PRIORITIZING HESI QUESTIONS WITH DETAILED
VERIFIED AND 100% ACCURATE ANSWERS
In which order would the nurse implement the interventions for a client
who sustained a soft tissue injury ?
1. Assess the neurovascular status
2. Obtain x - rays of the extremity
3. Elevate the involved limb
4. Apply a compression bandage Correct Answers 1, 3, 4, 2
Which client complication involving a simple venous catheter requires
the nurse to assess history of catheter use ?
1. Catheter rupture
2. Catheter migration
3. Catheter dislodgement
4. Catheter lumen occlusion . Correct Answers 4
Rationale The nurse must assess the history of catheter use in cases of
catheter lumen occlusion , Cases such catheter rupture can be resolved
by repairing the damaged segment using the repair kit designed for the
specific brand of catheter . In the case of both catheter migration and
dislodgement , the nurse would stop the infusion and flush the catheter .
In case of migration , the nurse would notify the primary health care
provider . In case of dislodgement , the nurse would never readvance the
catheter into the insertion site .
client who has arrived at the medical - surgical unit after discharge from
the postanesthesia Which observation would the nurse make first in a
focused assessment of the airway of a care unit ?
,1. O If the client's neck is in proper alignment
2. Rate and the depth of the respirations O
3. Quality and the pattern of the breathing
4. If the client is using accessory muscles to breathe Correct Answers 1
Which statement made by a client who underwent a myringotomy
indicates to the nurse the need for further postoperative teaching ?
1. can wash my hair after 2 days .
2. " should refrain from air travel for 2 to 3 weeks .
3. " need to change the ear dressing every 24 hours . "
4. should stay away from people with respiratory infections . " Correct
Answers 1
Rationale The priority care to be taken after a myringotomy is to keep
the external ear and ear canal clean and dry while . the incision is
healing . Hair should not be washed for several days . The client is to
refrain from air travel for 2 to 3 weeks after surgery , because the ear
may be disturbed by the high altitudes . The ear dressing can be changed
by every 24 hours . The client should stay away from others with
respiratory infections to prevent infections to the incision site and
affected ear .
Which intervention would the nurse perform first for a client with a
spinal cord injury who is experiencing autonomic dysreflexia ?
1.Assess for the cause .
2. Place the client in sitting position
3. Check the client for fecal impaction .
, 4. OGive an alpha blocker prophylactically . Correct Answers 2
which order would the nurse provide care for a client injured with
frostbite
1. Rewarm in a water bath at a temperature of 106 ° F
2. Elevate the injured areas above the heart level
3. Observe for signs of frostbite and preventing further tissue damage
4. Assess for the development of compartment syndrome Correct
Answers 3. 1, 2, 4 inorder
Which nursing intervention would the nurse perform first for a client
with multiple injuries resulting from a severe motor vehicle accident ?
1. Provide bag - valve - mask ventilation
2. Administer glucose by intravenous ( IV ) route
3. Apply direct pressure to the severe bleeding areas
4. Insert large - bore peripheral intravenous ( IV ) lines in the antecubital
area Correct Answers 1,
Then 2, 3, 4 in order
For which client condition would the triage nurse assign a red tag based
on priority ?
1. O Arrhythmia
2. Pressure injuries
3. Abdominal trauma
4. Second - degree burns Correct Answers 3
VERIFIED AND 100% ACCURATE ANSWERS
In which order would the nurse implement the interventions for a client
who sustained a soft tissue injury ?
1. Assess the neurovascular status
2. Obtain x - rays of the extremity
3. Elevate the involved limb
4. Apply a compression bandage Correct Answers 1, 3, 4, 2
Which client complication involving a simple venous catheter requires
the nurse to assess history of catheter use ?
1. Catheter rupture
2. Catheter migration
3. Catheter dislodgement
4. Catheter lumen occlusion . Correct Answers 4
Rationale The nurse must assess the history of catheter use in cases of
catheter lumen occlusion , Cases such catheter rupture can be resolved
by repairing the damaged segment using the repair kit designed for the
specific brand of catheter . In the case of both catheter migration and
dislodgement , the nurse would stop the infusion and flush the catheter .
In case of migration , the nurse would notify the primary health care
provider . In case of dislodgement , the nurse would never readvance the
catheter into the insertion site .
client who has arrived at the medical - surgical unit after discharge from
the postanesthesia Which observation would the nurse make first in a
focused assessment of the airway of a care unit ?
,1. O If the client's neck is in proper alignment
2. Rate and the depth of the respirations O
3. Quality and the pattern of the breathing
4. If the client is using accessory muscles to breathe Correct Answers 1
Which statement made by a client who underwent a myringotomy
indicates to the nurse the need for further postoperative teaching ?
1. can wash my hair after 2 days .
2. " should refrain from air travel for 2 to 3 weeks .
3. " need to change the ear dressing every 24 hours . "
4. should stay away from people with respiratory infections . " Correct
Answers 1
Rationale The priority care to be taken after a myringotomy is to keep
the external ear and ear canal clean and dry while . the incision is
healing . Hair should not be washed for several days . The client is to
refrain from air travel for 2 to 3 weeks after surgery , because the ear
may be disturbed by the high altitudes . The ear dressing can be changed
by every 24 hours . The client should stay away from others with
respiratory infections to prevent infections to the incision site and
affected ear .
Which intervention would the nurse perform first for a client with a
spinal cord injury who is experiencing autonomic dysreflexia ?
1.Assess for the cause .
2. Place the client in sitting position
3. Check the client for fecal impaction .
, 4. OGive an alpha blocker prophylactically . Correct Answers 2
which order would the nurse provide care for a client injured with
frostbite
1. Rewarm in a water bath at a temperature of 106 ° F
2. Elevate the injured areas above the heart level
3. Observe for signs of frostbite and preventing further tissue damage
4. Assess for the development of compartment syndrome Correct
Answers 3. 1, 2, 4 inorder
Which nursing intervention would the nurse perform first for a client
with multiple injuries resulting from a severe motor vehicle accident ?
1. Provide bag - valve - mask ventilation
2. Administer glucose by intravenous ( IV ) route
3. Apply direct pressure to the severe bleeding areas
4. Insert large - bore peripheral intravenous ( IV ) lines in the antecubital
area Correct Answers 1,
Then 2, 3, 4 in order
For which client condition would the triage nurse assign a red tag based
on priority ?
1. O Arrhythmia
2. Pressure injuries
3. Abdominal trauma
4. Second - degree burns Correct Answers 3
