Hesi rn fundamentals testbank
docx withcomplete question
and answer 2024/2025
The nurse is called to the waiting room of a
pediatric clinic. The frantic mother states, "I think
my 4-month-old baby is choking!" What steps will
the nurse take? (Select all that apply.)
A.
Compress the chest once between the nipples with
two fingers.
B.
Note any obstruction or absence of breathing.
C.
Deliver five backslaps between the shoulder blades.
D.
Place the infant over the nurse's arm.
E.
,Perform a blind finger sweep. -
<<<ANSWER>>>B, C, D
Rationale: The fingers are placed at the same
location on an infant as chest compressions for
CPR; however, the nurse must deliver five chest
thrusts, after the five back slaps. Blind sweeps are
not used as this action may push the object deeper
into the throat. The remaining steps are correct.
Which fluid will the nurse select to administer with
the prescribed blood transfusion?
A.
5% Dextrose and water
B.
Normal saline
C.
Lactated Ringers solution
D.
5% Dextrose and lactated ringers -
<<<ANSWER>>>B
Rationale: Normal saline solution is the only
solution that is compatible with blood.
When assisting a client from the bed to a chair,
which procedure is best for the nurse to follow?
,A.
Place the chair parallel to the bed, with its back
toward the head of the bed and assist the client in
moving to the chair.
B.
With the nurse's feet spread apart and knees aligned
with the client's knees, stand and pivot the client into
the chair.
C.
Assist the client to a standing position by gently
lifting upward, underneath the axillae.
D.
Stand beside the client, place the client's arms
around the nurse's neck, and gently move the client
to the chair. - <<<ANSWER>>>B
Rationale: Option B describes the correct
positioning of the nurse and affords the nurse a wide
base of support while stabilizing the client's knees
when assisting to a standing position. The chair
should be placed at a 45-degree angle to the bed,
with the back of the chair toward the head of the
bed. Clients should never be lifted under the axillae;
this could damage nerves and strain the nurse's
back. The client should be instructed to use the arms
of the chair and should never place his or her arms
, around the nurse's neck; this places undue stress on
the nurse's neck and back and increases the risk for
a fall.
How many mL will the nurse document on the
client's intake and output record from the items
listed? _____ mL
1200 mL water
4 ounce container of gelatin
8 ounces of orange juice
355 mL can of soda1 cup of soup -
<<<ANSWER>>>Answer: 2155
Rationale: 1200 + 240 (8 oz) + 240 (1 cup) + 120 (4
oz) + 355 = 2155
The nurse observes a UAP taking a client's blood
pressure in the lower extremity. Which observation
of this procedure requires the nurse to intervene
with the UAP's approach?
A.
The cuff wraps around the girth of the leg.
B.
The UAP auscultates the popliteal pulse with the
cuff on the lower leg.
C.
docx withcomplete question
and answer 2024/2025
The nurse is called to the waiting room of a
pediatric clinic. The frantic mother states, "I think
my 4-month-old baby is choking!" What steps will
the nurse take? (Select all that apply.)
A.
Compress the chest once between the nipples with
two fingers.
B.
Note any obstruction or absence of breathing.
C.
Deliver five backslaps between the shoulder blades.
D.
Place the infant over the nurse's arm.
E.
,Perform a blind finger sweep. -
<<<ANSWER>>>B, C, D
Rationale: The fingers are placed at the same
location on an infant as chest compressions for
CPR; however, the nurse must deliver five chest
thrusts, after the five back slaps. Blind sweeps are
not used as this action may push the object deeper
into the throat. The remaining steps are correct.
Which fluid will the nurse select to administer with
the prescribed blood transfusion?
A.
5% Dextrose and water
B.
Normal saline
C.
Lactated Ringers solution
D.
5% Dextrose and lactated ringers -
<<<ANSWER>>>B
Rationale: Normal saline solution is the only
solution that is compatible with blood.
When assisting a client from the bed to a chair,
which procedure is best for the nurse to follow?
,A.
Place the chair parallel to the bed, with its back
toward the head of the bed and assist the client in
moving to the chair.
B.
With the nurse's feet spread apart and knees aligned
with the client's knees, stand and pivot the client into
the chair.
C.
Assist the client to a standing position by gently
lifting upward, underneath the axillae.
D.
Stand beside the client, place the client's arms
around the nurse's neck, and gently move the client
to the chair. - <<<ANSWER>>>B
Rationale: Option B describes the correct
positioning of the nurse and affords the nurse a wide
base of support while stabilizing the client's knees
when assisting to a standing position. The chair
should be placed at a 45-degree angle to the bed,
with the back of the chair toward the head of the
bed. Clients should never be lifted under the axillae;
this could damage nerves and strain the nurse's
back. The client should be instructed to use the arms
of the chair and should never place his or her arms
, around the nurse's neck; this places undue stress on
the nurse's neck and back and increases the risk for
a fall.
How many mL will the nurse document on the
client's intake and output record from the items
listed? _____ mL
1200 mL water
4 ounce container of gelatin
8 ounces of orange juice
355 mL can of soda1 cup of soup -
<<<ANSWER>>>Answer: 2155
Rationale: 1200 + 240 (8 oz) + 240 (1 cup) + 120 (4
oz) + 355 = 2155
The nurse observes a UAP taking a client's blood
pressure in the lower extremity. Which observation
of this procedure requires the nurse to intervene
with the UAP's approach?
A.
The cuff wraps around the girth of the leg.
B.
The UAP auscultates the popliteal pulse with the
cuff on the lower leg.
C.
