N524 Fundamental Hesi Study Cards + Explanations
(Questions) With Complete Solutions
A 14-month-old child is admitted to the pediatric hospital with a
fractured right femur. The child is placed in Bryant traction.
When the parents see the child for the first time in traction, they
are surprised to see both legs in traction and ask why. What
information should the nurse share about Bryant traction?
A) Putting both legs in traction keeps one leg from becoming
longer than the other.
B) Putting both legs in traction keeps the baby from turning over
in bed and breaking his leg again.
C) As a means of ensuring counter-traction, both legs are placed
in traction, and the buttocks are suspended off the bed.
D) When the leg was x-rayed, the healthcare practitioner
apparently discovered that the other leg was broken as well.
Correct Answers C) As a means of ensuring counter-traction,
both legs are placed in traction, and the buttocks are suspended
off the bed.
In young infants the body weight doesn't provide adequate
countertraction to overcome the spasm of the muscles. With
both legs in traction and the buttocks suspended off the bed,
countertraction is sufficient to realign the femur.
Putting both legs in traction does not keep the child from having
one leg longer than the other.
A bed jacket could keep the child from turning over in bed;
keeping the baby from turning over in bed is not the reason for
,putting both legs in traction. This type of traction can be used
for one fractured femur; it is not reserved for bilateral fractures.
A client asks about the purpose of a pulse oximeter. The nurse
explains that it is used to measure what?
A) Respiratory rate
B) Amount of oxygen in the blood
C) Percentage of oxygen-carrying hemoglobin
D) Amount of carbon dioxide in the blood Correct Answers C)
Percentage of oxygen-carrying hemoglobin
The pulse oximeter measures the oxygen saturation of blood by
determining the percentage of oxygen-carrying hemoglobin.
A pulse oximeter does not measure respiratory rate, nor does it
interpret the amount of oxygen or carbon dioxide carried in the
blood.
A client is admitted for surgery. Although not physically
distressed, the client appears apprehensive and withdrawn. What
is the nurse's best action?
A) Orient the client to the unit environment.
B) Have a copy of hospital regulations available.
C) Explain that there is no reason to be concerned.
D) Reassure the client that the staff is available if the client has
questions. Correct Answers A) Orient the client to the unit
environment.
,Orienting the client to the hospital unit provides knowledge that
may reduce the strangeness of the environment.
Having a copy of hospital regulations available and reassuring
the client that the staff is available to answer questions are part
of orienting the client to the unit.
Explaining that there is no reason to be concerned may be false
reassurance because no one can guarantee that there is no reason
to be concerned.
A client is admitted to the hospital because of multiple chronic
health problems. What is the priority intervention at this time?
A) Advising the client to join a support group immediately after
discharge
B) Assuring the family that staff members will take care of the
client's needs
C) Reminding the client to keep medical follow-up
appointments after discharge
D) Conducting a multidisciplinary staff conference early during
the client's hospitalization Correct Answers D) Conducting a
multidisciplinary staff conference early during the client's
hospitalization
Collaboration of all team members involved in the client's care
early during hospitalization will allow for efficient planning of
care and help prepare for discharge.
The client may or may not be ready to join a support group at
this time.
, Assuring the family that staff members will take care of the
client's needs may promote dependence.
The client should be encouraged to assume self-care gradually.
Although this should be done eventually, it is not the priority at
this time.
A client is being admitted for a total hip replacement. When is it
necessary for the nurse to ensure that a medication reconciliation
is completed? Select all that apply.
A) After reporting severe pain
B) On admission to the hospital
C) Upon entering the operating room
D) Before transfer to a rehabilitation facility
E) At time of scheduling for the surgical procedure Correct
Answers B) On admission to the hospital &
D) Before transfer to a rehabilitation facility
Medication reconciliation involves the creation of a list of all
medications the client is taking and comparing it to the
healthcare provider's prescriptions on admission or when there is
a transfer to a different setting or service, or discharge.
A change in status (Severe pain) does not require medication
reconciliation.
A medication reconciliation should be completed long before
entering the operating room.
(Questions) With Complete Solutions
A 14-month-old child is admitted to the pediatric hospital with a
fractured right femur. The child is placed in Bryant traction.
When the parents see the child for the first time in traction, they
are surprised to see both legs in traction and ask why. What
information should the nurse share about Bryant traction?
A) Putting both legs in traction keeps one leg from becoming
longer than the other.
B) Putting both legs in traction keeps the baby from turning over
in bed and breaking his leg again.
C) As a means of ensuring counter-traction, both legs are placed
in traction, and the buttocks are suspended off the bed.
D) When the leg was x-rayed, the healthcare practitioner
apparently discovered that the other leg was broken as well.
Correct Answers C) As a means of ensuring counter-traction,
both legs are placed in traction, and the buttocks are suspended
off the bed.
In young infants the body weight doesn't provide adequate
countertraction to overcome the spasm of the muscles. With
both legs in traction and the buttocks suspended off the bed,
countertraction is sufficient to realign the femur.
Putting both legs in traction does not keep the child from having
one leg longer than the other.
A bed jacket could keep the child from turning over in bed;
keeping the baby from turning over in bed is not the reason for
,putting both legs in traction. This type of traction can be used
for one fractured femur; it is not reserved for bilateral fractures.
A client asks about the purpose of a pulse oximeter. The nurse
explains that it is used to measure what?
A) Respiratory rate
B) Amount of oxygen in the blood
C) Percentage of oxygen-carrying hemoglobin
D) Amount of carbon dioxide in the blood Correct Answers C)
Percentage of oxygen-carrying hemoglobin
The pulse oximeter measures the oxygen saturation of blood by
determining the percentage of oxygen-carrying hemoglobin.
A pulse oximeter does not measure respiratory rate, nor does it
interpret the amount of oxygen or carbon dioxide carried in the
blood.
A client is admitted for surgery. Although not physically
distressed, the client appears apprehensive and withdrawn. What
is the nurse's best action?
A) Orient the client to the unit environment.
B) Have a copy of hospital regulations available.
C) Explain that there is no reason to be concerned.
D) Reassure the client that the staff is available if the client has
questions. Correct Answers A) Orient the client to the unit
environment.
,Orienting the client to the hospital unit provides knowledge that
may reduce the strangeness of the environment.
Having a copy of hospital regulations available and reassuring
the client that the staff is available to answer questions are part
of orienting the client to the unit.
Explaining that there is no reason to be concerned may be false
reassurance because no one can guarantee that there is no reason
to be concerned.
A client is admitted to the hospital because of multiple chronic
health problems. What is the priority intervention at this time?
A) Advising the client to join a support group immediately after
discharge
B) Assuring the family that staff members will take care of the
client's needs
C) Reminding the client to keep medical follow-up
appointments after discharge
D) Conducting a multidisciplinary staff conference early during
the client's hospitalization Correct Answers D) Conducting a
multidisciplinary staff conference early during the client's
hospitalization
Collaboration of all team members involved in the client's care
early during hospitalization will allow for efficient planning of
care and help prepare for discharge.
The client may or may not be ready to join a support group at
this time.
, Assuring the family that staff members will take care of the
client's needs may promote dependence.
The client should be encouraged to assume self-care gradually.
Although this should be done eventually, it is not the priority at
this time.
A client is being admitted for a total hip replacement. When is it
necessary for the nurse to ensure that a medication reconciliation
is completed? Select all that apply.
A) After reporting severe pain
B) On admission to the hospital
C) Upon entering the operating room
D) Before transfer to a rehabilitation facility
E) At time of scheduling for the surgical procedure Correct
Answers B) On admission to the hospital &
D) Before transfer to a rehabilitation facility
Medication reconciliation involves the creation of a list of all
medications the client is taking and comparing it to the
healthcare provider's prescriptions on admission or when there is
a transfer to a different setting or service, or discharge.
A change in status (Severe pain) does not require medication
reconciliation.
A medication reconciliation should be completed long before
entering the operating room.
