___________)(&)$*&!)($)(*&&*^(&(#()))))))))))))))))))))))))))))))_______________________________________________________________
_________________________________________________________________________________________________________
Hurst Readiness Exam 3 Questions with Complete Answers with Rationales.pdfHurst Readiness Exam 3 Questions with Complete A
Hurst Readiness Exam 3 Questions with
Complete Answers with Rationales
Which menu selection by the client diagnosed with nephrotic syndrome indicates that teaching of
proper diet was understood? You answered this question Correctly 1. Pancakes with whipped butter,
syrup, bacon, apple juice 2. Scrambled eggs, sliced turkey, biscuit, whole milk 3. Grits, fresh fruit, toast,
coffee 4. Bagel with jelly, hash browns, tea
Rationale
2. Correct: Client needs low sodium and increased proteins. 1. Incorrect: This selection is too high in
sodium and fats. 3. Incorrect: This selection has no protein. Remember, nephrotic syndrome is the
exception to the rule of limiting protein. These clients need increased protein to compensate for the
large loss of protein in the urine. 4. Incorrect: This selection has no protein. Remember, nephrotic
syndrome is the exception to the rule of limiting protein. These clients need increased protein to
compensate for the large loss of protein in the urine.
Following a total hip replacement, the nurse provides discharge teaching to the client. The nurse knows
that teaching was effective when the client states which activities are safe to perform? You answered
this question Correctly 1. Using an abduction pillow while sleeping 2. Crossing the legs 3. Using a toilet
extender 4. Showering rather than taking a bath 5. Tying shoes
RationaleStrategies 1., 3., & 4. Correct: The client should use an abduction pillow to keep hip in proper
alignment and prevent hip dislocation. A toilet extender keeps the hip in proper alignment and prevents
hip dislocation. Showering rather than sitting in a tub will prevent flexion of the hip. 2. Incorrect:
Crossing the leg can pop the hip out of place and prevent total healing and success with the
replacement. 5. Incorrect: To tie shoes, the client has to bend over which can pop the hip out of place.
The client would need to have shoes that do not require tying or have someone do it for them.
What risk factors should the nurse include when conducting a class about type 2 diabetes mellitus? You
answered this question Correctly 1. Fat distribution greater in abdomen than in hips. 2. Being
underweight. 3. Having type 1 diabetes as a child increases risk for type 2 diabetes. 4. Caucasians are
more likely to develop type 2 diabetes than Hispanics. 5. Polycystic ovary syndrome.
___________)(&)$*&!)($)(*&&*^(&(#()))))))))))))))))))))))))))))))_______________________________________________________________
_________________________________________________________________________________________________________
Hurst Readiness Exam 3 Questions with Complete Answers with Rationales.pdf!#()*_*$_!*$__________________________)(&)$*&
,___________)(&)$*&!)($)(*&&*^(&(#()))))))))))))))))))))))))))))))_______________________________________________________________
_________________________________________________________________________________________________________
Hurst Readiness Exam 3 Questions with Complete Answers with Rationales.pdfHurst Readiness Exam 3 Questions with Complete A
RationaleStrategies 1., & 5. Correct: If the body stores fat primarily in the abdomen, risk of type 2
diabetes is greater than if body stores fat elsewhere, such as hips and thighs. Women with polycystic
ovary syndrome have increased risk of diabetes. 2. Incorrect: Being overweight is a primary risk factor
for type 2 diabetes. The more fatty tissue, the more resistant cells become to insulin. 3. Incorrect: A type
1 diabetic will remain a type 1 diabetic. 4. Incorrect: African Americans, Hispanics, American Indians, and
Asian Americans are more likely to develop type 2 diabetes than Caucasians are.
The nurse is caring for a client following spinal surgery. The client is placed on methylprednisolone.
What additional drug therapy would the nurse expect to be prescribed with methylprednisolone? You
answered this question Correctly 1. Pantoprazole 2. Phenytoin 3. Imipramine HCI 4. Aminocaproic acid
RationaleStrategies 1. Correct: A potential side effect of methylprednisolone is a peptic ulcer. The
primary healthcare provider will prescribe a proton pump inhibitor or H2 blocker to prevent this side
effect. 2. Incorrect: Phenytoin is an anticonvulsant. Seizures are not a side effect of methylprednisolone.
3. Incorrect: Imipramine HCI is an antidepressant which is not routinely given with methylprednisolone
(Although mood changes can occur with steroid administration, anti-depressants are not routinely
given). 4. Incorrect: Aminocaproic acid is given when clients are bleeding. Bleeding is not a side effect of
methylprednisolone.
In what order, after initially washing hands, should the nurse change a dressing on an infected
abdominal surgical wound that has a Penrose drain and a large amount of purulent drainage? Place in
priority order from first to last. You answered this question CorrectlyThe Correct Order Apply clean
gloves. Remove soiled dressings. Discard soiled dressings and clean gloves in red bag. Don sterile gloves.
Clean surgical wound with moistened sterile 4x4's. Clean around Penrose drain using a circular pattern
inside to outside. Place dry, sterile 4x4's over surgical wound and Penrose drain. Apply abdominal
dressing pad. Your Selected Order Apply clean gloves. Remove soiled dressings. Discard soiled dressings
and clean gloves in red bag. Don sterile gloves. Clean surgical wound with moistened sterile 4x4's. Clean
around Penrose drain using a circular pattern inside to outside. Place dry, sterile 4x4's over surgical
wound and Penrose drain. Apply abdominal dressing pad.
RationaleStrategies First, apply clean gloves. Second, remove soiled dressings. Third, discard soiled
dressings and clean gloves in red bag. Fourth, don sterile gloves. Fifth, clean surgical wound with
moistened sterile 4x4's. Sixth, clean around Penrose drain using circular pattern inside to outside.
Seventh, place dry, sterile 4x4's over surgical wound and Penrose drain. Eighth, apply abdominal
dressing pad.
___________)(&)$*&!)($)(*&&*^(&(#()))))))))))))))))))))))))))))))_______________________________________________________________
_________________________________________________________________________________________________________
Hurst Readiness Exam 3 Questions with Complete Answers with Rationales.pdf!#()*_*$_!*$__________________________)(&)$*&
,___________)(&)$*&!)($)(*&&*^(&(#()))))))))))))))))))))))))))))))_______________________________________________________________
_________________________________________________________________________________________________________
Hurst Readiness Exam 3 Questions with Complete Answers with Rationales.pdfHurst Readiness Exam 3 Questions with Complete A
A client diagnosed with schizophrenia who is taking monthly haloperidol injections develops slurred
speech, shuffling gait and drooling. Which prescribed PRN medication would the nurse administer? You
answered this question Incorrectly 1. Lorazepam 2. Atropine 3. Benztropine 4. Chlorpromazine
RationaleStrategies 3. Correct: These signs and symptoms are reflective of pseudoparkinsonism, a form
of extrapyramidal side effects which are side effects of the haloperidol. An anticholinergic agent maybe
used for treatment. This is an anticholinergic agent that may be used for extrapyramidal side effects. 1.
Incorrect: This is a sedative/hypnotic or antianxiety agent. It is not used for treatment of extrapyramidal
side effects. 2. Incorrect: This is an anticholinergic agent, but not one commonly used to treat
pseudoparkinsonism, a form of extrapyramidal side effects. It is commonly used to treat arrhythmias
and preoperatively to decrease secretions. 4. Incorrect: This is another antipsychotic medication.
A nurse is caring for a client who reports fatigue, weight loss, afternoon fevers, night sweats, cough, and
hemoptysis. What interventions should the nurse initiate? You answered this question Correctly 1. Wear
an N95 respirator when caring for client. 2. Restrict fluid intake to 500 mL per day. 3. Position client in
semi-Fowler's position. 4. Place client in a negative pressure airflow room. 5. Do not allow visitors for 48
hours.
RationaleStrategies 1., 3. & 4. Correct: The nurse should suspect that the client is suffering from
tuberculosis. Early pulmonary TB is asymptomatic. When the bacterial load increases, nonspecific
symptoms of fatigue, weight loss, afternoon fevers, and night sweats may set in. As disease advances,
cough, sputum production, and hemoptysis may appear. This client has the classic symptoms of TB and
should be placed on airborne precautions. N95 respirator ensures that the nurse does not inhale the TB
organism. Placing in a semi-Fowler's position reduces the work of breathing. 2. Incorrect: Unless
contraindicated, 3-4 liters of fluid is needed per day to liquefy secretions. 5. Incorrect: Visitors are
allowed if standard and airborne precautions are followed.
Which task should the nurse perform first? You answered this question Correctly 1. Suctioning the
tracheostomy. 2. Changing a colostomy bag that is leaking. 3. Performing an admission assessment on a
client. 4. Administering pain medication to a postoperative client.
RationaleStrategies 1. Correct: The tracheostomy tube must be suctioned to keep the client's airway
open. Suctioning the tracheostomy should take priority. Remember, airway first. 2. Incorrect: The client
may be uncomfortable from the colostomy bag leaking. This task can be delegated. The suctioning of the
client does not have priority over airway. 3. Incorrect: Important, but not priority over airway. There is
no indication from the question that the new client is in distress. The priority intervention is to maintain
the airway. 4. Incorrect: Important, but it does not take priority over airway.
___________)(&)$*&!)($)(*&&*^(&(#()))))))))))))))))))))))))))))))_______________________________________________________________
_________________________________________________________________________________________________________
Hurst Readiness Exam 3 Questions with Complete Answers with Rationales.pdf!#()*_*$_!*$__________________________)(&)$*&
,___________)(&)$*&!)($)(*&&*^(&(#()))))))))))))))))))))))))))))))_______________________________________________________________
_________________________________________________________________________________________________________
Hurst Readiness Exam 3 Questions with Complete Answers with Rationales.pdfHurst Readiness Exam 3 Questions with Complete A
A nurse is caring for a client hospitalized with Guillain-Barre syndrome. Which is the most important
nursing measure to include in the nursing care plan for this client? You answered this question Correctly
1. Observation and support of ventilation 2. Insertion of indwelling urinary catheter 3. Nasogastric
suctioning 4. Frequent assessments of level of consciousness
RationaleStrategies 1. Correct: Guillain-Barre syndrome is an acquired inflammatory disease that results
in demyelinization of the peripheral nerves. It is usually ascending in nature and can lead to respiratory
paresis or paralysis. 2. Incorrect: Insertion of an indwelling urinary catheter may in fact be necessary but
does not prioritize higher than support of ventilation. 3. Incorrect: Nasogastric suctioning is not a need
identified with Guillain-Barre syndrome. Guillain-Barre does not affect the LOC. 4. Incorrect: The client's
cognitive function remains intact, and there is no data in the stem of the question that indicates
otherwise; therefore, ventilation is the priority.
The nurse recognizes that treatment has been successful in resolving fluid volume excess based on
which assessment findings? You answered this question Correctly 1. Continued lethargy 2. Heart rate
112/min 3. Decreasing shortness of breath 4. BP 114/78 5. Increased thirst
RationaleStrategies 3. & 4. Correct: Urinary output should increase with decreasing shortness of breath
as hydration is corrected, and BP should be normal. 1. Incorrect: Level of consciousness (LOC) should
improve with perfusion to the brain. 2. Incorrect: Heart rate should decrease if hydration is corrected. 5.
Incorrect: Thirst level should be decreased if hydration is corrected.
The oncoming nurse has just received report and is preparing to make initial rounds. Which postpartum
client should the nurse see first? You answered this question Correctly 1. A primipara 6 hours
postpartum saturating one peripad every two hours 2. A multigravida 1 hour postpartum and reporting
intense perineal pain 3. A primigravida 12 hours postpartum with the uterine fundus at the umbilicus 4.
A multigravida 72 hours postpartum with a brownish pink lochia discharge.
RationaleStrategies 2. Correct: Intense perineal pain is a symptom of a perineal hematoma which is a
medical emergency. 1. Incorrect: Expected findings for the postpartum period are described here. This is
a normal peripad saturation and does not indicate a problem. 3. Incorrect: Expected findings for the
postpartum period are described here. This is the proper position of the fundus 12 hours postpartum. 4.
Incorrect: Expected findings for the postpartum period are described here also. A client postpartal 72
hours should have a brownish pink lochia discharge.
___________)(&)$*&!)($)(*&&*^(&(#()))))))))))))))))))))))))))))))_______________________________________________________________
_________________________________________________________________________________________________________
Hurst Readiness Exam 3 Questions with Complete Answers with Rationales.pdf!#()*_*$_!*$__________________________)(&)$*&
_________________________________________________________________________________________________________
Hurst Readiness Exam 3 Questions with Complete Answers with Rationales.pdfHurst Readiness Exam 3 Questions with Complete A
Hurst Readiness Exam 3 Questions with
Complete Answers with Rationales
Which menu selection by the client diagnosed with nephrotic syndrome indicates that teaching of
proper diet was understood? You answered this question Correctly 1. Pancakes with whipped butter,
syrup, bacon, apple juice 2. Scrambled eggs, sliced turkey, biscuit, whole milk 3. Grits, fresh fruit, toast,
coffee 4. Bagel with jelly, hash browns, tea
Rationale
2. Correct: Client needs low sodium and increased proteins. 1. Incorrect: This selection is too high in
sodium and fats. 3. Incorrect: This selection has no protein. Remember, nephrotic syndrome is the
exception to the rule of limiting protein. These clients need increased protein to compensate for the
large loss of protein in the urine. 4. Incorrect: This selection has no protein. Remember, nephrotic
syndrome is the exception to the rule of limiting protein. These clients need increased protein to
compensate for the large loss of protein in the urine.
Following a total hip replacement, the nurse provides discharge teaching to the client. The nurse knows
that teaching was effective when the client states which activities are safe to perform? You answered
this question Correctly 1. Using an abduction pillow while sleeping 2. Crossing the legs 3. Using a toilet
extender 4. Showering rather than taking a bath 5. Tying shoes
RationaleStrategies 1., 3., & 4. Correct: The client should use an abduction pillow to keep hip in proper
alignment and prevent hip dislocation. A toilet extender keeps the hip in proper alignment and prevents
hip dislocation. Showering rather than sitting in a tub will prevent flexion of the hip. 2. Incorrect:
Crossing the leg can pop the hip out of place and prevent total healing and success with the
replacement. 5. Incorrect: To tie shoes, the client has to bend over which can pop the hip out of place.
The client would need to have shoes that do not require tying or have someone do it for them.
What risk factors should the nurse include when conducting a class about type 2 diabetes mellitus? You
answered this question Correctly 1. Fat distribution greater in abdomen than in hips. 2. Being
underweight. 3. Having type 1 diabetes as a child increases risk for type 2 diabetes. 4. Caucasians are
more likely to develop type 2 diabetes than Hispanics. 5. Polycystic ovary syndrome.
___________)(&)$*&!)($)(*&&*^(&(#()))))))))))))))))))))))))))))))_______________________________________________________________
_________________________________________________________________________________________________________
Hurst Readiness Exam 3 Questions with Complete Answers with Rationales.pdf!#()*_*$_!*$__________________________)(&)$*&
,___________)(&)$*&!)($)(*&&*^(&(#()))))))))))))))))))))))))))))))_______________________________________________________________
_________________________________________________________________________________________________________
Hurst Readiness Exam 3 Questions with Complete Answers with Rationales.pdfHurst Readiness Exam 3 Questions with Complete A
RationaleStrategies 1., & 5. Correct: If the body stores fat primarily in the abdomen, risk of type 2
diabetes is greater than if body stores fat elsewhere, such as hips and thighs. Women with polycystic
ovary syndrome have increased risk of diabetes. 2. Incorrect: Being overweight is a primary risk factor
for type 2 diabetes. The more fatty tissue, the more resistant cells become to insulin. 3. Incorrect: A type
1 diabetic will remain a type 1 diabetic. 4. Incorrect: African Americans, Hispanics, American Indians, and
Asian Americans are more likely to develop type 2 diabetes than Caucasians are.
The nurse is caring for a client following spinal surgery. The client is placed on methylprednisolone.
What additional drug therapy would the nurse expect to be prescribed with methylprednisolone? You
answered this question Correctly 1. Pantoprazole 2. Phenytoin 3. Imipramine HCI 4. Aminocaproic acid
RationaleStrategies 1. Correct: A potential side effect of methylprednisolone is a peptic ulcer. The
primary healthcare provider will prescribe a proton pump inhibitor or H2 blocker to prevent this side
effect. 2. Incorrect: Phenytoin is an anticonvulsant. Seizures are not a side effect of methylprednisolone.
3. Incorrect: Imipramine HCI is an antidepressant which is not routinely given with methylprednisolone
(Although mood changes can occur with steroid administration, anti-depressants are not routinely
given). 4. Incorrect: Aminocaproic acid is given when clients are bleeding. Bleeding is not a side effect of
methylprednisolone.
In what order, after initially washing hands, should the nurse change a dressing on an infected
abdominal surgical wound that has a Penrose drain and a large amount of purulent drainage? Place in
priority order from first to last. You answered this question CorrectlyThe Correct Order Apply clean
gloves. Remove soiled dressings. Discard soiled dressings and clean gloves in red bag. Don sterile gloves.
Clean surgical wound with moistened sterile 4x4's. Clean around Penrose drain using a circular pattern
inside to outside. Place dry, sterile 4x4's over surgical wound and Penrose drain. Apply abdominal
dressing pad. Your Selected Order Apply clean gloves. Remove soiled dressings. Discard soiled dressings
and clean gloves in red bag. Don sterile gloves. Clean surgical wound with moistened sterile 4x4's. Clean
around Penrose drain using a circular pattern inside to outside. Place dry, sterile 4x4's over surgical
wound and Penrose drain. Apply abdominal dressing pad.
RationaleStrategies First, apply clean gloves. Second, remove soiled dressings. Third, discard soiled
dressings and clean gloves in red bag. Fourth, don sterile gloves. Fifth, clean surgical wound with
moistened sterile 4x4's. Sixth, clean around Penrose drain using circular pattern inside to outside.
Seventh, place dry, sterile 4x4's over surgical wound and Penrose drain. Eighth, apply abdominal
dressing pad.
___________)(&)$*&!)($)(*&&*^(&(#()))))))))))))))))))))))))))))))_______________________________________________________________
_________________________________________________________________________________________________________
Hurst Readiness Exam 3 Questions with Complete Answers with Rationales.pdf!#()*_*$_!*$__________________________)(&)$*&
,___________)(&)$*&!)($)(*&&*^(&(#()))))))))))))))))))))))))))))))_______________________________________________________________
_________________________________________________________________________________________________________
Hurst Readiness Exam 3 Questions with Complete Answers with Rationales.pdfHurst Readiness Exam 3 Questions with Complete A
A client diagnosed with schizophrenia who is taking monthly haloperidol injections develops slurred
speech, shuffling gait and drooling. Which prescribed PRN medication would the nurse administer? You
answered this question Incorrectly 1. Lorazepam 2. Atropine 3. Benztropine 4. Chlorpromazine
RationaleStrategies 3. Correct: These signs and symptoms are reflective of pseudoparkinsonism, a form
of extrapyramidal side effects which are side effects of the haloperidol. An anticholinergic agent maybe
used for treatment. This is an anticholinergic agent that may be used for extrapyramidal side effects. 1.
Incorrect: This is a sedative/hypnotic or antianxiety agent. It is not used for treatment of extrapyramidal
side effects. 2. Incorrect: This is an anticholinergic agent, but not one commonly used to treat
pseudoparkinsonism, a form of extrapyramidal side effects. It is commonly used to treat arrhythmias
and preoperatively to decrease secretions. 4. Incorrect: This is another antipsychotic medication.
A nurse is caring for a client who reports fatigue, weight loss, afternoon fevers, night sweats, cough, and
hemoptysis. What interventions should the nurse initiate? You answered this question Correctly 1. Wear
an N95 respirator when caring for client. 2. Restrict fluid intake to 500 mL per day. 3. Position client in
semi-Fowler's position. 4. Place client in a negative pressure airflow room. 5. Do not allow visitors for 48
hours.
RationaleStrategies 1., 3. & 4. Correct: The nurse should suspect that the client is suffering from
tuberculosis. Early pulmonary TB is asymptomatic. When the bacterial load increases, nonspecific
symptoms of fatigue, weight loss, afternoon fevers, and night sweats may set in. As disease advances,
cough, sputum production, and hemoptysis may appear. This client has the classic symptoms of TB and
should be placed on airborne precautions. N95 respirator ensures that the nurse does not inhale the TB
organism. Placing in a semi-Fowler's position reduces the work of breathing. 2. Incorrect: Unless
contraindicated, 3-4 liters of fluid is needed per day to liquefy secretions. 5. Incorrect: Visitors are
allowed if standard and airborne precautions are followed.
Which task should the nurse perform first? You answered this question Correctly 1. Suctioning the
tracheostomy. 2. Changing a colostomy bag that is leaking. 3. Performing an admission assessment on a
client. 4. Administering pain medication to a postoperative client.
RationaleStrategies 1. Correct: The tracheostomy tube must be suctioned to keep the client's airway
open. Suctioning the tracheostomy should take priority. Remember, airway first. 2. Incorrect: The client
may be uncomfortable from the colostomy bag leaking. This task can be delegated. The suctioning of the
client does not have priority over airway. 3. Incorrect: Important, but not priority over airway. There is
no indication from the question that the new client is in distress. The priority intervention is to maintain
the airway. 4. Incorrect: Important, but it does not take priority over airway.
___________)(&)$*&!)($)(*&&*^(&(#()))))))))))))))))))))))))))))))_______________________________________________________________
_________________________________________________________________________________________________________
Hurst Readiness Exam 3 Questions with Complete Answers with Rationales.pdf!#()*_*$_!*$__________________________)(&)$*&
,___________)(&)$*&!)($)(*&&*^(&(#()))))))))))))))))))))))))))))))_______________________________________________________________
_________________________________________________________________________________________________________
Hurst Readiness Exam 3 Questions with Complete Answers with Rationales.pdfHurst Readiness Exam 3 Questions with Complete A
A nurse is caring for a client hospitalized with Guillain-Barre syndrome. Which is the most important
nursing measure to include in the nursing care plan for this client? You answered this question Correctly
1. Observation and support of ventilation 2. Insertion of indwelling urinary catheter 3. Nasogastric
suctioning 4. Frequent assessments of level of consciousness
RationaleStrategies 1. Correct: Guillain-Barre syndrome is an acquired inflammatory disease that results
in demyelinization of the peripheral nerves. It is usually ascending in nature and can lead to respiratory
paresis or paralysis. 2. Incorrect: Insertion of an indwelling urinary catheter may in fact be necessary but
does not prioritize higher than support of ventilation. 3. Incorrect: Nasogastric suctioning is not a need
identified with Guillain-Barre syndrome. Guillain-Barre does not affect the LOC. 4. Incorrect: The client's
cognitive function remains intact, and there is no data in the stem of the question that indicates
otherwise; therefore, ventilation is the priority.
The nurse recognizes that treatment has been successful in resolving fluid volume excess based on
which assessment findings? You answered this question Correctly 1. Continued lethargy 2. Heart rate
112/min 3. Decreasing shortness of breath 4. BP 114/78 5. Increased thirst
RationaleStrategies 3. & 4. Correct: Urinary output should increase with decreasing shortness of breath
as hydration is corrected, and BP should be normal. 1. Incorrect: Level of consciousness (LOC) should
improve with perfusion to the brain. 2. Incorrect: Heart rate should decrease if hydration is corrected. 5.
Incorrect: Thirst level should be decreased if hydration is corrected.
The oncoming nurse has just received report and is preparing to make initial rounds. Which postpartum
client should the nurse see first? You answered this question Correctly 1. A primipara 6 hours
postpartum saturating one peripad every two hours 2. A multigravida 1 hour postpartum and reporting
intense perineal pain 3. A primigravida 12 hours postpartum with the uterine fundus at the umbilicus 4.
A multigravida 72 hours postpartum with a brownish pink lochia discharge.
RationaleStrategies 2. Correct: Intense perineal pain is a symptom of a perineal hematoma which is a
medical emergency. 1. Incorrect: Expected findings for the postpartum period are described here. This is
a normal peripad saturation and does not indicate a problem. 3. Incorrect: Expected findings for the
postpartum period are described here. This is the proper position of the fundus 12 hours postpartum. 4.
Incorrect: Expected findings for the postpartum period are described here also. A client postpartal 72
hours should have a brownish pink lochia discharge.
___________)(&)$*&!)($)(*&&*^(&(#()))))))))))))))))))))))))))))))_______________________________________________________________
_________________________________________________________________________________________________________
Hurst Readiness Exam 3 Questions with Complete Answers with Rationales.pdf!#()*_*$_!*$__________________________)(&)$*&
