additional recommendation?
A. 	Switch to skim milk.
B. 	Switch to orange juice.
C. 	Add a source of protein.
D. 	Add herbal tea.
Dietary recommendations to reduce cancer risk include reduced consumption of fats, with increased consumption of fruits, vegetables, and fiber. Option A promotes reduced fat consumption. Orange slices provide more fiber than orange juice. Options B, C, and D are not standard recommendations for reducing cancer risk.
33. The nurse initiates neurologic checks for a client who is at risk for neurologic compromise. Which manifestation typically provides the first indication of altered neurologic function?
A. 	Change in level of consciousness
B. 	Increasing muscular weakness
C. 	Changes in pupil size bilaterally
D. 	Progressive nuchal rigidity
A decrease or change in the level of consciousness is usually the first indication of neurologic deterioration. Options B and C may also occur but are much less likely to be the first sign of neurologic compromise. Option D is often a sign of meningitis.
34. Which nursing action would be appropriate for a client who is newly diagnosed with Cushing syndrome?
A. 	Monitor blood glucose levels daily.
B. 	Increase intake of fluids high in potassium.
C. 	Encourage adequate rest between activities.
D. 	Offer the client a sodium-enriched menu.
Cushing syndrome results from a hypersecretion of glucocorticoids in the adrenal cortex. Clients with Cushing syndrome often develop diabetes mellitus. Monitoring of serum glucose levels assesses for increased blood glucose levels so that treatment can begin early. A common finding in Cushing syndrome is generalized edema. Although potassium is needed, it is generally obtained from food intake, not by offering potassium-enhanced fluids. Fatigue is usually not an overwhelming factor in Cushing syndrome, so an emphasis on the need for rest is not indicated. A low-calorie, low-carbohydrate, low-sodium diet is not recommended.
35. A client is admitted to the hospital with severe lower left abdominal pain, nausea, vomiting, fever, and chills. Which nursing action has the highest priority?
A. 	Place the client on NPO status.
B. 	Assess the client’s temperature.
C. 	Obtain a stool specimen.
D. 	Administer IV fluids.
A client is showing signs of acute severe diverticulitis and is at risk for peritonitis and intestinal obstruction. The nurse should make the client NPO to reduce risk of intestinal rupture. Options B, C, and D are important but are less of a priority than option A, which is implemented to prevent a severe complication.
36. When a nurse assesses a client receiving total parenteral nutrition (TPN), which laboratory value is most important for the nurse to monitor regularly?
D. 	Alkaline phosphatase
TPN solutions contain high concentrations of glucose, so the blood glucose level is often monitored as often as q6h because of the risk for hyperglycemia. Option A is monitored periodically because an increase in the albumin level, a serum protein, is generally a desired effect of TPN. Option B may be added to TPN solutions, but calcium imbalances are not generally a risk during TPN administration. Option D may be decreased in the client with malnutrition who receives TPN, but abnormal values, reflecting liver or bone disorders, are not a common complication of TPN administration.
37. When educating a client after a total laryngectomy, which instruction would be most important for the nurse to include in the discharge teaching?
A. 	Recommend that the client carry suction equipment at all times.
B. 	Instruct the client to carry writing materials at all times.
C. 	Tell the client to carry a medical alert card that explains the condition.
D. 	Caution the client not to travel outside the United States alone.
Neck breathers carry a medical alert card that notifies health care personnel of the need to use mouth to stoma breathing in the event of a cardiac arrest in this client. Mouth-to-mouth resuscitation will not establish a patent airway. Options A and D are not necessary. There are many alternative means of communication for clients who have had a laryngectomy; dependence on writing messages is probably the least effective.
38. When developing a discharge teaching plan for a client after the insertion of a permanent pacemaker, the nurse writes a goal of “The client will verbalize symptoms of pacemaker failure.” Which behavior indicates that the goal has been met?
A. 	The client demonstrates the procedures to change the rate of the pacemaker using a magnet.
B. 	The client carries a card in his wallet stating the type and serial number of the pacemaker.
C. 	The client tells the nurse that it is important to report redness and tenderness at the insertion site.
D. 	The client states that changes in the pulse and feelings of dizziness are significant changes.
Changes in pulse rate and/or rhythm may indicate pacer failure. Feelings of dizziness may be caused by a decreased heart rate, leading to decreased cardiac output. The rate of a pacemaker is not changed by a client, although the client may be familiar with this procedure as explained by his health care provider. Option B is an important step in preparing the client for discharge but does not demonstrate knowledge of the symptoms of pacer failure. Option C indicates symptoms of possible incisional infection or irritation but does not indicate pacer failure.
39. The nurse assesses a client who has been prescribed furosemide for cardiac disease. Which electrocardiographic change would be a concern for a client taking a diuretic?
A. 	Tall, spiked T waves
B. 	A prolonged QT interval
C. 	A widening QRS complex
D. 	Presence of a U wave
A U wave is a positive deflection following the T wave and is often present with hypokalemia (low potassium level). Options A, B, and C are all signs of hyperkalemia.
40. What is the correct location for placement of the hands for manual chest compressions during cardiopulmonary resuscitation (CPR) on the adult client?
A. 	Just above the xiphoid process, on the upper third of the sternum
B. 	Below the xiphoid process, midway between the sternum and the umbilicus
C. 	Just above the xiphoid process, on the lower third of the sternum
D. 	Below the xiphoid process, midway between the sternum and the first rib
The correct placement of the hands for chest compressions in CPR is just above the notch where the ribs meet the sternum on the lower part of the sternum. Option A is too high. Option B would not compress the heart. Option D would likely cause damage to both structures, possibly causing a puncture of the heart, and would not render effective compressions.
41. Zolpidem tartrate, 1.75 mg PRN at bedtime, is prescribed for rest. The scored tablets are labeled 3.5 mg per tablet. What dose should the nurse plan to administer?____________
1.75 is ordered. 3.5 is available. 1.75/3.5 time one tab equals. 0.5 or one half tablet.
42. A central venous catheter has been inserted via a jugular vein, and a radiograph has confirmed placement of the catheter. A prescription has been received for a medication STAT, but IV fluids have not yet been started. Which action should the nurse take prior to administering the prescribed medication?
A. 	Assess for signs of jugular venous distention.
B. 	Obtain the needed intravenous solution.
C. 	Flush the line with heparinized solution.
D. 	Flush the line with normal saline.
Medication can be administered via a central line without additional IV fluids. The line should first be flushed with a normal saline solution to ensure patency. Insufficient evidence exists on the effectiveness of flushing catheters with heparin. Option A will not affect the decision to administer the medication and is not a priority. Administration of the medication STAT is of greater priority than option B.
43. A client diagnosed with chronic kidney disease (CKD) 2 years ago is regularly treated at a community hemodialysis facility. Before the scheduled dialysis treatment, which electrolyte imbalance should the nurse anticipate?
Hypocalcemia develops in CKD because of chronic hyperphosphatemia, not option A. Increased phosphate levels cause the peripheral deposition of calcium and resistance t