Hesi exit 5 - 160 Questions And Answers
With Correct Solution
Suicide vprecautions vare vinitiated vfor va vchild vadmitted vto vthe vmental vhealth vunit vfollowing van
vintentional vnarcotic voverdose. vAfter va vvisitor vleaves, vthe vnurse vfinds va vpackage vof vcigarettes vin
vthe vclient's vroom. vWhich vintervention vis vmost vimportant vfor vthe vnurse vto vimplement? v- vAnswer
v- vRemove vcigarettes vfor vthe vclient's vroom
A vfamily vmember vof va vfrail velderly vadult vasks vthe vnurse vabout veligibility vrequirements vfor
vhospice vcare. vWhat vinformation vshould vthe vnurse vprovide? v(Select vall vthat vapply.)
A.)A vclient vmust vbe vwilling vto vaccept vpalliative vcare, vnot vcurative vcare.
B.)The vhealthcare vprovider vmust vproject vthat vthe vclient vhas v6 vmonths vor vless vto vlive.
C.)The vclient vmust vbe vdiagnosed vwith vclinical vdepression v
D.)The vclient vmust vbe vof vsound vmind v- vAnswer v- vA,B
A vclient vwith vatrial vfibrillation vreceives va vnew vprescription vfor vdabigatran. vWhat vinstruction
vshould vthe vnurse vinclude vin vthis vclient's vteaching vplan? v- vAnswer v- vAvoid vuse vof vnonsteroidal
vant-inflammatory vdrugs v(NSAID).
An vinfant vwho vis vadmitted vfor vsurgical vrepair vof va vventricular vseptal vdefect v(VSD) vis virritable
vand vdiaphoretic vwith vjugular vvein vdistention. vWhich vprescription vshould vthe vnurse vadminister
vfirst? v- vAnswer v- vDigoxin
The vnursing vstaff von va vmedical vunit vincludes va vregistered vnurse v(RN), vpractical vnurse v(PN), vand
van vunlicensed vassistive vpersonnel v(UAP). vWhich vtask vshould vthe vcharge vnurse vassign vto vthe vRN?
v- vAnswer v- vSupervise va vnewly vhired vgraduate vnurse vduring van vadmission vassessment.
,While vteaching va vyoung vmale vadult vto vuse van vinhaler vfor vhis vnewly vdiagnosed vasthma, vthe
vclient vstares vinto vthe vdistance vand vappears vto vbe vconcentrating von vsomething vother vthan vthe
vlesson vthe vnurse vis vpresenting. vWhat vaction vshould vthe vnurse vtake? v- vAnswer v- vAsk vthe vclient
vwhat vhe vis vthinking vabout vat vhis vtime.
After vseveral vhours vof vnon-productive vcoughing, va vclient vpresents vto vthe vemergency vroom
vcomplaining vof vchest vtightness vand vshortness vof vbreath. vHistory vincludes vend vstage vchronic
vobstructive vpulmonary vdisease v(COPD) vand vdiabetes vmellitus. vWhile vcompleting vthe vpulmonary
vassessment, vthe vnurse vhears vwheezing vand vpoor vair vmovement vbilaterally. vWhich vactions vshould
vthe vnurse vimplement? v(Select vall vthat vapply.)
A.)Administer vPRN vnebulizer vtreatment.
B.)Obtain v12 vlead velectrocardiogram.
C.)Monitor vcontinuous voxygen vsaturation.
D.) vLay vthe vclient vin vthe vprone vposition v- vAnswer v- vA,B,C
The vnurse vcaring vfor va v3-month-old vboy vone vday vafter va vpylorotomy vnotices vthat vthe vinfant vis
vrestless, vis vexhibiting vfacial vgrimaces, vand vis vdrawing vhis vknees vto vhis vchest. vWhat vaction
vshould vthe vnurse vtake? v- vAnswer v- vAdminister va vprescribed vanalgesia vfor vpain.
A v4-year-old vwith vacute vlymphocytic vleukemia v(ALL) vis vreceiving va vchemotherapy v(CT) vprotocol
vthat vincludes vmethotrexate v(Mexate, vTrexal, vMIX), van vantimetabolite. vWhich vinformation vshould
vthe vnurse vprovide vthe vparents vabout vcaring vfor vtheir vchild? v- vAnswer v- vUse vsunblock vor
vprotective vclothing vwhen voutdoors.
Two vdays vafter vadmission va vmale vclient vremembers vthat vhe vis vallergic vto veggs, vand vinforms vthe
vnurse vof vthe vallergy. vWhich vactions vshould vthe vnurse vimplement? vSATA
A.) vTell vthe vclient vthat vits va vmild vreaction v
,B.)Notify vthe vfood vservices vdepartment vof vthe vallergy.
C.)Enter vthe vallergy vinformation vin vthe vclient's vrecord.
D.)Add vegg vallergy vto vthe vclient's vallergy varm vband. v- vAnswer v- vB,C,D
The vrapid vresponse vteam's vdetects vreturn vof vspontaneous vcirculation v(ROSC) vafter v2 vmin vof
vcontinuous vchest vcompressions. vThe vclient vhas va vweak, vfast vpulse vand vno vrespiratory veffort, vso
vthe vhealthcare vprovider vperforms va vsuccessful voral, vintubation. vWhat vaction vshould vthe vnurse
vimplement? v- vAnswer v- vPerform vbilateral vchest vauscultation.
After vadministering van vantipyretic vmedication. vWhich vintervention vshould vthe vnurse vimplement? v-
vAnswer v- vEncouraging vliberal vfluid vintake
A vclient vwith vhyperthyroidism vis vbeing vtreated vwith vradioactive viodine v(I-131). vWhich vexplanation
vshould vbe vincluded vin vpreparing vthis vclient vfor vthis vtreatment? v- vAnswer v- vDescribe vradioactive
viodine vas va vtasteless, vcolorless vmedication vadministered vby vthe vhealthcare vprovider
After va vcolon vresection vfor vcolon vcancer, va vmale vclient vis vmoaning vwhile vbeing vtransferred vto
vthe vPostanesthesia vCare vUnit v(PACU). vWhich vintervention vshould vthe vnurse vimplement vfirst? v-
vAnswer v- vDetermine vclient's vpulse, vblood vpressure, vand vrespirations
The vnurse vis vcaring vfor va vgroup vof vclients vwith vthe vhelp vof va vlicensed vpractical vnurse v(LPN) vand
van vexperienced vunlicensed vassistive vpersonnel v(UAP). vWhich vprocedures vcan vthe vnurse vdelegate
vto vthe vUAP? v(Select vall vthat vapply)
A.)Take vpostoperative vvital vsigns vfor va vclient vwho vhas van vepidual vfollowing vknee varthroplasty
B.)Collect va vsputum vspecimen vfor va vclient vwith va vfever vof vunknown vorigin
C.)Ambulate va vclient vwho vhad va vfemoral-popliteal vbypass vgraft vyesterday v- vAnswer v- vA,B,C
, A vmale vclient vwith vcirrhosis vhas vascites vand vreports vfeeling vshort vof vbreath. vThe vclient vis vin
vsemi vFowler vposition vwith vhis varms vat vhis vside. vWhat vaction vshould vthe vnurse vimplement? v-
vAnswer v- vRaise vthe vhead vof vthe vbed vto va vFowler's vposition vand vsupport vhis varms vwith va vpillow
A vclient vwith va vhistory vof vchronic vpain vrequests va vnonopioid vanalgesic. vThe vclient vis valert vbut
vhas vdifficulty vdescribing vthe vexact vnature vand vlocation vof vthe vpain vto vthe vnurse. vWhich vaction
vshould vthe vnurse vimplement vnext? v- vAnswer v- vAdminister vthe vanalgesic vas vrequested
The vnurse vuses vthe vparkland vformula v(4ml vx vkg vx vtotal vbody vsurface varea v= v24 vhours vfluid
vreplacement) vto vcalculate vthe v24-hours vIV vfluid vreplacement vfor va vclient vwith v40% vburns vwho
vweighs v76kg. vHow vmany vml vshould vthe vclient vreceive? v(Enter vnumeric vvalue vonly.) v- vAnswer v-
v12160
A vclient vwith vleukemia vundergoes va vbone vmarrow vbiopsy. vThe vclient's vlaboratory vvalues vindicate
vthe vclient vhas vthrombocytopenia. vBased von vthis vdata, vwhich vnursing vassessment vis vmost
vimportant vfollowing vthe vprocedure?
A.)Observe vaspiration vsite.
B.)Assess vbody vtemperature v
C.)Monitor vskin velasticity
D.)Measure vurinary voutput v- vAnswer v- vA
An v18-year-old vfemale vclient vis vseen vat vthe vhealth vdepartment vfor vtreatment vof vcondylomata
vacuminate v(perineal vwarts) vcaused vby vthe vhuman vpapillomavirus v(HPV). vWhich vintervention
vshould vthe vnurse vimplement? v- vAnswer v- vReinforce vthe vimportance vof vannual vpapanicolaou
v(Pap) vsmears.
A vclient vadmitted vto vthe vpsychiatric vunit vdiagnosed vwith vmajor vdepression vwants vto vsleep vduring
vthe vday, vrefuses vto vtake va vbath, vand vrefuses vto veat. vWhich vnursing vintervention vshould vthe
vnurse vimplement vfirst? v- vAnswer v- vEstablish va vstructured vroutine vfor vthe vclient vto vfollow.
With Correct Solution
Suicide vprecautions vare vinitiated vfor va vchild vadmitted vto vthe vmental vhealth vunit vfollowing van
vintentional vnarcotic voverdose. vAfter va vvisitor vleaves, vthe vnurse vfinds va vpackage vof vcigarettes vin
vthe vclient's vroom. vWhich vintervention vis vmost vimportant vfor vthe vnurse vto vimplement? v- vAnswer
v- vRemove vcigarettes vfor vthe vclient's vroom
A vfamily vmember vof va vfrail velderly vadult vasks vthe vnurse vabout veligibility vrequirements vfor
vhospice vcare. vWhat vinformation vshould vthe vnurse vprovide? v(Select vall vthat vapply.)
A.)A vclient vmust vbe vwilling vto vaccept vpalliative vcare, vnot vcurative vcare.
B.)The vhealthcare vprovider vmust vproject vthat vthe vclient vhas v6 vmonths vor vless vto vlive.
C.)The vclient vmust vbe vdiagnosed vwith vclinical vdepression v
D.)The vclient vmust vbe vof vsound vmind v- vAnswer v- vA,B
A vclient vwith vatrial vfibrillation vreceives va vnew vprescription vfor vdabigatran. vWhat vinstruction
vshould vthe vnurse vinclude vin vthis vclient's vteaching vplan? v- vAnswer v- vAvoid vuse vof vnonsteroidal
vant-inflammatory vdrugs v(NSAID).
An vinfant vwho vis vadmitted vfor vsurgical vrepair vof va vventricular vseptal vdefect v(VSD) vis virritable
vand vdiaphoretic vwith vjugular vvein vdistention. vWhich vprescription vshould vthe vnurse vadminister
vfirst? v- vAnswer v- vDigoxin
The vnursing vstaff von va vmedical vunit vincludes va vregistered vnurse v(RN), vpractical vnurse v(PN), vand
van vunlicensed vassistive vpersonnel v(UAP). vWhich vtask vshould vthe vcharge vnurse vassign vto vthe vRN?
v- vAnswer v- vSupervise va vnewly vhired vgraduate vnurse vduring van vadmission vassessment.
,While vteaching va vyoung vmale vadult vto vuse van vinhaler vfor vhis vnewly vdiagnosed vasthma, vthe
vclient vstares vinto vthe vdistance vand vappears vto vbe vconcentrating von vsomething vother vthan vthe
vlesson vthe vnurse vis vpresenting. vWhat vaction vshould vthe vnurse vtake? v- vAnswer v- vAsk vthe vclient
vwhat vhe vis vthinking vabout vat vhis vtime.
After vseveral vhours vof vnon-productive vcoughing, va vclient vpresents vto vthe vemergency vroom
vcomplaining vof vchest vtightness vand vshortness vof vbreath. vHistory vincludes vend vstage vchronic
vobstructive vpulmonary vdisease v(COPD) vand vdiabetes vmellitus. vWhile vcompleting vthe vpulmonary
vassessment, vthe vnurse vhears vwheezing vand vpoor vair vmovement vbilaterally. vWhich vactions vshould
vthe vnurse vimplement? v(Select vall vthat vapply.)
A.)Administer vPRN vnebulizer vtreatment.
B.)Obtain v12 vlead velectrocardiogram.
C.)Monitor vcontinuous voxygen vsaturation.
D.) vLay vthe vclient vin vthe vprone vposition v- vAnswer v- vA,B,C
The vnurse vcaring vfor va v3-month-old vboy vone vday vafter va vpylorotomy vnotices vthat vthe vinfant vis
vrestless, vis vexhibiting vfacial vgrimaces, vand vis vdrawing vhis vknees vto vhis vchest. vWhat vaction
vshould vthe vnurse vtake? v- vAnswer v- vAdminister va vprescribed vanalgesia vfor vpain.
A v4-year-old vwith vacute vlymphocytic vleukemia v(ALL) vis vreceiving va vchemotherapy v(CT) vprotocol
vthat vincludes vmethotrexate v(Mexate, vTrexal, vMIX), van vantimetabolite. vWhich vinformation vshould
vthe vnurse vprovide vthe vparents vabout vcaring vfor vtheir vchild? v- vAnswer v- vUse vsunblock vor
vprotective vclothing vwhen voutdoors.
Two vdays vafter vadmission va vmale vclient vremembers vthat vhe vis vallergic vto veggs, vand vinforms vthe
vnurse vof vthe vallergy. vWhich vactions vshould vthe vnurse vimplement? vSATA
A.) vTell vthe vclient vthat vits va vmild vreaction v
,B.)Notify vthe vfood vservices vdepartment vof vthe vallergy.
C.)Enter vthe vallergy vinformation vin vthe vclient's vrecord.
D.)Add vegg vallergy vto vthe vclient's vallergy varm vband. v- vAnswer v- vB,C,D
The vrapid vresponse vteam's vdetects vreturn vof vspontaneous vcirculation v(ROSC) vafter v2 vmin vof
vcontinuous vchest vcompressions. vThe vclient vhas va vweak, vfast vpulse vand vno vrespiratory veffort, vso
vthe vhealthcare vprovider vperforms va vsuccessful voral, vintubation. vWhat vaction vshould vthe vnurse
vimplement? v- vAnswer v- vPerform vbilateral vchest vauscultation.
After vadministering van vantipyretic vmedication. vWhich vintervention vshould vthe vnurse vimplement? v-
vAnswer v- vEncouraging vliberal vfluid vintake
A vclient vwith vhyperthyroidism vis vbeing vtreated vwith vradioactive viodine v(I-131). vWhich vexplanation
vshould vbe vincluded vin vpreparing vthis vclient vfor vthis vtreatment? v- vAnswer v- vDescribe vradioactive
viodine vas va vtasteless, vcolorless vmedication vadministered vby vthe vhealthcare vprovider
After va vcolon vresection vfor vcolon vcancer, va vmale vclient vis vmoaning vwhile vbeing vtransferred vto
vthe vPostanesthesia vCare vUnit v(PACU). vWhich vintervention vshould vthe vnurse vimplement vfirst? v-
vAnswer v- vDetermine vclient's vpulse, vblood vpressure, vand vrespirations
The vnurse vis vcaring vfor va vgroup vof vclients vwith vthe vhelp vof va vlicensed vpractical vnurse v(LPN) vand
van vexperienced vunlicensed vassistive vpersonnel v(UAP). vWhich vprocedures vcan vthe vnurse vdelegate
vto vthe vUAP? v(Select vall vthat vapply)
A.)Take vpostoperative vvital vsigns vfor va vclient vwho vhas van vepidual vfollowing vknee varthroplasty
B.)Collect va vsputum vspecimen vfor va vclient vwith va vfever vof vunknown vorigin
C.)Ambulate va vclient vwho vhad va vfemoral-popliteal vbypass vgraft vyesterday v- vAnswer v- vA,B,C
, A vmale vclient vwith vcirrhosis vhas vascites vand vreports vfeeling vshort vof vbreath. vThe vclient vis vin
vsemi vFowler vposition vwith vhis varms vat vhis vside. vWhat vaction vshould vthe vnurse vimplement? v-
vAnswer v- vRaise vthe vhead vof vthe vbed vto va vFowler's vposition vand vsupport vhis varms vwith va vpillow
A vclient vwith va vhistory vof vchronic vpain vrequests va vnonopioid vanalgesic. vThe vclient vis valert vbut
vhas vdifficulty vdescribing vthe vexact vnature vand vlocation vof vthe vpain vto vthe vnurse. vWhich vaction
vshould vthe vnurse vimplement vnext? v- vAnswer v- vAdminister vthe vanalgesic vas vrequested
The vnurse vuses vthe vparkland vformula v(4ml vx vkg vx vtotal vbody vsurface varea v= v24 vhours vfluid
vreplacement) vto vcalculate vthe v24-hours vIV vfluid vreplacement vfor va vclient vwith v40% vburns vwho
vweighs v76kg. vHow vmany vml vshould vthe vclient vreceive? v(Enter vnumeric vvalue vonly.) v- vAnswer v-
v12160
A vclient vwith vleukemia vundergoes va vbone vmarrow vbiopsy. vThe vclient's vlaboratory vvalues vindicate
vthe vclient vhas vthrombocytopenia. vBased von vthis vdata, vwhich vnursing vassessment vis vmost
vimportant vfollowing vthe vprocedure?
A.)Observe vaspiration vsite.
B.)Assess vbody vtemperature v
C.)Monitor vskin velasticity
D.)Measure vurinary voutput v- vAnswer v- vA
An v18-year-old vfemale vclient vis vseen vat vthe vhealth vdepartment vfor vtreatment vof vcondylomata
vacuminate v(perineal vwarts) vcaused vby vthe vhuman vpapillomavirus v(HPV). vWhich vintervention
vshould vthe vnurse vimplement? v- vAnswer v- vReinforce vthe vimportance vof vannual vpapanicolaou
v(Pap) vsmears.
A vclient vadmitted vto vthe vpsychiatric vunit vdiagnosed vwith vmajor vdepression vwants vto vsleep vduring
vthe vday, vrefuses vto vtake va vbath, vand vrefuses vto veat. vWhich vnursing vintervention vshould vthe
vnurse vimplement vfirst? v- vAnswer v- vEstablish va vstructured vroutine vfor vthe vclient vto vfollow.
