HESI QUESTION 2 REAL TEST (VERIFIED) SOLUTION 2021

1. Fall in home -- Nurse comes in and patient is on the ground-- What should the nurse do first?-- Assess for lacerations and fractures • 2. An elderly home is conducting surveys to see if the amount of falls is decreasing-- what indicates that the elderly home is improving?--decreased amount of hip fractures • 3. Prevention of tinea pedis-- Wear water shoes in public showers • 4. Patient has Allergic rhinitis--- Use saline spray frequently • 5. Aortobifemoral bypass patient---- Check distal pulses • 6. Ventilator alarm -- high pressure alarm is beeping--- check the patient-- Auscultate breath sounds • 7. Low pressure alarm is sounding--- Check machine • 8. Tympanic temp--- A UAP is taking an adult patients tympanic temperature and pulls the ear up and back-- What should the nurse do?--- Reassure-- she is doing it right • 9. A patient is catheterized and 50 ml urine comes out--What should the nurse do?-- Allow bladder to empty completely or up to 1000 ml • 10. What is the purpose of the Log rolling technique-- To maintain spinal alignment • 11. A patient in droplet precautions needs to be transported outside the room to do an x-ray or something but does not want to remove his glasses to put on the mask-- What should the nurse do?-- Put on the mask below his glasses • 12. A patient is described with all items to oxygen machine in place and on except the oxygen disconnected from oxygen flow-- What does the nurse do?-- reconnect the patient to oxygen flow • 13. PICTURE (Restraints)-- The nurse enters a patient's room to find the patients wrist restraint tied to the side rail--What should the nurse do?-- Reposition the restraint tie onto