BSN HESI 366 RN EXIT With NGN
BSN HESI 366 RN EXIT with NGN Test 3
Questions with 100% Correct Detailed Answers
Already Graded A+ Latest Versions 2025
A female client has been taking a high dose of prednisone, a corticosteroid, for several months.
After stopping the medication abruptly, the client reports feeling "very tired". Which nursing
intervention is most important for the nurse to implement?
a. Measure vital signs
b. Auscultate breath sounds
c. Palpate the abdomen
d. Observe the skin for bruising
Measure vital signs
Rationale: Abrupt withdrawal of an exogenous corticosteroids can precipitate adrenal
insufficiency and hypoglycemia, hypokalemia, and circulatory collapse can occur. Is most
important for the nurse to assess vital sign to impending shock.
A male client reports the onset of numbness and tingling in his fingers and around his mouth.
Which lab is important for the nurse to review before contacting the health care provider?
a. capillary glucose
b. urine specific gravity
c. Serum calcium
d. white blood cell count
Serum calcium
Rationale: Numbness and tingling of the fingers and around the mouth, along with muscle
cramps are signs of hypocalcemia
.!
What explanation is best for the nurse to provide a client who asks the purpose of using the log-
rolling technique for turning?
A+ TEST BANK 1
, BSN HESI 366 RN EXIT With NGN
a. working together can decrease the risk for back injury
b. The technique is intended to maintain straight spinal alignment.
c. Using two or three people increases client safety.
d. turning instead of pulling reduces the likelihood of skin damage
The technique is intended to maintain straight spinal alignment.
Rationale: The main rationale for use of the long-rolling technique is to maintain the client's
spine straight alignment.
.!
A client receiving chemotherapy has severe neutropenia. Which snack is best for the nurse to
recommend to the client?
a. Plain yogurt with sweetened with raw honey
b. Peanuts in the shell, roasted or un-roasted.
c. Aged farmer's cheese with celery sticks
d. Baked apples topped with dried raisins
Baked apples topped with dried raisins
Rationale: A patient with chemotherapy-induced severe neutropenia is at high risk for infection.
A low bacteria diet is required D is a healthy snack for a client receiving chemotherapy. A, B and
C have a high bacterial count and should be avoided.
Which action should the school nurse take first when conducting a screening for scoliosis?
a. Compare dorsal measurement of trunk
b. Extend arms over head for visualization
c. Inspect for symmetrical shoulder height.
d. Observe weight-bearing on each leg.
Inspect for symmetrical shoulder height.
Rationale: Children between 9 and 15 years old should be screening for scoliosis, which is
exhibited. ... Vertebral column. Screening for scoliosis should begin with inspection of shoulder
height
.!
An unlicensed assistive personnel (UAP) assigned to obtain client vital signs reports to the charge
nurse that a client has a weak pulse with a rate of 44 beat/ minutes. What action should the
charge nurse implement?
a- Instruct the UAP to count the client apical pulse rate for sixty seconds
b- Determine if the UAP also measured the client's capillary refill time.
A+ TEST BANK 2
, BSN HESI 366 RN EXIT With NGN
c- Assign a practical nurse (LPN) to determine if an apical radial deficit is present.
d- Notify the health care provider of the abnormal pulse rate and pulse volume.
Assign a practical nurse (LPN) to determine if an apical radial deficit is present
After a sudden loss of consciousness, a female client is taken to the ED and initial assessment
indicate that her blood glucose level is critically low. Once her glucose level is stabilized, the
client reports that was recently diagnosed with anorexia nervosa and is being treated at an
outpatient clinic. Which intervention is more important to include in this client's discharge plan?
a. Describe the signs and symptoms of hypoglycemia.
b. Encourage a low-carbohydrate and high-protein diet
c. Reinforce the need to continue outpatient treatment
d. Suggest wearing a medical alert bracelet at all time.
Encourage a low-carbohydrate and high-protein diet
Rationale: A client with anorexia nervosa with long term starvation or who self-restrict intake can
sign. ... Reserves. Providing the client with dietary selections such as low-carbohydrate, high
protein. ... Hypoglycemic episodes, which can become life-threating.
A 12 year old client who had an appendectomy two days ago is receiving 0.9% normal saline at
50 ml/hour. The client's urine specific gravity is 1.035. What action should the nurse implement?
a. Evaluate postural blood pressure measurements
b. Obtain specimen for uranalysis
c. Encourage popsicles and fluids of choice
d. Assess bowel sounds in all quadrants
Encourage popsicles and fluids of choice
Rationale: specific gravity of urine is a measurement of hydration status (normal range of 1.010
to 1.025) which is indicative of fluid volume deficit when Sp Gr increases as urine becomes more
concentrated.
.!
An older male client arrives at the clinic complaining that his bladder always feels full. He
complains of weak urine flow, frequent dribbling after voiding, and increasing nocturia with
difficulty initiating his urine stream. Which action should the nurse implement?
a. Obtain a urine specimen for culture and sensitivity
b. Palpate the client's suprapubic area for distention
c. Advise the client to maintain a voiding diary for one week
d. Instruct in effective technique to cleanse the glans penis
Palpate the client's suprapubic area for distention
A+ TEST BANK 3
, BSN HESI 366 RN EXIT With NGN
Rationale: the client is exhibiting classic signs of an enlarge prostate gland, which restricts urine
flow and cause bothersome lower urinary tract symptoms (LUTS) and urinary retention, which is
characterized by the client's voiding patterns and perception of incomplete bladder emptying.
.!
The nurse is preparing to administer 1.6 ml of medication IM to a 4 month old infant. Which
action should the nurse include?
a. Select a 22 gauge 1 ½ inch (3.8 cm) needle for the intramuscular injection
b. Administer into the deltoid muscle while the parent holds the infant securely
c. Divide the medication into two injections with volumes under 1ml
d. Use a quick dart-like motion to inject into the dorsogluteal site.
Divide the medication into two injection with volumes under 1ml
Rationale: IM injection for children under 3 of age should not exceed 1ml. divide the dose into
smaller volumes for injection in two different sites.
.!
A client who had a below the knee amputation is experiencing severe phantom limb pain (PLP)
and ask the nurse if mirror therapy will make the pain stop. Which response by the nurse is likely
to be most helpful?
a. Research indicates that mirror therapy is effective in reducing phantom limb pain
b. You can try mirror therapy, but do not expect to complete elimination of the pain
c. Transcutaneous electrical nerve stimulators (TENS) have been found to be more effective
d. Where did you learn about the use of mirror therapy in treating in treating phantom limb
pain?
Research indicates that mirror therapy is effective in reducing phantom limb pain
Rationale: pain relief associated with mirror therapy may be due to the activation of neurons in
the hemisphere of the brain that is contralateral to the amputated limb when visual input
reduces the activity of systems that perceive protopathic pain.
.!
An older adult client with heart failure (HF) develops cardiac tamponade. The client has muffled,
distant, heart sounds, and is anxious and restless. After initiating oxygen therapy and IV
hydration, which intervention is most important for the nurse to implement?
a. Observe neck for jugular vein distention
b. Notify healthcare provider to prepare for pericardiocentesis
A+ TEST BANK 4
BSN HESI 366 RN EXIT with NGN Test 3
Questions with 100% Correct Detailed Answers
Already Graded A+ Latest Versions 2025
A female client has been taking a high dose of prednisone, a corticosteroid, for several months.
After stopping the medication abruptly, the client reports feeling "very tired". Which nursing
intervention is most important for the nurse to implement?
a. Measure vital signs
b. Auscultate breath sounds
c. Palpate the abdomen
d. Observe the skin for bruising
Measure vital signs
Rationale: Abrupt withdrawal of an exogenous corticosteroids can precipitate adrenal
insufficiency and hypoglycemia, hypokalemia, and circulatory collapse can occur. Is most
important for the nurse to assess vital sign to impending shock.
A male client reports the onset of numbness and tingling in his fingers and around his mouth.
Which lab is important for the nurse to review before contacting the health care provider?
a. capillary glucose
b. urine specific gravity
c. Serum calcium
d. white blood cell count
Serum calcium
Rationale: Numbness and tingling of the fingers and around the mouth, along with muscle
cramps are signs of hypocalcemia
.!
What explanation is best for the nurse to provide a client who asks the purpose of using the log-
rolling technique for turning?
A+ TEST BANK 1
, BSN HESI 366 RN EXIT With NGN
a. working together can decrease the risk for back injury
b. The technique is intended to maintain straight spinal alignment.
c. Using two or three people increases client safety.
d. turning instead of pulling reduces the likelihood of skin damage
The technique is intended to maintain straight spinal alignment.
Rationale: The main rationale for use of the long-rolling technique is to maintain the client's
spine straight alignment.
.!
A client receiving chemotherapy has severe neutropenia. Which snack is best for the nurse to
recommend to the client?
a. Plain yogurt with sweetened with raw honey
b. Peanuts in the shell, roasted or un-roasted.
c. Aged farmer's cheese with celery sticks
d. Baked apples topped with dried raisins
Baked apples topped with dried raisins
Rationale: A patient with chemotherapy-induced severe neutropenia is at high risk for infection.
A low bacteria diet is required D is a healthy snack for a client receiving chemotherapy. A, B and
C have a high bacterial count and should be avoided.
Which action should the school nurse take first when conducting a screening for scoliosis?
a. Compare dorsal measurement of trunk
b. Extend arms over head for visualization
c. Inspect for symmetrical shoulder height.
d. Observe weight-bearing on each leg.
Inspect for symmetrical shoulder height.
Rationale: Children between 9 and 15 years old should be screening for scoliosis, which is
exhibited. ... Vertebral column. Screening for scoliosis should begin with inspection of shoulder
height
.!
An unlicensed assistive personnel (UAP) assigned to obtain client vital signs reports to the charge
nurse that a client has a weak pulse with a rate of 44 beat/ minutes. What action should the
charge nurse implement?
a- Instruct the UAP to count the client apical pulse rate for sixty seconds
b- Determine if the UAP also measured the client's capillary refill time.
A+ TEST BANK 2
, BSN HESI 366 RN EXIT With NGN
c- Assign a practical nurse (LPN) to determine if an apical radial deficit is present.
d- Notify the health care provider of the abnormal pulse rate and pulse volume.
Assign a practical nurse (LPN) to determine if an apical radial deficit is present
After a sudden loss of consciousness, a female client is taken to the ED and initial assessment
indicate that her blood glucose level is critically low. Once her glucose level is stabilized, the
client reports that was recently diagnosed with anorexia nervosa and is being treated at an
outpatient clinic. Which intervention is more important to include in this client's discharge plan?
a. Describe the signs and symptoms of hypoglycemia.
b. Encourage a low-carbohydrate and high-protein diet
c. Reinforce the need to continue outpatient treatment
d. Suggest wearing a medical alert bracelet at all time.
Encourage a low-carbohydrate and high-protein diet
Rationale: A client with anorexia nervosa with long term starvation or who self-restrict intake can
sign. ... Reserves. Providing the client with dietary selections such as low-carbohydrate, high
protein. ... Hypoglycemic episodes, which can become life-threating.
A 12 year old client who had an appendectomy two days ago is receiving 0.9% normal saline at
50 ml/hour. The client's urine specific gravity is 1.035. What action should the nurse implement?
a. Evaluate postural blood pressure measurements
b. Obtain specimen for uranalysis
c. Encourage popsicles and fluids of choice
d. Assess bowel sounds in all quadrants
Encourage popsicles and fluids of choice
Rationale: specific gravity of urine is a measurement of hydration status (normal range of 1.010
to 1.025) which is indicative of fluid volume deficit when Sp Gr increases as urine becomes more
concentrated.
.!
An older male client arrives at the clinic complaining that his bladder always feels full. He
complains of weak urine flow, frequent dribbling after voiding, and increasing nocturia with
difficulty initiating his urine stream. Which action should the nurse implement?
a. Obtain a urine specimen for culture and sensitivity
b. Palpate the client's suprapubic area for distention
c. Advise the client to maintain a voiding diary for one week
d. Instruct in effective technique to cleanse the glans penis
Palpate the client's suprapubic area for distention
A+ TEST BANK 3
, BSN HESI 366 RN EXIT With NGN
Rationale: the client is exhibiting classic signs of an enlarge prostate gland, which restricts urine
flow and cause bothersome lower urinary tract symptoms (LUTS) and urinary retention, which is
characterized by the client's voiding patterns and perception of incomplete bladder emptying.
.!
The nurse is preparing to administer 1.6 ml of medication IM to a 4 month old infant. Which
action should the nurse include?
a. Select a 22 gauge 1 ½ inch (3.8 cm) needle for the intramuscular injection
b. Administer into the deltoid muscle while the parent holds the infant securely
c. Divide the medication into two injections with volumes under 1ml
d. Use a quick dart-like motion to inject into the dorsogluteal site.
Divide the medication into two injection with volumes under 1ml
Rationale: IM injection for children under 3 of age should not exceed 1ml. divide the dose into
smaller volumes for injection in two different sites.
.!
A client who had a below the knee amputation is experiencing severe phantom limb pain (PLP)
and ask the nurse if mirror therapy will make the pain stop. Which response by the nurse is likely
to be most helpful?
a. Research indicates that mirror therapy is effective in reducing phantom limb pain
b. You can try mirror therapy, but do not expect to complete elimination of the pain
c. Transcutaneous electrical nerve stimulators (TENS) have been found to be more effective
d. Where did you learn about the use of mirror therapy in treating in treating phantom limb
pain?
Research indicates that mirror therapy is effective in reducing phantom limb pain
Rationale: pain relief associated with mirror therapy may be due to the activation of neurons in
the hemisphere of the brain that is contralateral to the amputated limb when visual input
reduces the activity of systems that perceive protopathic pain.
.!
An older adult client with heart failure (HF) develops cardiac tamponade. The client has muffled,
distant, heart sounds, and is anxious and restless. After initiating oxygen therapy and IV
hydration, which intervention is most important for the nurse to implement?
a. Observe neck for jugular vein distention
b. Notify healthcare provider to prepare for pericardiocentesis
A+ TEST BANK 4
