Study guides, Class notes & Summaries

RN HESI Maternity exam latest update 2023/2024 with questions & veried answers An infant born to a heorin addict mother is admitted to the neonatal care unit. . What behaviors can the baby exhibit? A. Lethargy and a poor suck B. Facial abnormalities and microcephaly C. Irritability and high pitched cry D. Low birth weight and intrauterine growth retardation A primipara has delivered a stillborn fetus at 30 weeks gestation. To asses the parents in the grieving process which intervention is ...

A female client with a nasogastric tube attached to low suction states that she is nauseated. The nurse assesses that there has been no drainage through the nasogastric tube in the last 2 hours. Which action should the nurse take first? - answer-Reposition the client on her side. The priority is to determined if the tube is functioning correctly, which would relieve the client's nausea. The least invasive intervention is to reposition the client (B), should be attempted first, followed by (A & ...

Enalapril maleate is prescribed for a hospitalized client. Which assessment does the nurse perform as a priority before administering the medication? Checking the client's blood pressure Checking the client's peripheral pulses Checking the most recent potassium level Checking the client's intake-and-output record for the last 24 hours - answer-Checking the client's blood pressure Rationale: Enalapril maleate is an angiotensin-converting enzyme (ACE) inhibitor used to treat hyperte...

1. A male client with stomach cancer returns to the unit following a total gastrectomy. He has a nasogastric tube to suction and is receiving Lactated Ringer's solution at 75 mL/hour IV. One hour after admission to the unit, the nurse notes 300 mL of blood in the suction canister, the client's heart rate is 155 beats/minute, and his blood pressure is 78/48 mmHg. In addition to reporting the finding to the surgeon. Which action should the nurse implement first? - answer-d. Increase the infusion...

The nurse is caring for a client who is receiving 24-hour total parenteral nutrition (TPN) via a central line at 54 ml/hr. When initially assessing the client, the nurse notes that the TPN solution has run out and the next TPN solution is not available. What immediate action should the nurse take? A. Infuse normal saline at a keep vein open rate. B. Discontinue the IV and flush the port with heparin. C. Infuse 10% dextrose and water at 54 ml/hour. D. Obtain a stat blood glucose level and not...

An adult client who is hospitalized after surgery reports sudden onset of chest pain and dyspnea. The client appears anxious, restless, and mildly cyanotic. The nurse should further assess the client for which condition? - pulmonary embolism - heart failure - tuberculosis - bronchitis - answer-pulmonary embolism Which information should the nurse obtain when performing an initial assessment of a client who presents to the emergency department with a painful ankle injury? (Select all that ...

1. A patient with a diagnosis of major depression who has attenpted suicide says to the nurse, "I should have died. I've always been a failure. Nothing ever goes right for me." Which response demonstrates therapeutic communication? a. "You have everything to live for" b. "Why do you see yourself as a failiure?" c. "Feeling like this is all part of being depressed." d. "You've been feeling like a failure for a while?" - answer-(D) "You've been feeling like a failure for a while?...

1. A 12-year-old female is seen by the school nurse after recently experiencing increasing difficulty sitting and paying attention in class, and increasingly illegible handwriting. The nurse observes that the child has protruding eyeballs and a staring expression. What action should the nurse take next? - answer-Gather additional data by taking a health history and measuring vital signs 2. When asked to help develop interventions to combat obesity among children, the community health nurse sh...

1. In an interview, the nurse may find it necessary to take notes to aid his or her memory later. Which statement is true regarding note-taking? A) Note-taking may impede the nurse's observation of the patient's nonverbal behaviors. B) Note-taking allows the patient to continue at his or her own pace as the nurse records what is said. C) Note-taking allows the nurse to shift attention away from the patient, resulting in an increased comfort level. D) Note-taking allows the nurse to brea...

The healthcare provider prescribes morphine sulfate 4mg IM STAT. Morphine comes in 8 mg per ml. How many ml should the nurse administer? - answer-0.5 ml. A hospitalized male client is receiving nasogastric tube feedings via a small-bore tube and a continuous pump infusion. He reports that he had a bad bout of severe coughing a few minutes ago, but feels fine now. What action is best for the nurse to take? - answer-After clearing the tube with 30 ml of air, check the pH of fluid withdrawn from...

The nurse is reviewing a patient's list of nursing diagnoses in the medical record. The most recent nursing diagnosis is diarrhea related to intestinal colitis. Why is this an incorrectly stated diagnosis statement? - answer-It identifies the medical diagnosis instead of the patient's response to the diagnosis Nurses in the presurgical unit are preparing patients with different medical conditions for surgical procedures. The nurse knows to expect which type of medical condition to cause an ...