2 - Hesi Rn Compass Exam (60) A Comprehensive Set Of
Questions And Answers With Verified Solutions Grade A+.
A nurse is monitoring a client receiving a blood transfusion. Which of the following actions
should the nurse take first?
A. Stop the blood transfusion.
B. Administer an antipyretic.
C. Encourage oral fluids.
D. Apply supplemental oxygen.
E. Send blood for type and crossmatch.
A. Stop the blood transfusion
After the nurse witnesses a preoperative client signing the surgical consent form, the nurse
signs the form as a witness. Which is the legal implication of the nurse's signature on the
client's surgical consent form? Select all that apply.
A. Verifies that the client understands the procedure that is being performed.
B. The client is competent to sign the consent without impairment of judgment.
C. The client voluntarily grants permission for the procedure to be done.
D. The surgeon has explained to the client why the surgery is necessary.
E. The client understands the risks and benefits associated with the procedure.
B. The client is competent to sign the consent without impairment of judgment.
C. The client voluntarily grants permission for the procedure to be done.
The healthcare provider prescribes a 5% dextrose injection with 20 units of regular insulin for
a client with a serum potassium level of 6.0 mEq/L (6.0 mmol/L) and glucose level of 180
mg/dL (10.0 mmol/L). Which evaluation is most important for the nurse to include in this
client's plan of care?
A. Assess the serum potassium level every 4 hours.
B. Evaluate glucose levels before and after meals.
C. Monitor and document strict intake and output.
,D. Obtain a 12-lead electrocardiogram daily.
A. Assess the serum potassium level every 4 hours.
A client expresses concern about receiving proper care in accordance with the client's
religion. Which action is best for the nurse to take?
A. Consult with a nurse who shares the same religious beliefs.
B. Research the religion on different social media platforms.
C. Ask the client about individual care preferences.
D. Explain that every client will receive the same high level of care.
C. Ask the client about individual care preferences.
The healthcare provider (HCP) prescribes 0.99% normal saline 500 mL IV bolus to be
infused over 30 minutes. How many mL/hour should the nurse set the infusion pump? (Enter
numerical value only)
1,000 mL/hr
The nurse has received funding to design a health promotion project for African-American
women who are at risk for developing breast cancer. Which resource is most important in
designing this program?
A. Participation of community leaders in planning the program.
B. Morbidity data for breast cancer in women of all races.
C. A listing of African-American women who live in the community.
D. Technical assistance to produce a video on breast self-examination.
A. Participation of community leaders in planning the program.
A client who received an open reduction and internal fixation (ORIF) of the right femur after
experiencing a fall at home experiences a sudden onset of increasing confusion and agitation.
When reporting to the healthcare provider using SBAR (Situation, Background, Assessment,
Recommendation) communication, which information should the nurse provide first?
A. Client's healthcare power of attorney.
, B. Fall at home as reason for admission.
C. Currently prescribed medications.
D. Increasing confusion of the client.
D. Increasing confusion of the client.
A client sustained a head injury when hit by a lead pipe two hours ago and is admitted for
observation after the computerized tomography (CT) scan indicates that no spinal cord injury
and no skull fractures are present. When the client begins projectile vomiting, the nurse
quickly turns the client's head to the side and administers ondansetron 4 mg IV as prescribed.
Reassessment indicates that the client's Glasgow coma score is 13 and the left pupil is dilated
without reaction to light. Which intervention(s) should the nurse implement? Select all that
apply.
A. Place in lateral Trendelenburg position.
B. Schedule a repeat CT scan.
C. Insert a second large bore IV catheter.
D. Apply artificial tear drops to the left eye.
E. Repeat Glasgow coma assessment.
B. Schedule a repeat CT scan.
E. Repeat Glasgow coma assessment.
The nurse observes an unlicensed assistive personnel (UAP) washing hands prior to entering
the client's room. Which action by the UAP requires additional teaching?
A. Lathering using a circular movement.
B. Turning the water off using bare hands.
C. Washing for a total of 20 seconds.
D. Holding hands below elbows when rinsing.
B. Turning the water off using bare hands.
Following a cardiac catheterization and placement of a stent in the right coronary artery, the
nurse administers prasugrel to the client. To monitor for adverse effects from the medication,
which assessment is most important for the nurse to include in this client's plan of care?
Questions And Answers With Verified Solutions Grade A+.
A nurse is monitoring a client receiving a blood transfusion. Which of the following actions
should the nurse take first?
A. Stop the blood transfusion.
B. Administer an antipyretic.
C. Encourage oral fluids.
D. Apply supplemental oxygen.
E. Send blood for type and crossmatch.
A. Stop the blood transfusion
After the nurse witnesses a preoperative client signing the surgical consent form, the nurse
signs the form as a witness. Which is the legal implication of the nurse's signature on the
client's surgical consent form? Select all that apply.
A. Verifies that the client understands the procedure that is being performed.
B. The client is competent to sign the consent without impairment of judgment.
C. The client voluntarily grants permission for the procedure to be done.
D. The surgeon has explained to the client why the surgery is necessary.
E. The client understands the risks and benefits associated with the procedure.
B. The client is competent to sign the consent without impairment of judgment.
C. The client voluntarily grants permission for the procedure to be done.
The healthcare provider prescribes a 5% dextrose injection with 20 units of regular insulin for
a client with a serum potassium level of 6.0 mEq/L (6.0 mmol/L) and glucose level of 180
mg/dL (10.0 mmol/L). Which evaluation is most important for the nurse to include in this
client's plan of care?
A. Assess the serum potassium level every 4 hours.
B. Evaluate glucose levels before and after meals.
C. Monitor and document strict intake and output.
,D. Obtain a 12-lead electrocardiogram daily.
A. Assess the serum potassium level every 4 hours.
A client expresses concern about receiving proper care in accordance with the client's
religion. Which action is best for the nurse to take?
A. Consult with a nurse who shares the same religious beliefs.
B. Research the religion on different social media platforms.
C. Ask the client about individual care preferences.
D. Explain that every client will receive the same high level of care.
C. Ask the client about individual care preferences.
The healthcare provider (HCP) prescribes 0.99% normal saline 500 mL IV bolus to be
infused over 30 minutes. How many mL/hour should the nurse set the infusion pump? (Enter
numerical value only)
1,000 mL/hr
The nurse has received funding to design a health promotion project for African-American
women who are at risk for developing breast cancer. Which resource is most important in
designing this program?
A. Participation of community leaders in planning the program.
B. Morbidity data for breast cancer in women of all races.
C. A listing of African-American women who live in the community.
D. Technical assistance to produce a video on breast self-examination.
A. Participation of community leaders in planning the program.
A client who received an open reduction and internal fixation (ORIF) of the right femur after
experiencing a fall at home experiences a sudden onset of increasing confusion and agitation.
When reporting to the healthcare provider using SBAR (Situation, Background, Assessment,
Recommendation) communication, which information should the nurse provide first?
A. Client's healthcare power of attorney.
, B. Fall at home as reason for admission.
C. Currently prescribed medications.
D. Increasing confusion of the client.
D. Increasing confusion of the client.
A client sustained a head injury when hit by a lead pipe two hours ago and is admitted for
observation after the computerized tomography (CT) scan indicates that no spinal cord injury
and no skull fractures are present. When the client begins projectile vomiting, the nurse
quickly turns the client's head to the side and administers ondansetron 4 mg IV as prescribed.
Reassessment indicates that the client's Glasgow coma score is 13 and the left pupil is dilated
without reaction to light. Which intervention(s) should the nurse implement? Select all that
apply.
A. Place in lateral Trendelenburg position.
B. Schedule a repeat CT scan.
C. Insert a second large bore IV catheter.
D. Apply artificial tear drops to the left eye.
E. Repeat Glasgow coma assessment.
B. Schedule a repeat CT scan.
E. Repeat Glasgow coma assessment.
The nurse observes an unlicensed assistive personnel (UAP) washing hands prior to entering
the client's room. Which action by the UAP requires additional teaching?
A. Lathering using a circular movement.
B. Turning the water off using bare hands.
C. Washing for a total of 20 seconds.
D. Holding hands below elbows when rinsing.
B. Turning the water off using bare hands.
Following a cardiac catheterization and placement of a stent in the right coronary artery, the
nurse administers prasugrel to the client. To monitor for adverse effects from the medication,
which assessment is most important for the nurse to include in this client's plan of care?
