HESI (HESI)

What instruction should the nurse include in the discharge teaching plan of a client who had a cataract extraction today? - Light housekeeping is permitted but avoid heavy lifting A male adult comes to the urgent care clinic 5 days after being diagnose with influenza. He is short of breath, febrile, and coughing green colored sputum. Which intervention should the nurse implement first? - Obtain a sputum sample for culture An elder male client tells the nurse that he is loosing sleep because...

The nurse is preparing to assist a client with a cuffed tracheostomy tube to eat. What intervention is the priority before the client is permitted to drink or eat? - Inflate the cuff Rationale: If a client with a tracheostomy is allowed to eat and the tracheostomy has a cuff, the nurse should inflate the cuff to prevent aspiration of food or fluids. The cuff would not be deflated because of the risk of aspiration. The nurse has implemented a bowel maintenance program for an unconscious clie...

A client with a productive cough has obtained a sputum specimen for culture as instructed. What is the best initial nursing action? A. Administer the first dose of antibiotic therapy B. Observe the color, consistency, and amount of sputum C. Encourage the client to consume plenty of warm liquids D. Send the specimen to the lab for analysis - B. Observe the color, consistency, and amount of sputum A client is brought to the ED by ambulance in cardiac arrest with cardiopulmonary resuscitati...

During a clinic visit, a client reports to the practical nurse (PN) that they felt a solid mass in their breast during self-examination, but it was not painful. What instruction should the PN reinforce with the client? A. Continue to monitor the mass until the next scheduled annual exam. B. Notify the PCP if the mass becomes soft or painful or starts to drain. C. Schedule an appointment with the PCP for evaluation D. Breast masses are usually insignificant if they feel soft or are easily mo...

An expectant father tells the nurse he fears that his wife is "losing her mind." He states that she is constantly rubbing her abdomen and talking to the baby and that she actually reprimands the baby when it moves too much. Which recommendation should the nurse make to this expectant father? A.Suggest that his wife seek professional counseling to deal with her symptoms. B.Explain that his wife is exhibiting ambivalence about the pregnancy. C. Ask him to report similar abnormal behaviors a...

The nurse is planning discharge teaching for a client who had an evacuation of gestational trophoblastic disease (GTD) two days ago. Which information is most important for the nurse to include in this client's teaching plan? - Oral contraceptive use for at least one year. The nurse is planning care for a client at 30-weeks gestation who is experiencing preterm labor. What maternal prescription is most important in preventing this fetus from developing respiratory distress syndrome? - Beta...

During the transition phase of labor, a client complains of tingling and numbness in her fingers and tells the nurse that she feels like she is going to pass out. What action should the nurse take? A. Encourage her to pant between contractions and blow with contractions. B. Coach her to take a deep cleansing breath and then refocus. C. Instruct her to pant three times and then exhale through pursed lips. D. Have her cup both hands over her nose and mouth while breathing. - D. Have her cup b...

The nurse observes a new mother avoiding eye contact with her newborn. Which action should the nurse take? - Observe the mother for other attachment behaviors. The nurse should explain to a 30-year-old gravid client that alpha fetoprotein testing is recommended for which purpose? - Screen for neural tube defects. What action should the nurse implement to decrease the client's risk for hemorrhage after a cesarean section? - Check the firmness of the uterus every 15 minutes. The nurse attem...

A 2 year old child with down syndrome is brought to the clinic for his regular physical examination. The nurse knows which problem is frequently associated with down syndrome? a. congenital heart disease b. fragile x syndrome c. trisomy 13 d. pyloric stenosis - a. congenital heart disease A female client is receiving an enteral feeding via NG feeding tube. The daughter reports to the charge nurse that her mother is coughing vigorously and sounds congested. Which staff member should the c...

(CAD) Which information in the client's history indicates an increased risk for coronary artery disease (CAD) and requires the nurse to provide disease management education? - -Family history of hyperlipidemia. Genetic predisposition is a significant factor in the development of CAD. -Consumption of a high-fat diet. Unhealthy habits, such as consuming fatty foods, are contributing risk factors to CAD. -Smoking two packs of cigarettes per day. Smoking is a modifiable risk factor for coro...