Hesi Management Exam
Which client is at greatest risk for respiratory depression while receiving opioids for
analgesia? - ✔️✔️Child with an arm fracture and cystic fibrosis
At greatest risk are elderly clients, opiate-naive clients, and those with underlying
pulmonary disease. The child has two of the three risk factors.
A client is crying and grimacing but denies pain and refuses pain medication, because
"my sibling is a drug addict and has ruined our lives." What is the priority intervention for
this client? - ✔️✔️Encourage expression of fears and past experiences.
This client has strong beliefs and emotions related to the issue of the sibling's addiction.
First, encourage expression. This indicates to the client that the feelings are real and
valid. It is also an opportunity to assess beliefs and fears. Giving facts and information is
appropriate at the right time. Family involvement is important, but it should be kept in
mind that their beliefs about drug addiction may be similar to those of the client.
In application of the principles of pain treatment, what is the first consideration? -
✔️✔️The client's perception of pain must be accepted.
The client must be believed, and his or her experience of pain must be acknowledged
as valid. The data gathered via client reports can then be applied to the other options in
developing the treatment plan.
When an analgesic is titrated to manage pain, what is the priority goal? - ✔️✔️Titrate to
the smallest dose that provides relief with the fewest side effects.
The goal is to control pain while minimizing side effects. For severe pain, the
medication can be titrated upward until the pain is controlled. Downward titration occurs
when the pain begins to subside. Adequate dosing is important; however, the concept of
controlled dosing applies more to potent vasoactive drugs.
The physician has ordered a placebo for a client with chronic pain. You are a newly
hired nurse and you feel very uncomfortable administering the medication. What is the
first action that you should take? - ✔️✔️Contact the charge nurse for advice.
Administering placebos is generally considered unethical. Consult the charge nurse as
a resource person who can help you clarify the situation and locate and review the
hospital policy. If the physician is insistent, suggest that he or she could give the
placebo. (Note: Use "could," not "should" when talking to the physician. This provides a
small opportunity to rethink the decision. "Should" is more commanding and elicits a
,more defensive response.) While following your own ethical code is correct, you must
ensure that the client is not abandoned and that care continues.
For a cognitively impaired client who cannot accurately report pain, what is the first
action that you should take? - ✔️✔️Obtain baseline behavioral indicators from family
members.
Complete information should be obtained from the family during the initial
comprehensive history taking and assessment. If this information is not obtained, the
nursing staff will have to rely on observation of nonverbal behavior and careful
documentation to determine pain and relief patterns.
Which patient is at greatest risk for pancreatic cancer? - ✔️✔️An elderly African-
American man who smokes
Pancreatic cancer is more common in African-Americans, males, and smokers. Other
associated factors include alcohol use, diabetes, obesity, history of pancreatitis,
exposure to organic chemicals, consumption of a high-fat diet, and previous abdominal
irradiation.
Patients receiving chemotherapy are at risk for thrombocytopenia related to
chemotherapy or disease processes. Which actions are needed for patients who must
be placed on bleeding precautions? (Select all that apply.) - ✔️✔️Mouthwash should
not include alcohol, because it has a drying action that leaves mucous membranes
more vulnerable. Insertion of suppositories, probes, or tampons into the rectal or vaginal
cavity is not recommended. All other options are appropriate.
For care of a patient who has oral cancer, which task would be appropriate to delegate
to an LPN/LVN? - ✔️✔️Giving antacids and sucralfate suspension as ordered
Giving medications is within the scope of practice of the LPN/LVN. Assisting the patient
in brushing and flossing should be delegated to the UAP. Explaining contraindications is
the responsibility of the RN. Recommendations for saliva substitutes should come from
the physician or pharmacist.
When staff assignments are made for the care of patients who are receiving
chemotherapy, what is the major consideration regarding chemotherapeutic drugs? -
✔️✔️During preparation, drugs may be absorbed through the skin or inhaled.
Chemotherapy drugs should be given by nurses who have received additional training
in how to safely prepare and deliver the drugs and protect themselves and others from
exposure. The other options express concerns, but the general principles of drug
administration apply.
, You are monitoring your patient who is at risk for spinal cord compression related to
tumor growth. Which patient statement is most likely to suggest an early manifestation?
- ✔️✔️"Last night my back really hurt, and I had trouble sleeping."
Back pain is an early sign of spinal cord compression occurring in 95% of patients. The
other symptoms are later signs.
You are caring for an older woman with hepatic cancer. The UAP informs you that the
patient's level of consciousness is diminished compared to earlier in the shift. Prioritize
the steps of assessment and intervention related to this patient's change of mental
status. - ✔️✔️Determine level of consciousness and responsiveness, and changes
from baseline. Oxygen should be administered immediately in the presence of
respiratory distress or risk for decreased oxygenation and perfusion. Pulse oximetry can
be used for continuous monitoring. Adequate pulse, blood pressure, and respirations
are required for cerebral perfusion. Increased temperature may signal infection or
sepsis. Blood glucose levels should be checked even if the patient is not diabetic.
Severe hypoglycemia should be immediately treated per protocol. A patent IV line may
be needed for delivery of emergency drugs. Electrolyte and ammonia levels are relevant
data for this patient, and abnormalities in these parameters may be contributing to
change in mental status. (Note: Laboratory results [i.e., electrolytes and ammonia
levels] may be concurrently available; however, you should train yourself to
systematically look at data. Look at electrolytes first because these are more commonly
ordered. In some cases, you may actually have to remind the physician to order the
ammonia level if the patient with a hepatic disorder is having a change in mental status.)
Which two cancer patients could potentially be placed together as roommates? -
✔️✔️A patient who underwent debulking of a tumor to relieve pressure
A patient who has undergone laminectomy for spinal cord compression
Debulking of tumor and laminectomy are palliative procedures. These patients can be
placed in the same room. The patient with a low neutrophil count and the patient who
has had a bone marrow transplantation need protective isolation.
People at risk are the target populations for cancer screening programs. Which of these
asymptomatic patients need extra encouragement to participate in cancer screening?
(Select all that apply.) - ✔️✔️Women age 21 or over should have annual Pap smears,
regardless of sexual activity. African-American men should begin prostate-specific
antigen testing at age 45. Colonoscopy and annual fecal occult blood testing are
recommended for those with average risk starting at age 50. Annual mammograms are
recommended for women over the age of 40. Women age 65 or older who have normal
results on previous Pap tests may forego additional screenings for cervical cancer.
A patient with lung cancer develops syndrome of inappropriate antidiuretic hormone
secretion (SIADH). After reporting symptoms of weight gain, weakness, and nausea and
Which client is at greatest risk for respiratory depression while receiving opioids for
analgesia? - ✔️✔️Child with an arm fracture and cystic fibrosis
At greatest risk are elderly clients, opiate-naive clients, and those with underlying
pulmonary disease. The child has two of the three risk factors.
A client is crying and grimacing but denies pain and refuses pain medication, because
"my sibling is a drug addict and has ruined our lives." What is the priority intervention for
this client? - ✔️✔️Encourage expression of fears and past experiences.
This client has strong beliefs and emotions related to the issue of the sibling's addiction.
First, encourage expression. This indicates to the client that the feelings are real and
valid. It is also an opportunity to assess beliefs and fears. Giving facts and information is
appropriate at the right time. Family involvement is important, but it should be kept in
mind that their beliefs about drug addiction may be similar to those of the client.
In application of the principles of pain treatment, what is the first consideration? -
✔️✔️The client's perception of pain must be accepted.
The client must be believed, and his or her experience of pain must be acknowledged
as valid. The data gathered via client reports can then be applied to the other options in
developing the treatment plan.
When an analgesic is titrated to manage pain, what is the priority goal? - ✔️✔️Titrate to
the smallest dose that provides relief with the fewest side effects.
The goal is to control pain while minimizing side effects. For severe pain, the
medication can be titrated upward until the pain is controlled. Downward titration occurs
when the pain begins to subside. Adequate dosing is important; however, the concept of
controlled dosing applies more to potent vasoactive drugs.
The physician has ordered a placebo for a client with chronic pain. You are a newly
hired nurse and you feel very uncomfortable administering the medication. What is the
first action that you should take? - ✔️✔️Contact the charge nurse for advice.
Administering placebos is generally considered unethical. Consult the charge nurse as
a resource person who can help you clarify the situation and locate and review the
hospital policy. If the physician is insistent, suggest that he or she could give the
placebo. (Note: Use "could," not "should" when talking to the physician. This provides a
small opportunity to rethink the decision. "Should" is more commanding and elicits a
,more defensive response.) While following your own ethical code is correct, you must
ensure that the client is not abandoned and that care continues.
For a cognitively impaired client who cannot accurately report pain, what is the first
action that you should take? - ✔️✔️Obtain baseline behavioral indicators from family
members.
Complete information should be obtained from the family during the initial
comprehensive history taking and assessment. If this information is not obtained, the
nursing staff will have to rely on observation of nonverbal behavior and careful
documentation to determine pain and relief patterns.
Which patient is at greatest risk for pancreatic cancer? - ✔️✔️An elderly African-
American man who smokes
Pancreatic cancer is more common in African-Americans, males, and smokers. Other
associated factors include alcohol use, diabetes, obesity, history of pancreatitis,
exposure to organic chemicals, consumption of a high-fat diet, and previous abdominal
irradiation.
Patients receiving chemotherapy are at risk for thrombocytopenia related to
chemotherapy or disease processes. Which actions are needed for patients who must
be placed on bleeding precautions? (Select all that apply.) - ✔️✔️Mouthwash should
not include alcohol, because it has a drying action that leaves mucous membranes
more vulnerable. Insertion of suppositories, probes, or tampons into the rectal or vaginal
cavity is not recommended. All other options are appropriate.
For care of a patient who has oral cancer, which task would be appropriate to delegate
to an LPN/LVN? - ✔️✔️Giving antacids and sucralfate suspension as ordered
Giving medications is within the scope of practice of the LPN/LVN. Assisting the patient
in brushing and flossing should be delegated to the UAP. Explaining contraindications is
the responsibility of the RN. Recommendations for saliva substitutes should come from
the physician or pharmacist.
When staff assignments are made for the care of patients who are receiving
chemotherapy, what is the major consideration regarding chemotherapeutic drugs? -
✔️✔️During preparation, drugs may be absorbed through the skin or inhaled.
Chemotherapy drugs should be given by nurses who have received additional training
in how to safely prepare and deliver the drugs and protect themselves and others from
exposure. The other options express concerns, but the general principles of drug
administration apply.
, You are monitoring your patient who is at risk for spinal cord compression related to
tumor growth. Which patient statement is most likely to suggest an early manifestation?
- ✔️✔️"Last night my back really hurt, and I had trouble sleeping."
Back pain is an early sign of spinal cord compression occurring in 95% of patients. The
other symptoms are later signs.
You are caring for an older woman with hepatic cancer. The UAP informs you that the
patient's level of consciousness is diminished compared to earlier in the shift. Prioritize
the steps of assessment and intervention related to this patient's change of mental
status. - ✔️✔️Determine level of consciousness and responsiveness, and changes
from baseline. Oxygen should be administered immediately in the presence of
respiratory distress or risk for decreased oxygenation and perfusion. Pulse oximetry can
be used for continuous monitoring. Adequate pulse, blood pressure, and respirations
are required for cerebral perfusion. Increased temperature may signal infection or
sepsis. Blood glucose levels should be checked even if the patient is not diabetic.
Severe hypoglycemia should be immediately treated per protocol. A patent IV line may
be needed for delivery of emergency drugs. Electrolyte and ammonia levels are relevant
data for this patient, and abnormalities in these parameters may be contributing to
change in mental status. (Note: Laboratory results [i.e., electrolytes and ammonia
levels] may be concurrently available; however, you should train yourself to
systematically look at data. Look at electrolytes first because these are more commonly
ordered. In some cases, you may actually have to remind the physician to order the
ammonia level if the patient with a hepatic disorder is having a change in mental status.)
Which two cancer patients could potentially be placed together as roommates? -
✔️✔️A patient who underwent debulking of a tumor to relieve pressure
A patient who has undergone laminectomy for spinal cord compression
Debulking of tumor and laminectomy are palliative procedures. These patients can be
placed in the same room. The patient with a low neutrophil count and the patient who
has had a bone marrow transplantation need protective isolation.
People at risk are the target populations for cancer screening programs. Which of these
asymptomatic patients need extra encouragement to participate in cancer screening?
(Select all that apply.) - ✔️✔️Women age 21 or over should have annual Pap smears,
regardless of sexual activity. African-American men should begin prostate-specific
antigen testing at age 45. Colonoscopy and annual fecal occult blood testing are
recommended for those with average risk starting at age 50. Annual mammograms are
recommended for women over the age of 40. Women age 65 or older who have normal
results on previous Pap tests may forego additional screenings for cervical cancer.
A patient with lung cancer develops syndrome of inappropriate antidiuretic hormone
secretion (SIADH). After reporting symptoms of weight gain, weakness, and nausea and
