BSN 266 HESI V2 Exam with All Correct & 100% Verified
Answers| Actual Complete Exam| Already Graded A+
(Just Released)
While caring for a client with full thickness burns covering 40% of the body, the nurse observes
purulent drainage from the wounds. Before reporting the finding, what is the best lab value to
evaluate? ✔Correct Answer-Neutrophil count- The patient is experiencing infection, so a nurse
should review the neutrophil count before contacting the HCP.
An older woman who experienced a cerebrovascular accident (CVA) has difficulty with visual
perception and she only eats half of the food on her meal tray. Her family expresses concern about
her nutritional status. How should the nurse respond to the family's concern? ✔Correct Answer-
Demonstrate the use of visual scanning during meals to the client and family.
Best position for respiratory distress? ✔Correct Answer-High Fowler's Position- High fowlers helps
to decrease venous return, which decreases fluid volume in the heart that results in decreased
cardiac workload.
A patient with peripheral artery disease has marked peripheral neuropath. An appropriate nursing
diagnosis for the patient is ✔Correct Answer-High risk for injury
Type 2 diabetes patient discharge teaching patient and family ✔Correct Answer-Check feet every
day for cuts or injuries.
Plan of care for patient with skin lesions of lower extremities with possible MRSA. SATA ✔Correct
Answer-Institute Contact precautions for staff and visitors
Send wound drainage for culture and sensitivity
Monitor the clients WBC count
A patient with acute anterior wall MI 1 week ago is given low-dose aspirin. The medication is related
to which problem and HCP should be notified? ✔Correct Answer-Hematemesis- - Contact HCP if
blood is visible in body fluids such as hematemesis.
For a patient with SLE exacerbation what is the most important to report which assessment finding?
✔Correct Answer-Elevated blood urea nitrogen (BUN)
Before selecting a medication to administer, which action should the nurse implement in the post-op
patient who reports incisional pain and has 2 PRN analgesia available in MAR? ✔Correct Answer-
Rate of pain on a scale from 0-10.
Patient had bariatric surgery 2 months ago who developed post-op strictures who is experiencing
nausea and vomiting and anorexia who is admitted for fluid resuscitation. Which intervention should
the nurse implement? ✔Correct Answer-Keep patient NPO- Patient should be kept NPO until
procedure is successfully completed. The patient should not take anything by mouth.
Acute Kidney Injury due to aminoglycoside antibiotic moved from oliguric phase to the diuretic
phase. Which parameters are most important to monitor? ✔Correct Answer-Vital sign changes and
, ECGs- Priority parameters are vital sign changes related to hypovolemia and ECG changes due to
serum electrolyte loss, which can be life threatening.
Patient has a calcium oxalate renal stone. Which food are you going to teach the patient to avoid?
✔Correct Answer-Nuts, chocolate, dark greens, and spinach.
A patient had a cholecystectomy 2 days ago, the patient is febrile, abdominal pain radiating to the
back and has had 3 episodes of vomiting in the last 8 hours. The patient is exhibiting symptoms for
which condition? ✔Correct Answer-Pancreatitis- complications include pancreatitis that may
manifest with upper left quadrant or mid-epigastric pain which radiates to the back and
accompanied by nausea, vomiting, and fever.
Patient has a bowel obstruction and ABGs read ph- 7.50 PaCO2-42 and HCO3-33. How would you
define this acid base balance? ✔Correct Answer-Uncompensated Metabolic Alkalosis
Psoriasis with silvery, scaly areas on elbows and palms that burn and bleed. Which prescription
should the nurse teach the client to use for skin condition? ✔Correct Answer-Prescription strength
Corticosteroids- decrease inflammation and help manage psoriasis plaques. Psoriasis is a skin cell
proliferation of the surface of the skin causing thick silvery scales or itchy red patches.
Patient with AIDs and oral candidiasis has several painful mouth ulcers. The nurse delegates oral care
to the UAP and discusses how to assist client. What instructions do you give to the UAP? ✔Correct
Answer-Provide a soft bristled toothbrush- allows for gentle cleaning with less risk of trauma than a
hard bristled brush. Candidiasis often called oral thrush which is a fungal infection of the mouth, it is
common in babies, people with immune deficiency, and those who use steroid sprays for asthma.
A young adult with osteoarthritis of both knee's desires to continue daily walks at the park with
friends. how should the nurse respond? ✔Correct Answer-Continue maintenance regimen and
walks
Patient with diabetes mellitus with upper respiratory infection. Which changes in blood glucose
management should the nurse tell the client to expect? ✔Correct Answer-Increase insulin dose.
What discharge instructions does the nurse provide for a patient with BPH following transurethral
needle ablation (TUNA)? ✔Correct Answer-**
Patient with ileal conduit urinary diversion. Which finding indicates to the nurse that the client is
experiencing complications? ✔Correct Answer-**
Which cue would lead the nurse to further assess the client for other symptoms of right sided heart
failure in a patient with sinus tachycardia? ✔Correct Answer-Signs of FVE- sx/sy of right sided heart
failure include jugular venous distension, liver engorgement (hepatomegaly) with ascites, and
peripheral edema, loss of appetite, and nausea and vomiting.
Which action should the nurse take next in a patient with right ulnar fracture and cast who reports
increase in arm pain? ✔Correct Answer-**
Patient reports the nodes are painful in degenerative joint disease observed Heberden's nodes, large
and prominence on patient fingers that are red? ✔Correct Answer-Chronic pain management
strategies- Patient may require chronic pain management strategies such as use of analgesic therapy.
Answers| Actual Complete Exam| Already Graded A+
(Just Released)
While caring for a client with full thickness burns covering 40% of the body, the nurse observes
purulent drainage from the wounds. Before reporting the finding, what is the best lab value to
evaluate? ✔Correct Answer-Neutrophil count- The patient is experiencing infection, so a nurse
should review the neutrophil count before contacting the HCP.
An older woman who experienced a cerebrovascular accident (CVA) has difficulty with visual
perception and she only eats half of the food on her meal tray. Her family expresses concern about
her nutritional status. How should the nurse respond to the family's concern? ✔Correct Answer-
Demonstrate the use of visual scanning during meals to the client and family.
Best position for respiratory distress? ✔Correct Answer-High Fowler's Position- High fowlers helps
to decrease venous return, which decreases fluid volume in the heart that results in decreased
cardiac workload.
A patient with peripheral artery disease has marked peripheral neuropath. An appropriate nursing
diagnosis for the patient is ✔Correct Answer-High risk for injury
Type 2 diabetes patient discharge teaching patient and family ✔Correct Answer-Check feet every
day for cuts or injuries.
Plan of care for patient with skin lesions of lower extremities with possible MRSA. SATA ✔Correct
Answer-Institute Contact precautions for staff and visitors
Send wound drainage for culture and sensitivity
Monitor the clients WBC count
A patient with acute anterior wall MI 1 week ago is given low-dose aspirin. The medication is related
to which problem and HCP should be notified? ✔Correct Answer-Hematemesis- - Contact HCP if
blood is visible in body fluids such as hematemesis.
For a patient with SLE exacerbation what is the most important to report which assessment finding?
✔Correct Answer-Elevated blood urea nitrogen (BUN)
Before selecting a medication to administer, which action should the nurse implement in the post-op
patient who reports incisional pain and has 2 PRN analgesia available in MAR? ✔Correct Answer-
Rate of pain on a scale from 0-10.
Patient had bariatric surgery 2 months ago who developed post-op strictures who is experiencing
nausea and vomiting and anorexia who is admitted for fluid resuscitation. Which intervention should
the nurse implement? ✔Correct Answer-Keep patient NPO- Patient should be kept NPO until
procedure is successfully completed. The patient should not take anything by mouth.
Acute Kidney Injury due to aminoglycoside antibiotic moved from oliguric phase to the diuretic
phase. Which parameters are most important to monitor? ✔Correct Answer-Vital sign changes and
, ECGs- Priority parameters are vital sign changes related to hypovolemia and ECG changes due to
serum electrolyte loss, which can be life threatening.
Patient has a calcium oxalate renal stone. Which food are you going to teach the patient to avoid?
✔Correct Answer-Nuts, chocolate, dark greens, and spinach.
A patient had a cholecystectomy 2 days ago, the patient is febrile, abdominal pain radiating to the
back and has had 3 episodes of vomiting in the last 8 hours. The patient is exhibiting symptoms for
which condition? ✔Correct Answer-Pancreatitis- complications include pancreatitis that may
manifest with upper left quadrant or mid-epigastric pain which radiates to the back and
accompanied by nausea, vomiting, and fever.
Patient has a bowel obstruction and ABGs read ph- 7.50 PaCO2-42 and HCO3-33. How would you
define this acid base balance? ✔Correct Answer-Uncompensated Metabolic Alkalosis
Psoriasis with silvery, scaly areas on elbows and palms that burn and bleed. Which prescription
should the nurse teach the client to use for skin condition? ✔Correct Answer-Prescription strength
Corticosteroids- decrease inflammation and help manage psoriasis plaques. Psoriasis is a skin cell
proliferation of the surface of the skin causing thick silvery scales or itchy red patches.
Patient with AIDs and oral candidiasis has several painful mouth ulcers. The nurse delegates oral care
to the UAP and discusses how to assist client. What instructions do you give to the UAP? ✔Correct
Answer-Provide a soft bristled toothbrush- allows for gentle cleaning with less risk of trauma than a
hard bristled brush. Candidiasis often called oral thrush which is a fungal infection of the mouth, it is
common in babies, people with immune deficiency, and those who use steroid sprays for asthma.
A young adult with osteoarthritis of both knee's desires to continue daily walks at the park with
friends. how should the nurse respond? ✔Correct Answer-Continue maintenance regimen and
walks
Patient with diabetes mellitus with upper respiratory infection. Which changes in blood glucose
management should the nurse tell the client to expect? ✔Correct Answer-Increase insulin dose.
What discharge instructions does the nurse provide for a patient with BPH following transurethral
needle ablation (TUNA)? ✔Correct Answer-**
Patient with ileal conduit urinary diversion. Which finding indicates to the nurse that the client is
experiencing complications? ✔Correct Answer-**
Which cue would lead the nurse to further assess the client for other symptoms of right sided heart
failure in a patient with sinus tachycardia? ✔Correct Answer-Signs of FVE- sx/sy of right sided heart
failure include jugular venous distension, liver engorgement (hepatomegaly) with ascites, and
peripheral edema, loss of appetite, and nausea and vomiting.
Which action should the nurse take next in a patient with right ulnar fracture and cast who reports
increase in arm pain? ✔Correct Answer-**
Patient reports the nodes are painful in degenerative joint disease observed Heberden's nodes, large
and prominence on patient fingers that are red? ✔Correct Answer-Chronic pain management
strategies- Patient may require chronic pain management strategies such as use of analgesic therapy.
