HESI MILESTONE 2 2024/25 EXAM UPDATE WITH CORRECT VERIFIED ANSWERS A+ GRADED

HESI MILESTONE 2 2024/25 EXAM UPDATE
WITH CORRECT VERIFIED ANSWERS A+
GRADED


Chemo Side Effects ...ANSWER... o Nausea/vomiting (24-48 hr,
v v vvv vv v v v


can be delayed up to 1 week)
v v v v v v v




Meningitis first step ...ANSWER... o Antibiotics - penicillin
v v vvv vv v v v


(ampicillin) AND cephalosporin
v v v




o Corticosteroids
v




Multiple sclerosis and urinary retention ...ANSWER... o
v v v v vvv vv


Sensation of void heeded immediately (bed pan/urinal @ bedside)
v v v v v v v v v




o Voiding schedule (start 1/5-2hr then extend)
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o Drink specific amt every 2 hour; urinate 30 min after w/ timer
v v v v v v v v v v v v




o Self-catherization
v




Acute renal failure priority ...ANSWER... o Maintain fluids
v v v vvv vv v v




o Avoid fluid excess
v v v




o Renal replacement therapy
v v v




o Reduce metabolic rate
v v v




o Promote pulmonary function
v v v

,Acute Respiratory distress priority findings ...ANSWER... o
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Hypoxia
v




o Intercostal retractions
v v




o Crackles
v




o BNP levels
v v




(alveoli collapse because small airways are narrowed due to
v v v v v v v v


interstitial fluid and bronchial obstruction)
v v v v v




End of life plan of care ...ANSWER... o Signs and symptoms of
v v v v v vvv vv v v v v


impending death are recognized and communicated in
v v v v v v v


developmentally appropriate language for children and patients
v v v v v v v


with cognitive disabilities with respect to family preference. Care
v v v v v v v v v


appropriate to this phase of illness is proved to the patient and the
v v v v v v v v v v v v v


family
v




Cushing Syndrome ...ANSWER... o Can result from
v vvv vv v v v


corticosteroids
v




v***Attempt to reduce/taper medication while still treating
v v v v v v


vunderlying disease v




o Alternate day therapy decrease symptoms and allows adrenal
v v v v v v v v


glands to recover
v v v




Valve replacement teaching ...ANSWER... o Anticoagulant
v v vvv vv v


therapy (frequent follow-up/lab tests)
v v v v




§ Pt on warfarin has specific normal ratios
v v v v v v v




o Prevent infection
v v

, o ANTIBIOTIC PROPHYALXIS FOR DETAL PROCEDURES!!!
v v v v v




Cancer intractable pain plan of care ...ANSWER... o Pain,
v v v v v vvv vv v


other symptoms and side effects are managed based on the best
v v v v v v v v v v v


available evidence, with attention to disease-specific pain and
v v v v v v v v


symptoms, which are skillfully and systematically applied. ??????
v v v v v v v v




Schizophrenia nursing diagnoses and interventions v v v v vv


...ANSWER... - Dx: 2 or more S&S for over 6 mo (Positive=
v vv v v v v v v v v v v


delusions, hallucinations, disorganized speech or Negative= 6 A's
v v v v v v v v


Anhedonia, Flat Affect, Apathy, Anergia, Algogia, Avolition)
v v v v v v v




-Establish rapport and trust, ask about hallucinations, distract,
v v v v v v v


lower environmental stimuli, monitor suicidal ideation, 1st or 2nd
v v v v v v v v v


generation antipsych
v v




Grief process therapeutic response ...ANSWER... Allow the 5
v v v vvv vv v v


steps of grieving (DABDA), active listening and offer a supportive
v v v v v v v v v v


presence
v




Dementia action refusing ADLs ...ANSWER... Encourage
v v v vvv vv


finger foods, distraction, speak therapeutically
v v v v v




Alcohol withdrawal ...ANSWER... - Needs to be done under
v vvv vv v v v v v


medical supervision b/c can be deadly
v v v v v v




- VS Q4, onset of symptoms 4-6 hours after last drink, give
v v v v v v v v v v v


lorazepam, reduce temp.
v v v




- Tremors, nausea, vomiting
v v v