BSN 246 HESI 2025/2026

BSN 246 HESI
2025/2026




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, BSN 246 HESI 2025/2026
Question 1
Which action can be assigned to the unlicensed assistive personnel (UAP)?
Correct Answer
Measure the client's urinary output.


Question 2
What is the best initial response by the nurse?
Correct Answer
Describe the location and type of pain you are having


Question 3
Based on the nurse's assessment, which assessment data supports the decision to administer
pain medication as the first intervention? (Select all that apply. One, some, or all options may
be correct.)
Correct Answer
Pain rating of 6/10 - Heart rate of 102 beats/minute - Blood pressure of 132/76 mmHg


Question 4
Which action should the nurse implement first?
Correct Answer
Administer an analgesic.


Question 5
Which interventions are important to include in the client's plan of care while receiving
multiple immunosuppressants? (Select all that apply. One, some, or all options may be
correct.)
Correct Answer
Instruct client to wear a mask when walking in the halls. - Instruct visitors that fresh flowers
should not be taken into the room. - Monitor immunosuppression drug levels regularly.


Question 6
Which intervention should the nurse ensure is included in the plan of care during the
immediate postoperative period?
a. Monitor Judy's urinary output hourly using an urimeter.
b. Assess Judy's surgical incision every shift.
c. Monitor Judy's nasogastric tube every 4 hours.
d. Encourage Judy to use the incentive spirometer daily.
Correct Answer
a


Question 7
Which is the priority nursing assessment during the first 24-hour postoperative period?
Correct Answer

,Vital signs


Question 8
The nurse is teaching the patient about fluid management between dialysis treatments.
Which instruction by the nurse is the most accurate?
Correct Answer
Limit fluids in between treatments to minimize the amount of fluid that needs to be removed
during dialysis.


Question 9
Which expected outcome should be included in the nurse's teaching plan?
Correct Answer
Client will avoid canned and processed foods.


Question 10
The nurse assesses the dialysis graft. Which assessment should be reported to the healthcare
provider (HCP) immediately? (Select all that apply. One, some, or all options may be correct.)
Correct Answer
Yellow, purulent drainage from graft incision site. - Absence of a thrill over the graft site. -
Capillary refill >10 seconds in the hand where the graft is placed.


Question 11
Which intervention should the nurse ensure has been include in the client's plan of care?
(Select all that apply. One, some, or all options may be correct.)
A. Instruct lab personnel to obtain blood specimens from the dual-lumen catheter.
B. Perform sterile dressing changes at the dual-lumen catheter site.
C. Empty and record the drainage from the graft tubing regularly.
D. Regularly rotate IV insertion sites above and below the graft site.
E. Assess Judy's distal pulses and circulation in the arm with the access
Correct Answer
B. Perform sterile dressing changes at the dual lumen catheter site - E. Assess the client's
distal pulses and circulation in the arm with the access.


Question 12
The nurse documents the assessment of the arteriovenous (AV) graft. Which documentation
best describes a properly functioning AV graft?
Correct Answer
Thrill present and palpated


Question 13
The client asks the nurse to clarify what palliative care involves. Which explanation provides
the client the best education regarding palliative care? (Select all that apply. One, some, or all
options may be correct.)
Correct Answer

, Palliative care provides relief from symptoms including pain. - Palliative care supports holistic
care and improves quality of life. -


Question 14
What complication would the client be most concerned about if choosing peritoneal dialysis?
Correct Answer
Abdominal infection/Peritonitis


Question 15
The nurse prepares and instructs the client for hemodialysis. Which statements by the client
indicate the need for further education? (Select all that apply. One, some, or all options may
be correct.)
Correct Answer
Hemodialysis will help restore kidney function back to a normal level. - Bowel or bladder
perforation may occur with hemodialysis catheter placement.


Question 16
What action should the nurse take based on the response from the healthcare provider
(HCP) phone call? (Select all that apply. One, some, or all options may be correct.)
Correct Answer
Document both phone calls and the HCP's prescriptions. - Notify the charge nurse and
activate the chain of command - Hold the potassium chloride


Question 17
Which intervention should the nurse implement?
Correct Answer
Call and speak directly with the healthcare provider (HCP).


Question 18
Which intervention is most important for the nurse to implement?
Correct Answer
Hold the dose of potassium chloride and contact the HCP to report the serum potassium
level.


Question 19
Based on these problems, which nursing intervention should be included in the client's plan
of care?
Correct Answer
Encourage the client to ask questions and discuss fears about diagnosis


Question 20
Which assessment data indicates to the nurse that the desired outcome of the epoetin alfa
has been achieved?
Correct Answer
Conjunctival sac returns to a reddish pink color