HESI MILESTONE EXAM 1 QUESTIONS & ANSWERS 2023 LATEST UPDATE

HESI MILESTONE #2 QUESTIONS AND
ANSWERS


-Chemo6Side6Effects6-6ans--o6Nausea/vomiting6(24-486hr,6can6be6delayed6up6to616week)

Meningitis6first6step6-6ans--o6Antibiotics6-6penicillin6(ampicillin)6AND6cephalosporin
o6Corticosteroids

Multiple6sclerosis6and6urinary6retention6-6ans--
o6Sensation6of6void6heeded6immediately6(bed6pan/urinal6@6bedside)
o6Voiding6schedule6(start61/5-2hr6then6extend)
o6Drink6specific6amt6every626hour;6urinate6306min6after6w/6timer
o6Self-catherization

Acute6renal6failure6priority6-6ans--o6Maintain6fluids
o6Avoid6fluid6excess
o6Renal6replacement6therapy
o6Reduce6metabolic6rate
o6Promote6pulmonary6function

Acute6Respiratory6distress6priority6findings6-6ans--o6Hypoxia
o6Intercostal6retractions
o6Crackles
o6BNP6levels

(alveoli6collapse6because6small6airways6are6narrowed6due6to6interstitial6fluid6and6bronchi
al6obstruction)

End6of6life6plan6of6care6-6ans--
o6Signs6and6symptoms6of6impending6death6are6recognized6and6communicated6in6develo
pmentally6appropriate6language6for6children6and6patients6with6cognitive6disabilities6with6r
espect6to6family6preference.6Care6appropriate6to6this6phase6of6illness6is6proved6to6the6pat
ient6and6the6family

Cushing6Syndrome6-6ans--o6Can6result6from6corticosteroids
6***Attempt6to6reduce/taper6medication6while6still6treating6underlying6disease

o6Alternate6day6therapy6decrease6symptoms6and6allows6adrenal6glands6to6recover

Valve6replacement6teaching6-6ans--o6Anticoagulant6therapy6(frequent6follow-up/lab6tests)

, §6Pt6on6warfarin6has6specific6normal6ratios
o6Prevent6infection
o6ANTIBIOTIC6PROPHYALXIS6FOR6DETAL6PROCEDURES!!!

Cancer6intractable6pain6plan6of6care6-6ans--
o6Pain,6other6symptoms6and6side6effects6are6managed6based6on6the6best6available6evid
ence,6with6attention6to6disease-
specific6pain6and6symptoms,6which6are6skillfully6and6systematically6applied.6??????

Schizophrenia6nursing6diagnoses6and6interventions6-6ans---
6Dx:626or6more6S&S6for6over666mo6(Positive=6delusions,6hallucinations,6disorganized6spe

ech6or6Negative=666A's6Anhedonia,6Flat6Affect,6Apathy,6Anergia,6Algogia,6Avolition)
-
Establish6rapport6and6trust,6ask6about6hallucinations,6distract,6lower6environmental6stimu
li,6monitor6suicidal6ideation,61st6or62nd6generation6antipsych

Grief6process6therapeutic6response6-6ans--
Allow6the656steps6of6grieving6(DABDA),6active6listening6and6offer6a6supportive6presence

Dementia6action6refusing6ADLs6-6ans--
Encourage6finger6foods,6distraction,6speak6therapeutically

Alcohol6withdrawal6-6ans---
6Needs6to6be6done6under6medical6supervision6b/c6can6be6deadly

-6VS6Q4,6onset6of6symptoms64-66hours6after6last6drink,6give6lorazepam,6reduce6temp.
-6Tremors,6nausea,6vomiting

Methadone6overdose6-6ans--
S&S=6constricted6pupils,6resp.6depression,6circul.6depression,6LOC6decreased

Give6naloxone

Domestic6violence6screening6tool6-6ans---
6Don't6probe,6write6evidence6down6verbatim,6provide6a6safe6environment

-6Increase6in6violence6during6pregnancy
-6Cycle6of6violence=6tension6building,6violent,6honeymoon

Aggression6response6-6ans--5-
phase6cycle=6Triggering6(event),6Escalation6(movement6toward6a6loss6of6control),6Crisis6
(loss6of6control),6Recovery6(regain6control),6Postcrisis6(reconciliation)

***Hx6=6likely6to6occur6again

Violence6handling6-6ans---
6Engage6in6dialogue6to6prevent6escalation,6intervene6early6in6the6cycle

-6Approach6as6non6threatening,6calm6manner6and6convey6empathy