NSG 300 HESI Review Questions
1. In providing care for a terminally ill resident of a long-term care facility, the nurse
determines that the resident is exhibiting signs of impending death and has a "do not resuscitate"
or DNR status. What intervention should the nurseimplement first?
Request hospice care for the client.
Report the client's acuity level to the nursing supervisor.
Notify family members of the client's condition.
Inform the chaplain that the client's death is imminent.: C
2. A 75-year-old client who has a history of end stage renal failure and advanced lung
cancer, recently had a stroke. Two days ago the healthcare provider discontinued the client's
dialysis treatments, stating that death is inevitable, but the client is disoriented and will not sign
a DNR directive. What
is the priority nursing intervention?
Review the client's most recent laboratory reports.
Refer the client and family members for hospice care.
Notify the hospital ethics committee of the client situation.
Determine who is legally empowered to make decisions.: D
3. As the nurse prepares the equipment to be used to start an IV on a
4-year-old boy in the treatment room, he cries continuously. What interventionshould the nurse
implement?
Take the child back to his room.
Recruit others to restrain the child.
Ask the mother to be present to soothe the child.
Show the child how to manipulate the equipment.: C
4. A client is demonstrating a positive Chvostek's sign. What action shouldthe nurse take?
Observe the client's pupil size and response to light.
Ask the client about numbness or tingling in the hands.
Assess the client's serum potassium level.
Restrict dietary intake of calcium-rich foods.: B
,5. A female nurse who sometimes tries to save time by putting medications in her uniform
pocket to deliver to clients, confides that after arriving home she found a hydrocodone
(Vicodin) tablet in her pocket. Which possible outcome of this situation should be the nurse's
greatest concern?
Accused of diversion.
Reported for stealing.
Reported for a HIPAA violation.
Accused of unprofessional conduct.: A
6. A middle-aged woman who enjoys being a teacher and mentor feels thatshe should pass
down her legacy of knowledge and skills to the younger generation. According to Erikson,
she is involved in what developmental stage?
Generativity.
Ego integrity.
Identification.
Valuing wisdom.: A
7. When preparing to administer an intravenous medication through a central venous catheter,
the nurse aspirates a blood return in one of the lumens of the triple lumen catheter. Which action
should the nurse implement?
Flush the lumen with the saline solution and administer the medicationthrough the lumen.
Determine if a PRN prescription for a thrombolytic agent is listed on themedication record.
Clamp the lumen and obtain a syringe of a dilute heparin solution to flushthrough the tubing.
Withdraw the aspirated blood into the syringe and use a new syringe toadminister the
medication.: A
8. The nurse is digitally removing a fecal impaction for a client. The nurse should stop the
procedure and take corrective action if which client reactionis noted?
Temperature increases from 98.8 to 99.0 F.
Pulse rate decreases from 78 to 52 beats/min.
Respiratory rate increases from 16 to 24 breaths/min.
Blood pressure increases from 110/84 to 118/88 mm/Hg.: B
9. Which nursing intervention is most beneficial in reducing the risk ofurosepsis in a
hospitalized client with an indwelling urinary catheter? Ensure that the client's perineal area is
, cleansed twice a day.
Maintain accurate documentation of the fluid intake and output.
Encourage frequent ambulation if allowed or regular turning if on bedrest.
Obtain a prescription for removal of the catheter as soon as possible.: D
10. The nurse assesses an immobile, elderly male client and determines thathis blood pressure
is 138/60, his temperature is 95.8 F, and his output is 100 mlof concentrated urine during the last
hour. He has wet-sounding lung sounds,and increased respiratory secretions. Based on these
assessment findings, what nursing action is most important for the nurse to implement?
Administer a PRN antihypertensive prescription.
Provide the client with an additional blanket.
Encourage additional fluid intake.
Turn the client q2h.: D
11. A male client has a nursing diagnosis of "spiritual distress." What inter-vention is best for
the nurse to implement when caring for this client?
Use distraction techniques during times of spiritual stress and crisis.
Reassure the client that his faith will be regained with time and support.
Consult with the staff chaplain and ask that the chaplain visit with the client.
Use reflective listening techniques when the client expresses spiritual doubts.: D
12. What client statement indicates to the nurse that the client requires assis-tance with
bathing?
"I wasn't able to pack a bag before I left for the hospital."
"I don't understand why I'm so weak and tired."
"I only bathe every other day."
"I left my eyeglasses at home.": B
13. A nurse observes a student nurse taking a copy of a client's medication administration
record. When questioned, the student states, "Another studentis scheduled to administer
medications for this client tomorrow, so I am going to make a copy to help my friend prepare
for tomorrow's clinical." Whatresponse should the nurse provide first?
Ask the nursing supervisor to meet with the students.
Notify the student's clinical instructor of the situation.
Ask the student if permission was obtained from the client.
1. In providing care for a terminally ill resident of a long-term care facility, the nurse
determines that the resident is exhibiting signs of impending death and has a "do not resuscitate"
or DNR status. What intervention should the nurseimplement first?
Request hospice care for the client.
Report the client's acuity level to the nursing supervisor.
Notify family members of the client's condition.
Inform the chaplain that the client's death is imminent.: C
2. A 75-year-old client who has a history of end stage renal failure and advanced lung
cancer, recently had a stroke. Two days ago the healthcare provider discontinued the client's
dialysis treatments, stating that death is inevitable, but the client is disoriented and will not sign
a DNR directive. What
is the priority nursing intervention?
Review the client's most recent laboratory reports.
Refer the client and family members for hospice care.
Notify the hospital ethics committee of the client situation.
Determine who is legally empowered to make decisions.: D
3. As the nurse prepares the equipment to be used to start an IV on a
4-year-old boy in the treatment room, he cries continuously. What interventionshould the nurse
implement?
Take the child back to his room.
Recruit others to restrain the child.
Ask the mother to be present to soothe the child.
Show the child how to manipulate the equipment.: C
4. A client is demonstrating a positive Chvostek's sign. What action shouldthe nurse take?
Observe the client's pupil size and response to light.
Ask the client about numbness or tingling in the hands.
Assess the client's serum potassium level.
Restrict dietary intake of calcium-rich foods.: B
,5. A female nurse who sometimes tries to save time by putting medications in her uniform
pocket to deliver to clients, confides that after arriving home she found a hydrocodone
(Vicodin) tablet in her pocket. Which possible outcome of this situation should be the nurse's
greatest concern?
Accused of diversion.
Reported for stealing.
Reported for a HIPAA violation.
Accused of unprofessional conduct.: A
6. A middle-aged woman who enjoys being a teacher and mentor feels thatshe should pass
down her legacy of knowledge and skills to the younger generation. According to Erikson,
she is involved in what developmental stage?
Generativity.
Ego integrity.
Identification.
Valuing wisdom.: A
7. When preparing to administer an intravenous medication through a central venous catheter,
the nurse aspirates a blood return in one of the lumens of the triple lumen catheter. Which action
should the nurse implement?
Flush the lumen with the saline solution and administer the medicationthrough the lumen.
Determine if a PRN prescription for a thrombolytic agent is listed on themedication record.
Clamp the lumen and obtain a syringe of a dilute heparin solution to flushthrough the tubing.
Withdraw the aspirated blood into the syringe and use a new syringe toadminister the
medication.: A
8. The nurse is digitally removing a fecal impaction for a client. The nurse should stop the
procedure and take corrective action if which client reactionis noted?
Temperature increases from 98.8 to 99.0 F.
Pulse rate decreases from 78 to 52 beats/min.
Respiratory rate increases from 16 to 24 breaths/min.
Blood pressure increases from 110/84 to 118/88 mm/Hg.: B
9. Which nursing intervention is most beneficial in reducing the risk ofurosepsis in a
hospitalized client with an indwelling urinary catheter? Ensure that the client's perineal area is
, cleansed twice a day.
Maintain accurate documentation of the fluid intake and output.
Encourage frequent ambulation if allowed or regular turning if on bedrest.
Obtain a prescription for removal of the catheter as soon as possible.: D
10. The nurse assesses an immobile, elderly male client and determines thathis blood pressure
is 138/60, his temperature is 95.8 F, and his output is 100 mlof concentrated urine during the last
hour. He has wet-sounding lung sounds,and increased respiratory secretions. Based on these
assessment findings, what nursing action is most important for the nurse to implement?
Administer a PRN antihypertensive prescription.
Provide the client with an additional blanket.
Encourage additional fluid intake.
Turn the client q2h.: D
11. A male client has a nursing diagnosis of "spiritual distress." What inter-vention is best for
the nurse to implement when caring for this client?
Use distraction techniques during times of spiritual stress and crisis.
Reassure the client that his faith will be regained with time and support.
Consult with the staff chaplain and ask that the chaplain visit with the client.
Use reflective listening techniques when the client expresses spiritual doubts.: D
12. What client statement indicates to the nurse that the client requires assis-tance with
bathing?
"I wasn't able to pack a bag before I left for the hospital."
"I don't understand why I'm so weak and tired."
"I only bathe every other day."
"I left my eyeglasses at home.": B
13. A nurse observes a student nurse taking a copy of a client's medication administration
record. When questioned, the student states, "Another studentis scheduled to administer
medications for this client tomorrow, so I am going to make a copy to help my friend prepare
for tomorrow's clinical." Whatresponse should the nurse provide first?
Ask the nursing supervisor to meet with the students.
Notify the student's clinical instructor of the situation.
Ask the student if permission was obtained from the client.
