Hesi Leadership Exit exam Version 2 Already Passed

Hesi Leadership Exit exam Version 2 Already Passed 1.A nurse is performing telephone triage at the clinic office. Which client has the most acute problem and should be scheduled for the first available appointment? A 21 year old with a history of a kidney transplant. Today the client reports flu-like symptoms with a fever of 100.4 F (38 C) 2.The nurse is admitting a woman who has an arteriovenous (AV) fistula in her right arm that is used for hemodialysis. She missed her last hemodialysis session and is experiencing shortness of breath and an irregular heartbeat. Which action should the nurse assign to the UPA who is working with the nurse? Measure Vital Signs 3.The nurse should assess the client with which problem first? Paresthesia secondary to an arterial occlusion 4.A young adult client with a brain tumor refuses further treatment and requests to be allowed to die a natural death. The healthcare provides does not agree with the client's decision and refuses to write do-not-resuscitate instructions. Which action should the nurse take? Initiate a review of the situation by the hospital's ethics committee. 5.A healthcare provider notifies the nurse that new prescriptions have been written for a client. Which is the 1st action the nurse should implement? Read all of the new prescriptions for the client written by the provider 6.The nurse is observing the staff provide care to a client with acquired immune deficiency syndrome Unlicensed assistive personnel wearing a mask to take client's blood pressure. 7.The nurse caring for a client with bacterial meningitis is preparing report for the oncoming nurse. It is most important to include which assessment finding in the report? Increasing Pulse Pressure 8.The charge nurse notices that a respiratory therapist who has been cross-trained to work as a phlebotomist and unlicensed assistive personnel (UAP) seems to be avoiding HIV positive clients Provide the employee with feedback about observed behavior 9.The nursing supervisor sends an unlicensed assistant personnel ( UAP) to a medical unit to replace an absent UAP. When delegating the task of obtaining client's blood sugar levels using a glucometer, which action is most important for the nurse to implement? Observe the UAP obtain a fingerstick glucose level using the glucometer. 10.The nurse manager conducts regular audits of patient care medication records and notices that the amount of narcotic pain medications administered during the evening shift on a postsurgical unit Conduct a closer examination of staff nurse's distribution of pain medication from evening shift 11.The smell of cigarette smoke is coming from a client's bathroom. Which action should the nurse Educate the client about the hospital smoking policy. 12.The practical nurse (PN) reports to the charge nurse that the transparent dressing covering a single lumen central venous catheter inserted in the subclavian vein of a client has come loose and the insertion site is inflamed. Which action should the charge nurse implement? Confirm the findings of the PN while securing the transparent dressing and notify the healthcare provider. 13.At 0200 the nurse phones the healthcare provider to request a PRN medication for a client who is unable to sleep. The healthcare provider is awakened and gives the nurse a prescription for four times the normal dosage. When questioned by the nurse, the healthcare provider responds in a sleepy Call the healthcare or back, and report that the dosage prescribed is our times the normal dosage. 14.The charge nurse notices that a female practical nurse (PN), who has a long work history on the unit and is a valued employee, seems tired and slow to respond verbally during the change of shift report. One hour later the charge nurse overhears the PN telling an unlicensed assistive personnel (UAP) that she took a sleeping pill 4 hours ago and she is still feeling its effects. Which action should the charge nurse take? Send the PN to the employee health center for a urine drug Screen 15.It is most important to assign which client to a registered nurse rather than a practical nurse? After ambulating, a postoperative client grimaces and reports incisional pain at a "9" on a point scale. 16.After receiving a change of shift report for clients on a medical surgical unit, which task should the nurse Apply hydrocolloid dressings to venous 17.The charge nurse observes unlicensed assistive personnel (UAP) and a nurse arguing at the nurse's station. What action is best for the charge nurse to implement? Inform both individuals that their behavior is inappropriate in a work setting 18.A male client with metastatic lung cancer has requested that "no heroic measures" are used to extend his life, so the healthcare provider prescribes transferring the client to the palliative care Ensure the prescriptions or transfer include the client's end-of-life choice. 19.The charge nurse observes that a client with a nasogastric tube applied to low intermittent suction is drinking a glass of water immediately after the unlicensed assistive personnel (UAP) left the room. What is the best initial action for the charge nurse to take. Remove the glass of water and speak to the UAP. 20.The nurse hears a newly employed unlicensed assistive personnel (UAP) who is working in a long-term care facility calling the adult residents "honey" and "dearie." What is the best action for the nurse to take? Meet with the UAP to discuss respectful client care strategies. 21.The charge nurse is providing instructions to unlicensed assistive personnel (UAP) who will be assisting with the care of a client who has a hiatal hernia. Which instruction should the charge provide the UPA? Elevate the head of the bed before the client begins to eat 22.A nurse (RN), practical nurse (PN), and unlicensed assistive personnel (UAP) are working as a team to provide care for an acutely ill client requiring immediate bedside insertion of a chest tube. Which assignment is best use of each persons skills? The UAP obtains oxygen saturation level while the RN reports findings to the healthcare provider 23.The nurse is caring for a group of clients with the help of an experienced unlicensed assistive personnel UAP . Several specimens need to be collected and sent to the lab. Wich specimen collection can the nurse delegate to the UAP? Urine from indwelling catheter. Fecal drainage sample. 24.The nurse observes that a practical nurse (PN) charted that wound care was performed on a client. However, the nurse's assessment indicates that the date on the dressing is 2 days old, and the dressing does not appear to have been changed since the date noted. Which is the best initial intervention Consult with the PN about the discrepancy 25.After reviewing the morning laboratory findings for four clients, which client should the nurse follow-up The BNP assay for a client with shortness of breath after a MI increases to 1000 pg/mL. 26.After receiving morning report on an acute care unit, which client should the nurse assess first? A client sitting close to the nurse's station who has been restrained the past six hours 27.An older woman with a long history of hypertension is transferred from a long-term care facility to the hospital intensive care unit because of an exacerbation of heart failure (HF). She has a signed and witnessed "do not resuscitate" from in her record. Which action should the nurse take? Confirm current resuscitation wishes with client and family. 28.During a 24-hour chart review of a client in acute renal failure, the nurse notices that a prescription, written 12 hours ago for every 6 hours serum potassium levels, was not transcribed by the previous shift. Which is the best immediate action for the nurse to take? Order the lab work as prescribed and follow procedures for completing an incident report 29.The nurse is performing a sterile dressing change when a rapid response code is called for another client on the unit who is experiencing respiratory distress. Which action should the nurse take? Respond to code 30.The nurse assigns unlicensed assistive personnel (UAP) to apply sequential compression devices to a client. Which instruction should the nurse include when assigning this task to the UAP? Report any change in color in the client's feet or legs. 31.A client is receiving ibuprofen 600 mg PO every 6 hours for back pain. The medication administration record indicates that the last scheduled dose was not given, and the nurse learns that the dose was Resume administration of the client's prescribed dose of ibuprofen. 32.The nurse receives change-of-shift report from the prior nurse assigned to a group of clients on a post-surgical unit. Which client requires the most immediate intervention by the nurse? A client who fell off from a ladder and has collapsed left lower lung with 100 ML drainage in a chest tube collection container. 33. A client has a prescription for 20 units of isophane insulin suspension and regular insulin 70/30 to be administered subcutaneously. The pharmacy has provided vial of isophane insulin Notify the pharmacy that the incorrect insulin has been delivered to the unit 34.The nurse manager decides to report a staff nurse to the Peer Review Committee (PRC). A 73 year old diagnosed with chronic obstructive pulmonary disease who has a pulse oximeter reading of 84%ment before assessing the client 35.After receiving the morning shift report, which client should the nurse assess first? 36.The nursing staff expresses concern about a new policy that increases the nurse-to-patient ratio by 25% on all shifts. Which action is best for the nurse manager to take? Encourage the nursing staff to organize a group meeting to voice their complaints. 37.The nurse is making assignments for a nurse (RN) and a practical nurse (PN) working at an adult daycare Obtain Capillary glucose readings and administer insulin via sliding scale 38.When making assignments on a psychiatric unit, it is most essential for the charge nurse to assign a nurse to a client with Depression, who was admitted during the night and denies any suicide ideations. 39. In planning care on the nursing unit, which task is best to assign to the nurse (RN), rather than a practical nurse PN? Teach a client with diabetes to inject insulin 40.The nurse is reviewing fall risk precautions with a practical nurse employed at an extended care facility. Which finding should the nurse include that identifies a client at the highest risk for falls? Mini-Metal State Exam score of 22. 41.Which older client should the charge nurse assign to the most experienced nurse? A 72-yr old with type 1 diabetes mellitus who is newly diagnosed and scheduled for discharged today 42. The nurse is assigned to care for clients on a medical unit. Based on the notes taken during the shift report, which client situation warrants the nurse's immediate attention? A 10 year old child who is receiving chemotherapy and the infusion pump is beeping 43.An older male client who lives alone has a history of heart failure and is admitted to the hospital after passing out while walking to the mailbox. The nurse notes multiple bruises at various stages of healing.The client is being treated with a cardiac glycoside, diuretic and restricted sodium diet. Which intervention is most important for the nurse to include in the clients plan of care? Continuous electrocardiogram monitoring. 44. The hospice nurse reviews the plan of care for a client receiving palliative end of life home care. The client is cachexic and only able to take sips of water by mouth occasionally. Which instruction should the nurse provide to the unlicensed assistive personnel UAP, assisting with the clients care? Keep Mucous membranes Moist 45. The charge nurse in an emergency center is planning client care assignments for the staff. Which action may be safely delegated to the practical nurse? ( PN) Remove Peripheral Intravenous (PIV) Catheter 46. A client is transferred to the surgical intensive care unit after an exploratory laparotomy following a gunshot wound to the abdomen. The post anesthesia care unit ( PACU) nurse reports to the receiving nurse the total amount of blood loss during surgery, intravenous catheter sites and fluid currently infusing. The PACU nurse also includes the time of the last administration of pain and nausea mediations. Which additional information should the nurse provide to complete the report? Refuses to take ice chips for complaints of dry mouth 47. Which use of technology by the nurse is most likely to result in a violation of health insurance portability and accountability act? HIPAA? Encrypted email is used to communicate client data among the healthcare team 48. The charge nurse on the surgical unit is assessing the morning lab work on four clients. Which clients lab finding should be reported to the healthcare provider immediately? An elderly client in end-stage renal disease who has creatinine level of 2.4 mg/dL (212 micromol/L) and a BUN of 84 mg/DL (30mmoL 49. an unlicensed assistive personnel UAP is preparing to assist a client who has influenza and pneumonia with a bath. The nurse observes the UAP wearing a gown and gloves to enter the clients room. Which action should the nurse take? Review the need for the UPA to wear a face mask while in close contact with the client 50. At 0730 two clients with diabetes mellitus need capillary blood glucose levels obtained and subcutaneous sliding scale insulin administration. The breakfast trays for the clients need to be delivered. Which tasks should the nurse assign to an unlicensed assistive personnel UAP? Perform the capillary glucose measurement Deliver meal trays to the clients with diabetes 51. A client was admitted during the night for a postoperative wound infection and was assigned to a semiprivate room with a client who has lung cancer and is neutrapenic. At morning report the nurse learns that the wound infection is positive for MRSA. Which intervention should the nurse implement? Transfer the client with Neutropenia to a Private Room 52. At change of shift a female nurse informs the charge nurse that earlier in the shift she suffered a needlestick while working with a client who is suspected to be positive for HIV. Which action is most important for the nurse with the needlestick to take? Complete a work Injury report 53. The charge nurse observes a newly employed nurse begin to administer a liquid medication via a clients gastrostomy feeding tube system as seen in the picture. What action should the charge nurse take? Direct the nurse to stop the medication administration 54. A nurse who works on a medical surgical unit is assigned to work on the telemetry unit this shift. Which client is best to assign to this float nurse? 78-year-old one day postoperative pacemaker placement 55.While making rounds, the nurse working the night shift finds the wife of a terminally ill client lying in the bed with him, and both are sleeping. Which action should the nurse implement? Close the door Quietly and do not take any further action