EXIT HESI V1
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A client is receiving ophthalmic drops preoperatively for a cataract extraction and asks
the nurse why the healthcare provider has prescribed all these medications. Which
information should the nurse included when responding to this client? (Select all that
apply.) - • B Pupillary dilation is necessary to access the eye chamber for lens removal.
• C The iris must be paralyzed during surgery to prevent it from reacting to light.
E One of the medications is used to anesthetize the corneal surface.
An adult client presents to the clinic with large draining ulcers on both lower legs that
are characteristic of Kaposi's sarcoma lesions. The client is accompanied by two family
members. Which action should the nurse take? - • C Send family to the waiting area
while the client's history is taken.
The nurse is developing a teaching plan for a client with acute gastritis caused by
drinking contaminated water. The nurse should emphasize the need to report the onset
of which problem? - A Bloody mesis
The charge nurse in an extended care facility is organizing unit activities for the day.
Which action may be safely delegated to the practical nurse (PN)? - Establish blood
pressure parameters for client monitoring.
The school nurse is preparing a teaching pamphlet in response to requests from
parents regarding an outbreak of pinworms at the local preschool. Which information
about the most commonly prescribed medication, mebendazole, should be included? -
A Only children with perianal itching should take the medication.
A 3-year-old boy was successfully toilet trained prior to his admission to the hospital for
inuries sustained from a fall. His parents are very concerned that the child has
regressed in his toileting behaviors. Which information should the nurse provide to the
parents? - Children usually resume their toileting behaviors when they leave the
hospital.
The healthcare provider prescribes the antibiotic cefdinir 300 mg by mouth every 12
hours for a client with a postoperative wound infection.
Which foods should the nurse encourage this client to eat? - • B Yogurt or buttermilk.
A 10-year-old with acute decompensated heart failure has a 3 pound (1.4 kg) weight
gain in the last 24 hours. Which intervention is most important for the nurse to
implement? - Assess bilateral lung sounds.
, A client with delusions tells the nurse, "You aren't doing your job. Go get those people
over there and shoot them before they get me." Which statement is the nurse's best
response? - "You seem quite frightened right now."
The nurse is caring for a client who receives a prescription for valproic acid in which the
maximum safe dosage is 60 mg/kg/day. How many mg/day is the maximum safe
dosage for a client who weighs 176 pounds? (Enter numerical value only.) - 4800
The public health nurse receives funding to initiate a primary prevention program in the
community. Which program best fits the nurse's proposal? - Vitamin supplements for
high-risk pregnant women.
A client is admitted with the diagnosis of Wernicke's syndrome. Which assessment
finding should the nurse use in planning the client's care? - Confusion.
The nurse is caring for a client after a thoracentesis that drained 50 mL of clear fluid
from the left lung. Which assessment finding should the nurse report to the healthcare
provider immediately? - Mediastinal shift to the right.
A client arrives to the emergency department with chest pain after taking sildenafil.
Based on the client's history, which medication should the nurse withhold? -
Nitroglycerin.
Six weeks after the birth of a child with Trisomy 21, the parents return to the prenatal
clinic for a follow-up visit. They have spoken with a genetic counselor, but are still
unsure about the risk of having another child with Trisomy 21. The couple brings
literature from the counselor with them, and asks the nurse to explain it. Which action
should the nurse take? - Review the literature and answer any questions the nurse is
able to answer.
A client who is one day postpartum tells the nurse that her baby cannot latch onto the
breast. The nurse determines that the client's nipples are inverted. - Recommend using
a breast shield.
While a child is hospitalized with acute glomerulonephritis, the parents ask why blood
pressure readings are taken so often. Which response by the nurse is most accurate? -
Elevated blood pressure must be anticipated and identified quickly.
A week after admission to intensive care for a bowel obstruction, a client is confused to
time and place. The nurse frequently attempts to reorient the client but the client
remains confused. Which intervention should the nurse implement for the client's
safety? - Increase direct observation times.
A client who is obese reports severe pain and is unable to bear weight in the right ankle
after making dietary changes 3 weeks ago for weight loss. The client's medical history
includes hypertension, gouty arthritis, and cholecystitis. Which instruction should the
Save
A client is receiving ophthalmic drops preoperatively for a cataract extraction and asks
the nurse why the healthcare provider has prescribed all these medications. Which
information should the nurse included when responding to this client? (Select all that
apply.) - • B Pupillary dilation is necessary to access the eye chamber for lens removal.
• C The iris must be paralyzed during surgery to prevent it from reacting to light.
E One of the medications is used to anesthetize the corneal surface.
An adult client presents to the clinic with large draining ulcers on both lower legs that
are characteristic of Kaposi's sarcoma lesions. The client is accompanied by two family
members. Which action should the nurse take? - • C Send family to the waiting area
while the client's history is taken.
The nurse is developing a teaching plan for a client with acute gastritis caused by
drinking contaminated water. The nurse should emphasize the need to report the onset
of which problem? - A Bloody mesis
The charge nurse in an extended care facility is organizing unit activities for the day.
Which action may be safely delegated to the practical nurse (PN)? - Establish blood
pressure parameters for client monitoring.
The school nurse is preparing a teaching pamphlet in response to requests from
parents regarding an outbreak of pinworms at the local preschool. Which information
about the most commonly prescribed medication, mebendazole, should be included? -
A Only children with perianal itching should take the medication.
A 3-year-old boy was successfully toilet trained prior to his admission to the hospital for
inuries sustained from a fall. His parents are very concerned that the child has
regressed in his toileting behaviors. Which information should the nurse provide to the
parents? - Children usually resume their toileting behaviors when they leave the
hospital.
The healthcare provider prescribes the antibiotic cefdinir 300 mg by mouth every 12
hours for a client with a postoperative wound infection.
Which foods should the nurse encourage this client to eat? - • B Yogurt or buttermilk.
A 10-year-old with acute decompensated heart failure has a 3 pound (1.4 kg) weight
gain in the last 24 hours. Which intervention is most important for the nurse to
implement? - Assess bilateral lung sounds.
, A client with delusions tells the nurse, "You aren't doing your job. Go get those people
over there and shoot them before they get me." Which statement is the nurse's best
response? - "You seem quite frightened right now."
The nurse is caring for a client who receives a prescription for valproic acid in which the
maximum safe dosage is 60 mg/kg/day. How many mg/day is the maximum safe
dosage for a client who weighs 176 pounds? (Enter numerical value only.) - 4800
The public health nurse receives funding to initiate a primary prevention program in the
community. Which program best fits the nurse's proposal? - Vitamin supplements for
high-risk pregnant women.
A client is admitted with the diagnosis of Wernicke's syndrome. Which assessment
finding should the nurse use in planning the client's care? - Confusion.
The nurse is caring for a client after a thoracentesis that drained 50 mL of clear fluid
from the left lung. Which assessment finding should the nurse report to the healthcare
provider immediately? - Mediastinal shift to the right.
A client arrives to the emergency department with chest pain after taking sildenafil.
Based on the client's history, which medication should the nurse withhold? -
Nitroglycerin.
Six weeks after the birth of a child with Trisomy 21, the parents return to the prenatal
clinic for a follow-up visit. They have spoken with a genetic counselor, but are still
unsure about the risk of having another child with Trisomy 21. The couple brings
literature from the counselor with them, and asks the nurse to explain it. Which action
should the nurse take? - Review the literature and answer any questions the nurse is
able to answer.
A client who is one day postpartum tells the nurse that her baby cannot latch onto the
breast. The nurse determines that the client's nipples are inverted. - Recommend using
a breast shield.
While a child is hospitalized with acute glomerulonephritis, the parents ask why blood
pressure readings are taken so often. Which response by the nurse is most accurate? -
Elevated blood pressure must be anticipated and identified quickly.
A week after admission to intensive care for a bowel obstruction, a client is confused to
time and place. The nurse frequently attempts to reorient the client but the client
remains confused. Which intervention should the nurse implement for the client's
safety? - Increase direct observation times.
A client who is obese reports severe pain and is unable to bear weight in the right ankle
after making dietary changes 3 weeks ago for weight loss. The client's medical history
includes hypertension, gouty arthritis, and cholecystitis. Which instruction should the
