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Exam (elaborations)

HESI RN LATEST VERSION GUARANTEED A+ 2024

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The nurse is caring for a client who has a fiberglass long leg cast on the right leg. Which nursing actions should be implemented in the cast care of this client? SATA a) Smelling the cast and feeling for the presence of hot spots on the cast. b) Checking neurovascular status of the right exposed foot and toes every four hours. c) Using a soft cotton-tipped 6-inch swab to help scratch beneath the cast. d) Placing the nurse's finger in the client's cast while performing cast care. e) Covering the perineal area of the cast with plastic before client uses the fracture bedpan. - correct answera) Smelling the cast and feeling for the presence of hot spots on the cast. b) Checking neurovascular status of the right exposed foot and toes every four hours. d) Placing the nurse's finger in the client's cast while performing cast care. e) Covering the perineal area of the cast with plastic before client uses the fracture bedpan. Rationale Cast care should include ensuring the cast is not too tight, by placing a finger between the client's skin and cast; by protecting the cast from being soiled by placing a protective plastic covering in the perineal area before the client uses a bedpan; by smelling for a foul odor coming from the cast; by palpating for hot spots on the cast every shift; and by performing neurovascular checks distal to the cast every four hours. Nothing should be placed in the cast to facilitate scratching beneath the cast. The nurse is caring for an older client being treated for a cardiac condition who has developed "dry eyes". Which medication may be contributing to this condition? a) Procainamide (Procanbid). b) Iron supplements. c) Atenolol (Tenormin). d) Lipitor (Atorvastatin). - correct answerc) Atenolol (Tenormin). Rationale Dry eyes is an annoying side effect of some medications that can cause a client to feel like they have something in their eye or a continuous scratchy sensation. This condition can cause eye strain and discomfort to a client. Clients prescribed Atenolol for hypertension are at risk of developing dry eyes as a side effect of the medication. The UAP is assisting a client getting into the shower. The charge nurse answers a call from the cast clinic to immediately send the UAP's other assigned client to the clinic. Which action should the nurse take? a) Ask the UAP to find another team member to take the client to the clinic. b) Notify the delegating nurse of the current request from the cast clinic. c) Instruct the UAP to take the client to clinic after helping the other client taking a shower. d) While the client is showering the UAP should take the other client to cast clinic. - correct answerb) Notify the delegating nurse of the current request from the cast clinic. Rationale The charge nurse should notify the delegating nurse of the situation. The third principle of delegation is "The person to whom the assignment was delegated cannot delegate that assignment to someone else... the delegating nurse needs to be notified and reassign the task..." During a literature review for a research study, the nurse discovers a separate study has already proved the proposed hypothesis to be true. Which action should the nurse take regarding the proposed research study? a) Discontinue the research. b) Revise the hypothesis of the current study so it is unique. c) Perform the current study as a replication study. d) Contact the authors of the original study for permission to continue. - correct answerc) Perform the current study as a replication study. Rationale Because of inherent scientific error that may exist within all research studies, hypotheses require more than one test to support their accuracy. A critical weakness with nursing research is a lack of replication. Retesting a hypothesis that has been shown to be true strengthens the findings of the earlier study and supports the use of those findings to influence clinical practice.

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