HESI Fundamentals V.2 Questions and Answers with
Complete Solutions UPDATED!!!!.
Correct
Incorrect
,
, A) Assist the ambulatng client back to the bed.
An oxygen saturaton below 90% indicates inadequate oxygen. First, the client should
be assisted to return to bed (A) to minimize oxygen demands. Ambulaton increases
aeraton of the lungs to prevent pooling of respiratory secretons, but the client's
actvity at this tme is depletng oxygen saturaton of the blood, so (B) is
contraindicated. Increased actvity increases respiratory efort, and oxygen may be
necessary to contnue ambulaton (C), but frst the
C) Afer clearing the tube with 30 ml of air, check the pH of fuid withdrawn fromclient should
return to the bed to rest. Oxygen saturaton levels at diferent the tube.sites should be
evaluated AFTER the client returns to bed (D).
Coughing, vomitng, and suctoning can precipitate displacement of the tp of the small bore
feeding tube upward into the esophagus, placing the client at increased risk for aspiraton.
Checking the sample of fuid withdrawn from the tube (afer clearing the tube with 30 ml of
air) for acidic (stomach) or alkaline (intestne) values is a more sensitve method for these
tubes, and the nurse should assess tube placement in this way prior to taking any other
acton (C). (A and B) are not indicated. The auscultatng method (D) has been found to be
unreliable for smallbore feeding tubes.
C) Restart the IV, perform tracheotomy care, change coccyx dressing.
Don't know?
3 of 175
Term
The nurse assesses a 2-year-old who is admited for dehydraton and fnds that
the peripheral IV rate by gravity has slowed, even though the venous access
site is healthy. What should the nurse do next?
A) Apply a warm compress proximal to the site.
, B) Check for kinks in the tubing and raise the IV pole.
Complete Solutions UPDATED!!!!.
Correct
Incorrect
,
, A) Assist the ambulatng client back to the bed.
An oxygen saturaton below 90% indicates inadequate oxygen. First, the client should
be assisted to return to bed (A) to minimize oxygen demands. Ambulaton increases
aeraton of the lungs to prevent pooling of respiratory secretons, but the client's
actvity at this tme is depletng oxygen saturaton of the blood, so (B) is
contraindicated. Increased actvity increases respiratory efort, and oxygen may be
necessary to contnue ambulaton (C), but frst the
C) Afer clearing the tube with 30 ml of air, check the pH of fuid withdrawn fromclient should
return to the bed to rest. Oxygen saturaton levels at diferent the tube.sites should be
evaluated AFTER the client returns to bed (D).
Coughing, vomitng, and suctoning can precipitate displacement of the tp of the small bore
feeding tube upward into the esophagus, placing the client at increased risk for aspiraton.
Checking the sample of fuid withdrawn from the tube (afer clearing the tube with 30 ml of
air) for acidic (stomach) or alkaline (intestne) values is a more sensitve method for these
tubes, and the nurse should assess tube placement in this way prior to taking any other
acton (C). (A and B) are not indicated. The auscultatng method (D) has been found to be
unreliable for smallbore feeding tubes.
C) Restart the IV, perform tracheotomy care, change coccyx dressing.
Don't know?
3 of 175
Term
The nurse assesses a 2-year-old who is admited for dehydraton and fnds that
the peripheral IV rate by gravity has slowed, even though the venous access
site is healthy. What should the nurse do next?
A) Apply a warm compress proximal to the site.
, B) Check for kinks in the tubing and raise the IV pole.
