Final HESI - Nsg123
Study online at https://quizlet.com/_g7rmdp
1. A client with a productive cough has obtained a spu- B. Observe the
tum specimen for culture as instructed. What is the color, consistency,
best initial nursing action? and amount of
sputum
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 fo
2. A client is brought to the ED by ambulance in car- A. Breath sounds
diac arrest with cardiopulmonary resuscitation (CPR) over bilateral lung
in progress. The client is intubated and is receiving fields.
100% oxygen per self-inflating (ambu) bag. The nurse
determines that the client is cyanotic, cold, and di-
aphoretic. Which assessment is most important for
the nurse to obtain?
A. Breath sounds over bilateral lung fields.
B. Carotid pulsation during compressions
C. Deep tendon reflexes
D. Core body temperature
3. After a hospitalization for Syndrome of Inappropri- A. Reorient client
ate Antidiuretic Hormone (SIADH), a client develops to his room
pontine myselinolysis. Which intervention should the
nurse implement first?
A. Reorient client to his room
B. Place a patch on one eye
C. Evaluate client's ability to swallow
D. Perform range of motion exercises
4. A male client with heart failure (HF) calls the clin- B. Has his weight
ic and reports that he cannot put his shoes on be- changed in the
cause they are too tight. Which additional information last several days?
should the nurse obtain?
, Final HESI - Nsg123
Study online at https://quizlet.com/_g7rmdp
A. What time did he take his last medications?
B. Has his weight changed in the last several days?
C. Is he still able to tighten his belt buckle?
D. How many hours did he sleep last night?
5. An older adult woman with a long history of chronic D. Assist her to an
obstructive pulmonary disease (COPD) is admitted upright position
with progressive shortness of breath and a persistent
cough. She is anxious and is complaining of a dry
mouth. Which intervention should the nurse imple-
ment?
A. Administer a prescribed sedative
B. Encourage client to drink water
C. Apply a high-flow venturi mask
D. Assist her to an upright position
6. A client with a history of asthma and bronchitis ar- A. Increase the
rives at the clinic with shortness of breath, productive daily intake of oral
cough with thickened tenacious mucous, and the in- fluids to liquefy se-
ability to walk up a flight of stairs without experienc- cretions
ing breathlessness. Which action is most important
for the nurse to instruct the client about self-care?
A. Increase the daily intake of oral fluids to liquefy
secretions
B. Avoid crowded enclosed areas to reduce pathogen
exposure
C. Call the clinic if undesirable side effects of media-
tions occur
D. Teach anxiety reduction methods for feelings of
suffocation
7. A cardiac catherterization of a client with heart dis- C. Three main ar-
ease indicates the following blockages: 95% proximal teries have ma-
left anterior descending (LAD), 99% proximal circum- jor blockages, with
flex, and ? % proximal right coronary artery (RCA). only 1 to 5% of
The client later asks the nurse "what does all this blood flow get-
mean for me?" What information should the nurse
, Final HESI - Nsg123
Study online at https://quizlet.com/_g7rmdp
provide? ting through to the
heart muscle.
A. Blood supply to the heart is diminished by
artherosclerotic lesions, which necessitate lifestyle
changes.
B. Blood vessels supplying the pumping chamber
have blockages indicating a past heart attack.
C. Three main arteries have major blockages, with
only 1 to 5% of blood flow getting through to the heart
muscle.
D. The heart is not receiving enough blood, so there
is a risk of heart failure and fluid retention.
8. A client who weighs 175 pounds is receiving IV bolus 0.6 ml
dose of heparin 80 units/kg. The heparin is available
in a 2 ml vial, labeled 10,000 units/ml. How many ml
should the nurse administer? (Enter numeric value
only. If rounding is required, round to the nearest
tenth.)
9. What information should the nurse include in the C. Minimize symp-
teaching plan of a client diagnosed with gastroe- toms by wearing
sophageal reflux disease (GERD)? loose, comfortable
clothing
A. Sleep without pillows at night to maintain neck
alignment.
B. Adjust food intake to three full meals per day and
no snacks.
C. Minimize symptoms by wearing loose, comfortable
clothing
D. Avoid participation in any aerobic exercise pro-
grams
10. The nurse is caring for a client with a lower left lobe A. left lateral
pulmonary abscess. Which position should the nurse
instruct the client to maintain?
A. left lateral
B. Supine, knees flexed
, Final HESI - Nsg123
Study online at https://quizlet.com/_g7rmdp
C. Dorsal recumbent
D. Knee-chest
11. A client with cholelithiasis has a gallstone lodged in C. Yellow sclera
the common bile duct and is unable to eat or drink
without becoming nauseated and vomiting. Which
finding should the nurse report to the healthcare
provider.
A. Belching
B. Amber urine
C. Yellow sclera
D. Flatulence
12. While caring for a client with Amyotrophic Later- C. Weakened
al Sclerosis (ALS), the nurse performs a neurolog- cough effort
ical assessment every four hours. Which assess-
ment finding warrants immediate intervention by the
nurse?
A. Inappropriate laughter
B. Increasing anxiety
C. Weakened cough effort
D. Asymmetrical weakness
13. The nurse is providing preoperative education for a B. The xenograft is
Jewish client scheduled to receive a xenograft graft taken from nonhu-
to promote burn healing. Which information should man sources
the nurse provide this client?
A. Grafting increases the risk for bacterial infections
B. The xenograft is taken from nonhuman sources
C. Grafts are later removed by a debriding procedure
D. As the burn heals, the graft permanently attaches
14. A male client who had colon surgery 3 days ago B. Prepare the
is anxious and requesting assistance to reposition. client to return
While the nurse is turning him, the wound dehis- to the operating
cences and eviscerates. The nurse moistens an avail- room
able sterile dressing and places it over the wound.
Study online at https://quizlet.com/_g7rmdp
1. A client with a productive cough has obtained a spu- B. Observe the
tum specimen for culture as instructed. What is the color, consistency,
best initial nursing action? and amount of
sputum
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 fo
2. A client is brought to the ED by ambulance in car- A. Breath sounds
diac arrest with cardiopulmonary resuscitation (CPR) over bilateral lung
in progress. The client is intubated and is receiving fields.
100% oxygen per self-inflating (ambu) bag. The nurse
determines that the client is cyanotic, cold, and di-
aphoretic. Which assessment is most important for
the nurse to obtain?
A. Breath sounds over bilateral lung fields.
B. Carotid pulsation during compressions
C. Deep tendon reflexes
D. Core body temperature
3. After a hospitalization for Syndrome of Inappropri- A. Reorient client
ate Antidiuretic Hormone (SIADH), a client develops to his room
pontine myselinolysis. Which intervention should the
nurse implement first?
A. Reorient client to his room
B. Place a patch on one eye
C. Evaluate client's ability to swallow
D. Perform range of motion exercises
4. A male client with heart failure (HF) calls the clin- B. Has his weight
ic and reports that he cannot put his shoes on be- changed in the
cause they are too tight. Which additional information last several days?
should the nurse obtain?
, Final HESI - Nsg123
Study online at https://quizlet.com/_g7rmdp
A. What time did he take his last medications?
B. Has his weight changed in the last several days?
C. Is he still able to tighten his belt buckle?
D. How many hours did he sleep last night?
5. An older adult woman with a long history of chronic D. Assist her to an
obstructive pulmonary disease (COPD) is admitted upright position
with progressive shortness of breath and a persistent
cough. She is anxious and is complaining of a dry
mouth. Which intervention should the nurse imple-
ment?
A. Administer a prescribed sedative
B. Encourage client to drink water
C. Apply a high-flow venturi mask
D. Assist her to an upright position
6. A client with a history of asthma and bronchitis ar- A. Increase the
rives at the clinic with shortness of breath, productive daily intake of oral
cough with thickened tenacious mucous, and the in- fluids to liquefy se-
ability to walk up a flight of stairs without experienc- cretions
ing breathlessness. Which action is most important
for the nurse to instruct the client about self-care?
A. Increase the daily intake of oral fluids to liquefy
secretions
B. Avoid crowded enclosed areas to reduce pathogen
exposure
C. Call the clinic if undesirable side effects of media-
tions occur
D. Teach anxiety reduction methods for feelings of
suffocation
7. A cardiac catherterization of a client with heart dis- C. Three main ar-
ease indicates the following blockages: 95% proximal teries have ma-
left anterior descending (LAD), 99% proximal circum- jor blockages, with
flex, and ? % proximal right coronary artery (RCA). only 1 to 5% of
The client later asks the nurse "what does all this blood flow get-
mean for me?" What information should the nurse
, Final HESI - Nsg123
Study online at https://quizlet.com/_g7rmdp
provide? ting through to the
heart muscle.
A. Blood supply to the heart is diminished by
artherosclerotic lesions, which necessitate lifestyle
changes.
B. Blood vessels supplying the pumping chamber
have blockages indicating a past heart attack.
C. Three main arteries have major blockages, with
only 1 to 5% of blood flow getting through to the heart
muscle.
D. The heart is not receiving enough blood, so there
is a risk of heart failure and fluid retention.
8. A client who weighs 175 pounds is receiving IV bolus 0.6 ml
dose of heparin 80 units/kg. The heparin is available
in a 2 ml vial, labeled 10,000 units/ml. How many ml
should the nurse administer? (Enter numeric value
only. If rounding is required, round to the nearest
tenth.)
9. What information should the nurse include in the C. Minimize symp-
teaching plan of a client diagnosed with gastroe- toms by wearing
sophageal reflux disease (GERD)? loose, comfortable
clothing
A. Sleep without pillows at night to maintain neck
alignment.
B. Adjust food intake to three full meals per day and
no snacks.
C. Minimize symptoms by wearing loose, comfortable
clothing
D. Avoid participation in any aerobic exercise pro-
grams
10. The nurse is caring for a client with a lower left lobe A. left lateral
pulmonary abscess. Which position should the nurse
instruct the client to maintain?
A. left lateral
B. Supine, knees flexed
, Final HESI - Nsg123
Study online at https://quizlet.com/_g7rmdp
C. Dorsal recumbent
D. Knee-chest
11. A client with cholelithiasis has a gallstone lodged in C. Yellow sclera
the common bile duct and is unable to eat or drink
without becoming nauseated and vomiting. Which
finding should the nurse report to the healthcare
provider.
A. Belching
B. Amber urine
C. Yellow sclera
D. Flatulence
12. While caring for a client with Amyotrophic Later- C. Weakened
al Sclerosis (ALS), the nurse performs a neurolog- cough effort
ical assessment every four hours. Which assess-
ment finding warrants immediate intervention by the
nurse?
A. Inappropriate laughter
B. Increasing anxiety
C. Weakened cough effort
D. Asymmetrical weakness
13. The nurse is providing preoperative education for a B. The xenograft is
Jewish client scheduled to receive a xenograft graft taken from nonhu-
to promote burn healing. Which information should man sources
the nurse provide this client?
A. Grafting increases the risk for bacterial infections
B. The xenograft is taken from nonhuman sources
C. Grafts are later removed by a debriding procedure
D. As the burn heals, the graft permanently attaches
14. A male client who had colon surgery 3 days ago B. Prepare the
is anxious and requesting assistance to reposition. client to return
While the nurse is turning him, the wound dehis- to the operating
cences and eviscerates. The nurse moistens an avail- room
able sterile dressing and places it over the wound.
