Answers
A client is comatose upon arrival to the emergency department after falling a
roof. The client flexes with painful stimuli, and the nurse determines the
client's Glasgow Coma Scale (GCS) is 6. Which intervention should the nurse
prepare to implement to maintain the client's airway? - correct
answers✅✅A nasopharyngeal tube
A client is receiving a continuous half strength tube feeding at 50 ml/hr. To
prepare enough of the solution for eight hours, how many ml of full strength
feeding will the nurse need? - correct answers✅✅Answer: 200
25 ml x 8hrs = 200
The alarm of a client's pulse oximeter sounds and the nurse notes that the
oxygen saturation rate is indicated at 85%. What action should the nurse
take first? - correct answers✅✅Check the probe position
A client is known to have an irregular respiratory rate with periods of apnea
lasting 10 to 15 seconds. Currently, the nurse counts 22 respiratory cycles in
a 30-second interval followed by an apneic period. What intervention should
the nurse implement? - correct answers✅✅Reassess the respiratory rate,
counting for one full minute
A retiree with depression complains of feeling "lonely and having no
purpose" in life.Based on Erikson's developmental theory, which questions
suggest that the nurse understands the client's most important emotional
need? - correct answers✅✅"What about your life makes you proud?"
Following a precipitous labor, a client has a continuous trickling of bright red
blood from her vagina. Her uterus is firm and her vital signs are within
normal limits. The
,Cat exam 1-Hesi Exit Questions and
Answers
nurse determines that the client's symptoms may indicate which condition? -
correct answers✅✅A cervical laceration
In preparing assignments for the shift, which client is best for the charge
nurse to assign to a practical nurse? - correct answers✅✅An elderly client
with Alzheimer's disease complicated by dysphagia
The healthcare provider prescribes oxygen per nasal cannula at 2 L/min.
Which action has the highest priority when the nurse implements this
prescription? - correct answers✅✅Set the flow meter
9. A nurse who is new to the pediatric unit is positioning a 6-month-old for an
injection of penicillin V (Pen V) in the dorsogluteal muscle. Which action
should the nurse-manager who is supervising this nurse take first? - correct
answers✅✅C. Instruct the nurse to select another injection site
10. After diagnosis and initial treatment of a 3-year-old child with cystic
fibrosis, the nurse provides home care instructions to the mother. Which
statement by the child's mother indicates that she understands home care
treatment to promote pulmonary function? - correct answers✅✅"Chest
physiotherapy should be performed at least twice a day"
The nurse is preparing a community education program on osteoporosis.
Which instruction is helpful in preventing bone loss and promoting bone
formation? - correct answers✅✅Encourage physical activity
The nurse reviews the signs of hypoglycemia with the parents of a child with
Type 1 diabetes mellitus. The parents correctly understands signs of
hypoglycemia if they include which symptom? - correct
answers✅✅Sweating
, Cat exam 1-Hesi Exit Questions and
Answers
The nurse observes a 2 cm area nonblanchable erythema on the sacrum of
an immobile client. What documentation of this finding is best for the nurse
to enter into the client's record? - correct answers✅✅Stage 1 pressure
ulcer on sacrum
When assessing a 7-year-old girl, the nurse notes that she has multiple
bruises on her back and upper arms. The child's aunt tells the nurse that the
child's parents abuse drugs and alcohol. What intervention is most essential
for the nurse to implement? - correct answers✅✅Report assessment
findings to the proper legal authorities
15. A 14-year-old male client arrives at the emergency room in status
epilepticus. He was diagnosed with a seizure disorder in childhood. What is
the most likely cause of his present condition? - correct answers✅✅Acute
withdrawal from anticonvulsant medication
A Chinese-American client who just delivered a baby states that she will not
be able to take the prescribed sitz baths to help heal her episiotomy incision
because this will cause an unhealthy balance of cold and hot forces. When
planning nursing care, what nursing diagnosis has the highest priority? -
correct answers✅✅Impaired tissue integrity related to episiotomy
17. A 2-year-old with sickle cell anemia has an axillary temperature of 102 F.
In planning care for this child, which nursing diagnosis has the highest
priority? - correct answers✅✅High risk for fluid volume deficit related to
temperature elevation
During the first trimester of pregnancy, a client who was treated for genital
herpes with acyclovir (Zovirax) prior to this pregnancy tells the nurse that
she is experiencing an episode of genital herpes. Which nursing intervention
has the highest priority? - correct answers✅✅Determine if the client has
taken acyclovir (Zovirax) for this outbreak of genital herpes