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Examen

HESI RN MED SURG V1

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A nurse is planning care for a client who has extensive burn injuries and is immunocompromised. Which of the following precautions should the nurse include in the plan of care to prevent a pseudomonas aeruginosa infection? Avoid placing plants or flowers in the client’s room 17. A nurse is teaching a class about client rights. Which of the following instructions should the nurse include? A client should sign an informed consent receiving a placebo during a research trial. 18. A nurse is caring for a client who is receiving morphine for daily dressing changes. The client tells the nurse, “ I don’t want any more morphine because I don’t want to get addicted.” Which of the following actions should the nurse take? Instruct the client on alternative therapies for pain reduction 19. A nurse is preparing a client who has supraventricular tachycardia for elective cardioversion. Which of the following prescribed medications should the nurse instruct the client to withhold for 48 hr prior to cardioversion? Digoxin 20. A nurse is caring for a client 1 hr following a cardiac catheterization. The nurse notes the formation of a hematoma at the insertion site and a decreased pulse rate in the affected extremity. Which of the following interventions is the nurse’s priority? Apply firm pressure to the insertion site 21. A nurse is assessing a client who has graves’ disease. Which of the following images should indicate to the nurse that the client has exophthalmos? The nurse should identify an outward protrusion of the eyes as exophthalmos, a common finding of graves’ disease. An overproduction of the thyroid hormone causes edema of the extraocular muscle and increases fatty tissue behind the eye, which results in the eyes protruding outward. Exophthalmos can cause the client to experience problems with vision,including focusing on objects, as well as pressure on the optic nerve. 22. A nurse is caring for a client who has a stage 111 pressure injury. Which of the following findings contributes to delayed wound healing? Urine output 25 mL/hr 23. A nurse is providing teaching to a client who is receiving chemotherapy and has a new prescription for epoetin alfa.Which of the following client statements indicates an understanding of the teaching? “ I will monitor my blood pressure while taking this medicatio

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HESI RN Medical Surgical V1

1.A home health nurse is assigned to a client who was recently discharged from a rehabilitation
center after experiencing a right-hemispheric stroke. Which of the following neurologic deficits
should the nurse expect to find when assessing the client? ( select all that apply)

Visual spatial deficits
Left hemianopsia ( blindness in the left half of the visual field)
One-sided neglect

2. A nurse is reviewing the health record of a client who is scheduled for allergy skin testing. The
nurse should postpone the testing and report to the provider which of the following findings?

Current medications

3. A nurse is caring for a group of clients. The nurse should plan to make a referral to physical
therapy for which of the following clients?

A client who is receiving preoperative teaching for a right knee arthroplasty

4.A nurse is caring for a client who is having a seizure. Which of the following interventions is
the nurse’s priority?

Turn the client to the side

5.A nurse is caring for a client who is 12 hr postoperative following a total hip arthroplasty.
Which of the following actions should the nurse take?

Place a pillow between the client’s leg

6. A nurse is preparing to admit a client who has dysphagia. The nurse should plan to place
which of the following items at the client’s bedside?

Suction machine

7.A nurse is planning teaching for a client who has bladder cancer and is to undergo a
cutaneous diversion procedure to establish a ureterostomy. Which of the following statements
should the nurse include in the teaching?

“You should cut the opening of the skin barrier one-eight inch wider than the stoma”

8.A nurse in an emergency department is caring for a client who reports vomiting and diarrhea
for the past 3 days. Which of the following findings should indicate to the nurse that the client is
experiencing fluid volume deficit?

, Heart rate 110/min

9.A nurse is planning care for a client who is undergoing brachytherapy via a sealed vaginal
implant to treat endometrial cancer.Which of the following actions should the nurse include in
the client’s plan of care?

Wear a lead apron while providing care to the client

10.A nurse is planning to provide discharge teaching for the family of an older adult client who
has hemianopsia and is at risk for falls. Which of the following instructions should the nurse
include?

Remind the client to scan their complete range of vision during ambulation

11.A nurse is planning care to decrease psychosocial health issues for a client who is starting
dialysis treatments for chronic kidney disease. Which of the following interventions should the
nurse include in the plan?

Tell the client that it is possible to return to similar previous levels of activity

12.A nurse is caring for a client who has a closed head injury and has an intraventricular
catheter placed. Which of the following findings indicates that the client is experiencing
increased intracranial pressure (ICP)

Sleepiness exhibited by the client
Widening pulse pressure
Decerebrated posturing

13.An older adult client is brought to an emergency department by a family member. Which of
the following assessment findings should cause the nurse to suspect that the client has
hypertonic dehydration?

Urine specific gravity 1.045

14.A nurse is caring for a client who has a prescription for enalapril. The nurse should identify
which of the following findings as an adverse effect of the medication?

Orthostatic hypotension

15.A nurse in a provider’s office is caring for a client who requests sildenafil to treat erectile
dysfunction. Which of the following statements should the nurse make?

“ You will not be able to use sildenafil if you are taking nitroglycerin

Información del documento

Subido en
10 de febrero de 2022
Número de páginas
13
Escrito en
2022/2023
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Examen
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