BSN 225 HESI RN Specialty
Fundamentals of Nursing Exam V1
(Latest Update ) Questions
& Answers | 100% Correct | Grade A -
Nightingale
What is the rationale for using the nursing process in planning
care for clients?
a. As a scientific process to identify nursing diagnoses of a
clients' healthcare problems.
b. To establish nursing theory that incorporates the
biopsychosocial nature of humans.
c. As a tool to organize thinking and clinical decision making
about clients' healthcare needs.
d. To promote the management of client care in collaboration
with other healthcare professionals.
c. As a tool to organize thinking and clinical decision making
about clients' healthcare needs.
,Rationale: The nursing process is a problem-solving approach
that provides an organized, systematic, decision making process
to effectively address the client's needs and problems. The
nursing process includes an organized framework using
knowledge, judgments, and actions by the nurse as the client's
plan of care is determined, and encompasses assessment,
analysis, planning, implementation, and evaluation of client
care.
The nurses determines a client's IV solution is infusing at 250
ml/hr. The prescribed rate is 125 ml/hr. What action should the
nurse take first?
a. Determine when the IV solution was started.
b. Slow the IV infusion to keep vein open rate.
c. Assess the IV insertion site for swelling.
d. Report the finding to the healthcare provider.
b. Slow the IV infusion to keep vein open rate.
Rationale: The nurse should first slow the IV flow rate to keep
vein open (KVO) rate (B) to prevent further risk of fluid volume
overload, then gather additional assessment data, such as when
the IV solution was started (A) and the appearance of the IV
insertion site (C) before contacting the healthcare provider (D)
for further instructions.
What action should the nurse implement to prevent the
formation of a sacral ulcer for a client who is immobile?
, Maintain in a lateral position using protective wrist and vest
devices.
Position prone with a small pillow below the diaphragm.
Raise the head and knee gatch when lying in a supine position.
Transfer into a wheelchair close to the nurse's station for
observation.
b. Position prone with a small pillow below the diaphragm.
Rationale: The prone position (B) using a small pillow below the
diaphragm maintains alignment and provides the best pressure
relief over the sacral bony prominence.
Reading comprehension for a pt family member
Asking someone else to read the form, waiting for help with the
forms, and partially or inaccurately filling out forms are
behaviors indicative of potential health literacy issues. Needing
glasses does not correlate directly with health literacy
Comprehending D/C instructions
Letting the client perform or return-demonstrate the instillation
of ear medication as the nurse observes is the best way to gauge
if the client understood the discharge teaching.
Which food substances will the nurse include in the child's diet
plan to alleviate severe bruises and bleeding caused by a vitamin
deficiency?
A.Broccoli, spinach, and cabbage
Fundamentals of Nursing Exam V1
(Latest Update ) Questions
& Answers | 100% Correct | Grade A -
Nightingale
What is the rationale for using the nursing process in planning
care for clients?
a. As a scientific process to identify nursing diagnoses of a
clients' healthcare problems.
b. To establish nursing theory that incorporates the
biopsychosocial nature of humans.
c. As a tool to organize thinking and clinical decision making
about clients' healthcare needs.
d. To promote the management of client care in collaboration
with other healthcare professionals.
c. As a tool to organize thinking and clinical decision making
about clients' healthcare needs.
,Rationale: The nursing process is a problem-solving approach
that provides an organized, systematic, decision making process
to effectively address the client's needs and problems. The
nursing process includes an organized framework using
knowledge, judgments, and actions by the nurse as the client's
plan of care is determined, and encompasses assessment,
analysis, planning, implementation, and evaluation of client
care.
The nurses determines a client's IV solution is infusing at 250
ml/hr. The prescribed rate is 125 ml/hr. What action should the
nurse take first?
a. Determine when the IV solution was started.
b. Slow the IV infusion to keep vein open rate.
c. Assess the IV insertion site for swelling.
d. Report the finding to the healthcare provider.
b. Slow the IV infusion to keep vein open rate.
Rationale: The nurse should first slow the IV flow rate to keep
vein open (KVO) rate (B) to prevent further risk of fluid volume
overload, then gather additional assessment data, such as when
the IV solution was started (A) and the appearance of the IV
insertion site (C) before contacting the healthcare provider (D)
for further instructions.
What action should the nurse implement to prevent the
formation of a sacral ulcer for a client who is immobile?
, Maintain in a lateral position using protective wrist and vest
devices.
Position prone with a small pillow below the diaphragm.
Raise the head and knee gatch when lying in a supine position.
Transfer into a wheelchair close to the nurse's station for
observation.
b. Position prone with a small pillow below the diaphragm.
Rationale: The prone position (B) using a small pillow below the
diaphragm maintains alignment and provides the best pressure
relief over the sacral bony prominence.
Reading comprehension for a pt family member
Asking someone else to read the form, waiting for help with the
forms, and partially or inaccurately filling out forms are
behaviors indicative of potential health literacy issues. Needing
glasses does not correlate directly with health literacy
Comprehending D/C instructions
Letting the client perform or return-demonstrate the instillation
of ear medication as the nurse observes is the best way to gauge
if the client understood the discharge teaching.
Which food substances will the nurse include in the child's diet
plan to alleviate severe bruises and bleeding caused by a vitamin
deficiency?
A.Broccoli, spinach, and cabbage
