HESI BSN 266 EXAM | ALL QUESTIONS AND
CORRECT ANSWERS | VERIFIED ANSWERS
| LATEST VERSION 2025 | GRADED A+
(JUST RELEASED)
The nurse is caring for a client in the post anesthesia care unit (PACU) who
underwent a thoracotomy two hours ago. The nurse observes the following
vital signs; heart rate 140 beats/minute, respirations 26 breaths/minute, and
blood pressure 140/90 mmHg. Which intervention is most important for the
nurse to implement?
a. Apply oxygen at 10 L via non-rebreather mask and monitor pulse
oximeter.
b. Medicate for pain and monitor vital signs according to protocol.
c. Administer intravenous fluid bolus as prescribed by the healthcare
provider.
d. Encourage the
client to splint the incision with a pillow to cough and deep breathe ---------
CORRECT ANSWER-----------------b. Medicate for pain and monitor vital
signs according to protocol.
While assessing a client with degenerative joint disease, the nurse
observes Heberden's nodes, large prominences on the client's fingers that
are reddened. The client reports that the nodes are painful. Which action
should the nurse take?
a. Assesses the client's radical pulses and capillary refill time.
b. Discuss approaches to chronic pain control with the client.
c. Notify the healthcare provider of the finding immediately.
,d. Review the client's dietary intake of high-
protein foods ---------CORRECT ANSWER-----------------b. Discuss
approaches to chronic pain control with the client.
A client with draining skin lesions of the lover extremity is admitted with
possible Methicillin-Resistant Staphylococcus Aureus (MRSA).
Which nursing interventions should the nurse i
include in the plan of care? (Select all that apply.)
a. Explain the purpose of a low bacteria diet.
b. Monitor the client's white blood cell count.
c. Send wound drainage for culture and sensitivity
d. Use standard precautions and wear a
mask
e. Institute contact precautions for staff and visitors ---------CORRECT
ANSWER-----------------b. Monitor the client's white blood cell count.
c. Send wound drainage for culture and sensitivity
e. Institute contact precautions for staff and visitors
(MIS)
The nurse is preparing to obtain a rapid coronavirus (COVID-19) test for a
client who was exposed to the virus eight days ago. The client is
experiencing fever, cough and shortness of breath.
Which action is most important for the
nurse to take?
a. Counsel family members to monitor for illness symptoms for 2 weeks
after last contact with patient.
b. Move the client to a private room, keep the door
closed, and initiate droplet precautions.
,c. Start an intravenous infusion for antiviral drug to be administered for
positive COVID-19 test results.
d. Assist the client to recall everyone possibly exposed since onset
symptoms. ---------CORRECT ANSWER-----------------b. Move the client to a
private room, keep the door
closed, and initiate droplet precautions
A client with multiple sclerosis has urinary retention related to sensorimotor
details.
Which action should the nurse include in the client's plan of care?
a. Remind the client to practice pelvic floor (Kegel) exercises regularly.
b. Provide a bedside commode for immediate use in the client's discomfort.
c. Explain the need to limit intake
of oral fluids to reduce client discomfort.
d. Teach the client techniques for performing intermittent catheterization. ---
------CORRECT ANSWER-----------------d. Teach the client techniques for
performing intermittent catheterization
A client who has a history of hypothyroidism was initially with lethargy and
confusion.
Which additional finishing warrants finding warrants the most immediate
action by the nurse?
a. Facial puffiness and periorbital edema.
b. Further decline in level consciousness.
c. Hematocrit of 30% (0.30).
, d. Cold and dry skin. ---------CORRECT ANSWER-----------------b. Further
decline in level consciousness.
A client is diagnosed with chronic kidney disease and needs to begin
dialysis.
Which condition entered on the client's medical record should the nurse
recognize as a contraindication for peritoneal dialysis?
a. Nephrotic syndrome history.
b. Latent hepatitis C.
c. Crohn's disease with colectomy.
d. Type 2 diabetes mellitus ---------CORRECT ANSWER-----------------c.
Crohn's disease with colectomy.
When providing care for an unconscious client who has seizures.
Which nursing intervention is most essential?
a. Maintain the client in a semi-Fowler's position.
b. Keep the room at a comfortable
temperature.
c. Ensure oral suction is available.
d. Provide frequent mouth care ---------CORRECT ANSWER-----------------c.
Ensure oral suction is available.
A client presents to the emergency department reporting chest pain that is
radiation to the left arm, shortness of breath, and diaphoresis.
CORRECT ANSWERS | VERIFIED ANSWERS
| LATEST VERSION 2025 | GRADED A+
(JUST RELEASED)
The nurse is caring for a client in the post anesthesia care unit (PACU) who
underwent a thoracotomy two hours ago. The nurse observes the following
vital signs; heart rate 140 beats/minute, respirations 26 breaths/minute, and
blood pressure 140/90 mmHg. Which intervention is most important for the
nurse to implement?
a. Apply oxygen at 10 L via non-rebreather mask and monitor pulse
oximeter.
b. Medicate for pain and monitor vital signs according to protocol.
c. Administer intravenous fluid bolus as prescribed by the healthcare
provider.
d. Encourage the
client to splint the incision with a pillow to cough and deep breathe ---------
CORRECT ANSWER-----------------b. Medicate for pain and monitor vital
signs according to protocol.
While assessing a client with degenerative joint disease, the nurse
observes Heberden's nodes, large prominences on the client's fingers that
are reddened. The client reports that the nodes are painful. Which action
should the nurse take?
a. Assesses the client's radical pulses and capillary refill time.
b. Discuss approaches to chronic pain control with the client.
c. Notify the healthcare provider of the finding immediately.
,d. Review the client's dietary intake of high-
protein foods ---------CORRECT ANSWER-----------------b. Discuss
approaches to chronic pain control with the client.
A client with draining skin lesions of the lover extremity is admitted with
possible Methicillin-Resistant Staphylococcus Aureus (MRSA).
Which nursing interventions should the nurse i
include in the plan of care? (Select all that apply.)
a. Explain the purpose of a low bacteria diet.
b. Monitor the client's white blood cell count.
c. Send wound drainage for culture and sensitivity
d. Use standard precautions and wear a
mask
e. Institute contact precautions for staff and visitors ---------CORRECT
ANSWER-----------------b. Monitor the client's white blood cell count.
c. Send wound drainage for culture and sensitivity
e. Institute contact precautions for staff and visitors
(MIS)
The nurse is preparing to obtain a rapid coronavirus (COVID-19) test for a
client who was exposed to the virus eight days ago. The client is
experiencing fever, cough and shortness of breath.
Which action is most important for the
nurse to take?
a. Counsel family members to monitor for illness symptoms for 2 weeks
after last contact with patient.
b. Move the client to a private room, keep the door
closed, and initiate droplet precautions.
,c. Start an intravenous infusion for antiviral drug to be administered for
positive COVID-19 test results.
d. Assist the client to recall everyone possibly exposed since onset
symptoms. ---------CORRECT ANSWER-----------------b. Move the client to a
private room, keep the door
closed, and initiate droplet precautions
A client with multiple sclerosis has urinary retention related to sensorimotor
details.
Which action should the nurse include in the client's plan of care?
a. Remind the client to practice pelvic floor (Kegel) exercises regularly.
b. Provide a bedside commode for immediate use in the client's discomfort.
c. Explain the need to limit intake
of oral fluids to reduce client discomfort.
d. Teach the client techniques for performing intermittent catheterization. ---
------CORRECT ANSWER-----------------d. Teach the client techniques for
performing intermittent catheterization
A client who has a history of hypothyroidism was initially with lethargy and
confusion.
Which additional finishing warrants finding warrants the most immediate
action by the nurse?
a. Facial puffiness and periorbital edema.
b. Further decline in level consciousness.
c. Hematocrit of 30% (0.30).
, d. Cold and dry skin. ---------CORRECT ANSWER-----------------b. Further
decline in level consciousness.
A client is diagnosed with chronic kidney disease and needs to begin
dialysis.
Which condition entered on the client's medical record should the nurse
recognize as a contraindication for peritoneal dialysis?
a. Nephrotic syndrome history.
b. Latent hepatitis C.
c. Crohn's disease with colectomy.
d. Type 2 diabetes mellitus ---------CORRECT ANSWER-----------------c.
Crohn's disease with colectomy.
When providing care for an unconscious client who has seizures.
Which nursing intervention is most essential?
a. Maintain the client in a semi-Fowler's position.
b. Keep the room at a comfortable
temperature.
c. Ensure oral suction is available.
d. Provide frequent mouth care ---------CORRECT ANSWER-----------------c.
Ensure oral suction is available.
A client presents to the emergency department reporting chest pain that is
radiation to the left arm, shortness of breath, and diaphoresis.
