NURS 209 Practice HESI Questions (IGGY BOOK) Exam Review With Verified Rationales A+
Which critically ill client has the greatest risk for developing acute respiratory distress syndrome (ARDS)?
A. Client with diabetic ketoacidosis (DKA)
B. Client with atrial fibrillation
C. Client with aspiration pneumonia
D. Client with acute kidney failure - CORRECT ANS-C. Client with aspiration pneumonia
Aspiration of acidic gastric contents is a risk for ARDS. Clients with DKA may develop metabolic acidosis,
but not ARDS, which develops in lung injury. Atrial fibrillation does not cause lung injury unless
embolization occurs. Acute kidney failure results in metabolic acidosis, not in acute lung injury.
Which are risk factors that are known to contribute to atherosclerosis-related diseases? (Select all that
apply.)
A. Low-density lipoprotein cholesterol (LDL-C) of 160 mg/dL
B. Smoking
C. Aspirin (acetylsalicylic acid [ASA]) consumption
D. Type 2 diabetes
E. Vegetarian diet - CORRECT ANS-A. Low-density lipoprotein cholesterol (LDL-C) of 160 mg/dL
B. Smoking
D. Type 2 diabetes
Having an LDL-C value of less than 100 mg/dL is optimal; 100 to 129 mg/dL is near or less than optimal;
with LDL-C 130 to 159 mg/dL (borderline high), the client is advised to modify diet and exercise. Smoking
is a modifiable risk factor and should be avoided or terminated, and diabetes is a risk factor for
atherosclerotic disease. ASA is used as prophylaxis for atherosclerotic disease/coronary artery disease to
prevent platelet adhesion. A diet high in whole grains, fruits, and vegetables is desirable to prevent
atherosclerosis; vegetarians usually consume fruits, vegetables, and nonanimal sources of protein.
,Which member of the health care team demonstrates reducing the risk for infection for a client with
acquired immune deficiency syndrome (AIDS)?
A. The dietary worker hands the disposable meal trays to the LPN assigned to the client.
B. The social worker encourages the client to verbalize about stressors at home.
C. A member of the housekeeping staff thoroughly cleans and disinfects the hallways near the client's
room.
D. The health care provider orders vital signs, including temperature, every 8 hours. - CORRECT ANS-A.
The dietary worker hands the disposable meal trays to the LPN assigned to the client.
The dietary worker giving the meal tray to the LPN limits the number of health care personnel entering
the room, thus reducing the risk for infection. Verbalizing stressors does not reduce the risk for
infection. Cleaning of bathrooms, not hallways, at least once daily by housekeeping staff reduces risk for
infection. Vital signs, including temperature, should be taken every 4 hours to detect potential infection,
but this does not reduce the risk for infection.
The nurse is instructing an unlicensed health care worker on the care of a client with human immune
deficiency virus (HIV) who also has active genital herpes. Which statement by the health care worker
indicates effective teaching of Standard Precautions?
A. "I need to know my HIV status, so I must get tested before caring for any clients."
B. "Putting on a gown and gloves will cover up the itchy sores on my elbows."
C. "Washing my hands and putting on a gown and gloves is what I must do before starting care."
D. "I will wash my hands before going into the room, and then will put on a gown and gloves only for
direct contact with the client's genitals." - CORRECT ANS-C. "Washing my hands and putting on a gown
and gloves is what I must do before starting care."
Standard Precautions include whatever personal protective equipment (PPE) is necessary for the
prevention of transmission of HIV and genital herpes. Knowing HIV status is important for preventing
transmission of HIV, but is not a Standard Precaution. Health care workers with weeping dermatitis
should not provide direct client care regardless of the use of a gown and gloves. Unlicensed health care
workers cannot make the determination of what is required for PPE or Standard Precautions.
,Which statement made to the nurse by a health care worker assigned to care for a client with human
immune deficiency virus (HIV) indicates a breach of confidentiality and requires further education by the
nurse?
A. "I told family members they need to wash their hands when they enter and leave the room."
B. "The other health care worker and I were out in the hallway discussing our concern about getting HIV
from our client."
C. "Yes, I understand the reasons why I have to wear gloves when I bathe the client."
D. "The client's spouse told me she got HIV from a blood transfusion." - CORRECT ANS-B. "The other
health care worker and I were out in the hallway discussing our concern about getting HIV from our
client."
Discussing this client's illness outside of the client's room is a breach of confidentiality and requires
further education by the nurse. Instruction on handwashing to family members or friends is not a breach
of confidentiality. Understanding the reasons for wearing gloves recognizes Standard Precautions in
direct care and is not a breach of confidentiality. Relaying a direct conversation to the nurse is not a
breach of confidentiality.
When preparing a client newly diagnosed with human immune deficiency virus (HIV) and the significant
other for discharge, which explanation by the nurse accurately describes proper condom use?
A. "Condoms should be used when lesions are present on the penis."
B. "Always position the condom with a space at the tip of an erect penis."
C. "Make sure it fits loosely to allow for penile erection."
D. "Use adequate lubrication, such as petroleum jelly." - CORRECT ANS-B. "Always position the condom
with a space at the tip of an erect penis."
Positioning the condom with a space at the tip of the erect penis allows for the collection of semen at
the tip of the condom. Condoms must be used by HIV-infected people at all times for sexual activity,
with or without the presence of lesions. Condoms should be applied on an erect penis and should fit
snugly, leaving space without air at the tip. Lubricants should be water-based only.
, The home health nurse is making an initial home visit to a client currently living with family members
after being hospitalized with pneumonia and newly diagnosed with acquired immune deficiency
syndrome (AIDS). Which statement by the nurse best acknowledges the client's fear of discovery by his
family?
A. "Do you think that I could post a sign on your bedroom door for everyone about the need to wash
their hands?"
B. "Is there somewhere private in the home where we can go and talk?"
C. "I hope that all of your family members know about your disease and how you need to be protected,
because you have been so sick."
D. "It is your duty to protect your family members from getting AIDS." - CORRECT ANS-B. "Is there
somewhere private in the home where we can go and talk?"
A nonthreatening approach used initially to find out whether the client has informed family members or
desires privacy is very important. The client has a right to privacy and can make the decision whether to
post handwashing signs; caution signs invade the client's right to privacy. Protection from infection is
important, but stating that the family members should know about the disease is not respectful of the
client's right to privacy. The nurse suggesting that it is the client's responsibility to protect his or her
family from getting AIDS is an intimidating statement. It is the client's right to make the decision
whether to inform family members about his or her illness. However, this "nonaction" could be grounds
for a lawsuit if the client were to infect someone inadvertently.
In discharging a client diagnosed with acquired immune deficiency syndrome (AIDS), which statement by
the nurse uses a nonjudgmental approach in discussing sexual practices and behaviors?
A. "Have you had sex with men or women or both?"
B. "I hope you use condoms to protect your partners."
C. "You must tell me all of your partners' names, so I can let them know about possibly having AIDS."
D. "You must tell me if you have a history of any sexually transmitted diseases because the public health
department needs to know." - CORRECT ANS-A. "Have you had sex with men or women or both?"
The straightforward approach of asking the client about having sex with men or women is
nonjudgmental and most appropriate. "I hope you use..." is a judgmental statement. Naming partners is
voluntary; also, assuming that more than one partner exists is judgmental and presumptuous. Asking for
Which critically ill client has the greatest risk for developing acute respiratory distress syndrome (ARDS)?
A. Client with diabetic ketoacidosis (DKA)
B. Client with atrial fibrillation
C. Client with aspiration pneumonia
D. Client with acute kidney failure - CORRECT ANS-C. Client with aspiration pneumonia
Aspiration of acidic gastric contents is a risk for ARDS. Clients with DKA may develop metabolic acidosis,
but not ARDS, which develops in lung injury. Atrial fibrillation does not cause lung injury unless
embolization occurs. Acute kidney failure results in metabolic acidosis, not in acute lung injury.
Which are risk factors that are known to contribute to atherosclerosis-related diseases? (Select all that
apply.)
A. Low-density lipoprotein cholesterol (LDL-C) of 160 mg/dL
B. Smoking
C. Aspirin (acetylsalicylic acid [ASA]) consumption
D. Type 2 diabetes
E. Vegetarian diet - CORRECT ANS-A. Low-density lipoprotein cholesterol (LDL-C) of 160 mg/dL
B. Smoking
D. Type 2 diabetes
Having an LDL-C value of less than 100 mg/dL is optimal; 100 to 129 mg/dL is near or less than optimal;
with LDL-C 130 to 159 mg/dL (borderline high), the client is advised to modify diet and exercise. Smoking
is a modifiable risk factor and should be avoided or terminated, and diabetes is a risk factor for
atherosclerotic disease. ASA is used as prophylaxis for atherosclerotic disease/coronary artery disease to
prevent platelet adhesion. A diet high in whole grains, fruits, and vegetables is desirable to prevent
atherosclerosis; vegetarians usually consume fruits, vegetables, and nonanimal sources of protein.
,Which member of the health care team demonstrates reducing the risk for infection for a client with
acquired immune deficiency syndrome (AIDS)?
A. The dietary worker hands the disposable meal trays to the LPN assigned to the client.
B. The social worker encourages the client to verbalize about stressors at home.
C. A member of the housekeeping staff thoroughly cleans and disinfects the hallways near the client's
room.
D. The health care provider orders vital signs, including temperature, every 8 hours. - CORRECT ANS-A.
The dietary worker hands the disposable meal trays to the LPN assigned to the client.
The dietary worker giving the meal tray to the LPN limits the number of health care personnel entering
the room, thus reducing the risk for infection. Verbalizing stressors does not reduce the risk for
infection. Cleaning of bathrooms, not hallways, at least once daily by housekeeping staff reduces risk for
infection. Vital signs, including temperature, should be taken every 4 hours to detect potential infection,
but this does not reduce the risk for infection.
The nurse is instructing an unlicensed health care worker on the care of a client with human immune
deficiency virus (HIV) who also has active genital herpes. Which statement by the health care worker
indicates effective teaching of Standard Precautions?
A. "I need to know my HIV status, so I must get tested before caring for any clients."
B. "Putting on a gown and gloves will cover up the itchy sores on my elbows."
C. "Washing my hands and putting on a gown and gloves is what I must do before starting care."
D. "I will wash my hands before going into the room, and then will put on a gown and gloves only for
direct contact with the client's genitals." - CORRECT ANS-C. "Washing my hands and putting on a gown
and gloves is what I must do before starting care."
Standard Precautions include whatever personal protective equipment (PPE) is necessary for the
prevention of transmission of HIV and genital herpes. Knowing HIV status is important for preventing
transmission of HIV, but is not a Standard Precaution. Health care workers with weeping dermatitis
should not provide direct client care regardless of the use of a gown and gloves. Unlicensed health care
workers cannot make the determination of what is required for PPE or Standard Precautions.
,Which statement made to the nurse by a health care worker assigned to care for a client with human
immune deficiency virus (HIV) indicates a breach of confidentiality and requires further education by the
nurse?
A. "I told family members they need to wash their hands when they enter and leave the room."
B. "The other health care worker and I were out in the hallway discussing our concern about getting HIV
from our client."
C. "Yes, I understand the reasons why I have to wear gloves when I bathe the client."
D. "The client's spouse told me she got HIV from a blood transfusion." - CORRECT ANS-B. "The other
health care worker and I were out in the hallway discussing our concern about getting HIV from our
client."
Discussing this client's illness outside of the client's room is a breach of confidentiality and requires
further education by the nurse. Instruction on handwashing to family members or friends is not a breach
of confidentiality. Understanding the reasons for wearing gloves recognizes Standard Precautions in
direct care and is not a breach of confidentiality. Relaying a direct conversation to the nurse is not a
breach of confidentiality.
When preparing a client newly diagnosed with human immune deficiency virus (HIV) and the significant
other for discharge, which explanation by the nurse accurately describes proper condom use?
A. "Condoms should be used when lesions are present on the penis."
B. "Always position the condom with a space at the tip of an erect penis."
C. "Make sure it fits loosely to allow for penile erection."
D. "Use adequate lubrication, such as petroleum jelly." - CORRECT ANS-B. "Always position the condom
with a space at the tip of an erect penis."
Positioning the condom with a space at the tip of the erect penis allows for the collection of semen at
the tip of the condom. Condoms must be used by HIV-infected people at all times for sexual activity,
with or without the presence of lesions. Condoms should be applied on an erect penis and should fit
snugly, leaving space without air at the tip. Lubricants should be water-based only.
, The home health nurse is making an initial home visit to a client currently living with family members
after being hospitalized with pneumonia and newly diagnosed with acquired immune deficiency
syndrome (AIDS). Which statement by the nurse best acknowledges the client's fear of discovery by his
family?
A. "Do you think that I could post a sign on your bedroom door for everyone about the need to wash
their hands?"
B. "Is there somewhere private in the home where we can go and talk?"
C. "I hope that all of your family members know about your disease and how you need to be protected,
because you have been so sick."
D. "It is your duty to protect your family members from getting AIDS." - CORRECT ANS-B. "Is there
somewhere private in the home where we can go and talk?"
A nonthreatening approach used initially to find out whether the client has informed family members or
desires privacy is very important. The client has a right to privacy and can make the decision whether to
post handwashing signs; caution signs invade the client's right to privacy. Protection from infection is
important, but stating that the family members should know about the disease is not respectful of the
client's right to privacy. The nurse suggesting that it is the client's responsibility to protect his or her
family from getting AIDS is an intimidating statement. It is the client's right to make the decision
whether to inform family members about his or her illness. However, this "nonaction" could be grounds
for a lawsuit if the client were to infect someone inadvertently.
In discharging a client diagnosed with acquired immune deficiency syndrome (AIDS), which statement by
the nurse uses a nonjudgmental approach in discussing sexual practices and behaviors?
A. "Have you had sex with men or women or both?"
B. "I hope you use condoms to protect your partners."
C. "You must tell me all of your partners' names, so I can let them know about possibly having AIDS."
D. "You must tell me if you have a history of any sexually transmitted diseases because the public health
department needs to know." - CORRECT ANS-A. "Have you had sex with men or women or both?"
The straightforward approach of asking the client about having sex with men or women is
nonjudgmental and most appropriate. "I hope you use..." is a judgmental statement. Naming partners is
voluntary; also, assuming that more than one partner exists is judgmental and presumptuous. Asking for
