A client who has a prescription for fluid restriction asks the nurse for a
mid-afternoon snack. What is the
best snack to bring to the client
Custard
The nurse is developing a teaching plan for a client who was recently
diagnosedwith pernicious anemia
and requires vitamin B12 replacement therapy. Which precaution is
most importantfor the nurse to
include in the clients plan of care.
Schedule daily rest periods to minimize fatigue
In preparing to administer an intravenous medication, the nurse notes
that the drugis listed in drug
reference guide as being incompatible with the currently infusing
intravenoussolution of Ringer’s
Lactate. What action should the nurse take?
Flush the line with a compatible solution before and after
administeringthe medication
A client with an overactive bladder receives a prescription Oxybutynin
(Ditropan) ananticholinergic
agent. Which information should the nurse include in this client
teaching plan.
Sugar free hard candies may relieve dry mouth
A female client who is receiving chemotherapy asks the nurse if she
can have afresh green salad because
she is nauseated. Which response should the nurse provide.
Canned vegetables are recommended while taking chemotherapy
The health care provider telephones the nurse and provides a verbal
prescription fora client’s persistent
cough and pulmonary wheezing. The prescription includes a chest x-
ray andantibiotic and a nebulizer
treatment now and PRN, in what order should these interventions be
implemented?(Arrange the first
action on top, and the last action on the bottom)
Read prescriptions back to the healthcare provider
Enter the verbal prescription in the electronic medical record
Administer the PRN nebulizer breathing treatment
Prepare the client for transport to radiology for a chest x-ray
Based on the Braden Risk Assessment Scales, Which client is at
,highest risk?
A male who is aphasic and experiencing bladder incontinence
Prior to removing surgical wound staples, what assessment is most
important forthe nurse to complete?
Determine the level of incisional pain
Which technique should the school nurse use to assess a group of
children withpediculosis capitis (head
lice).
Inspect the hair shaft for white……
A nurse assesses a client’s care after receiving a report from the
practical nurse,who is leaving the unit.
The PN report that the clients’ dressing was changes, and the dressing
change andwound appearance
,were documented in the nurses’ note. The nurse later observes that the
date on theclients dressing is from
the previous day and was initialed by the nurse who cared for the client
theprevious day, What action
should the nurse take?
Confirm the finding with the charge nurse before completing and
documenting the dressing change
HESI V3 FrmRN2u
Because a client with Bells’ palsy is at risk for impaired nutrition, which
actionshould nurse include in
the clients plan of care?
Teach the client to chew food on the unaffected side of the face
A new employee in a long term care facility for clients with Alzheimer’s
tells thenurse that an elderly
male client constantly asks for his mother who died many years ago.
The UAP asksthe nurse for advice
on how to respond to the client. Which response should the nurse
provide? Remind the client that his mother died many years ago
and change thesubject.
A client with metastatic cancer and a very limited prognosis is being
dischargedfrom the hospital, when
developing a plan for this client, which goal has the highest priority?
Intake of adequate nutrients will be maintained.
A nurse is observing the appearance of an older clients eyes. Which
findingwarrants immediate
intervention?
conjunctival sacs are pale
A client with type 2 diabetes mellitus (DM) receives a new prescription
forsitagliptin (januvia) In
providing client teaching, the nurse should emphasize the importance
of reportingwhich problem to the
healthcare provider immediately?
Upper respiratory infection
When analyzing objective data obtained during a physical assessment,
what actionshould the nurse
perform first?
Compare the data against established norms
The nurse is assessing the reflexes of a 35 year old male client who
came to theclinic for his annual
physical exam. When the nurse strikes the patellar tendon, there is no
response.
What action should thenurse take next?
Record the patellar reflex as a zero
, A charge nurse overhears a practical nurse (PN) tell unlicensed
Assistive personnel(UAP) to apply
sequential Compression devices to the legs of a postoperative client.
What actionshould the charge
nurse take?
Advise that the PN should apply the devices rather than assign the
workto the UAP
mid-afternoon snack. What is the
best snack to bring to the client
Custard
The nurse is developing a teaching plan for a client who was recently
diagnosedwith pernicious anemia
and requires vitamin B12 replacement therapy. Which precaution is
most importantfor the nurse to
include in the clients plan of care.
Schedule daily rest periods to minimize fatigue
In preparing to administer an intravenous medication, the nurse notes
that the drugis listed in drug
reference guide as being incompatible with the currently infusing
intravenoussolution of Ringer’s
Lactate. What action should the nurse take?
Flush the line with a compatible solution before and after
administeringthe medication
A client with an overactive bladder receives a prescription Oxybutynin
(Ditropan) ananticholinergic
agent. Which information should the nurse include in this client
teaching plan.
Sugar free hard candies may relieve dry mouth
A female client who is receiving chemotherapy asks the nurse if she
can have afresh green salad because
she is nauseated. Which response should the nurse provide.
Canned vegetables are recommended while taking chemotherapy
The health care provider telephones the nurse and provides a verbal
prescription fora client’s persistent
cough and pulmonary wheezing. The prescription includes a chest x-
ray andantibiotic and a nebulizer
treatment now and PRN, in what order should these interventions be
implemented?(Arrange the first
action on top, and the last action on the bottom)
Read prescriptions back to the healthcare provider
Enter the verbal prescription in the electronic medical record
Administer the PRN nebulizer breathing treatment
Prepare the client for transport to radiology for a chest x-ray
Based on the Braden Risk Assessment Scales, Which client is at
,highest risk?
A male who is aphasic and experiencing bladder incontinence
Prior to removing surgical wound staples, what assessment is most
important forthe nurse to complete?
Determine the level of incisional pain
Which technique should the school nurse use to assess a group of
children withpediculosis capitis (head
lice).
Inspect the hair shaft for white……
A nurse assesses a client’s care after receiving a report from the
practical nurse,who is leaving the unit.
The PN report that the clients’ dressing was changes, and the dressing
change andwound appearance
,were documented in the nurses’ note. The nurse later observes that the
date on theclients dressing is from
the previous day and was initialed by the nurse who cared for the client
theprevious day, What action
should the nurse take?
Confirm the finding with the charge nurse before completing and
documenting the dressing change
HESI V3 FrmRN2u
Because a client with Bells’ palsy is at risk for impaired nutrition, which
actionshould nurse include in
the clients plan of care?
Teach the client to chew food on the unaffected side of the face
A new employee in a long term care facility for clients with Alzheimer’s
tells thenurse that an elderly
male client constantly asks for his mother who died many years ago.
The UAP asksthe nurse for advice
on how to respond to the client. Which response should the nurse
provide? Remind the client that his mother died many years ago
and change thesubject.
A client with metastatic cancer and a very limited prognosis is being
dischargedfrom the hospital, when
developing a plan for this client, which goal has the highest priority?
Intake of adequate nutrients will be maintained.
A nurse is observing the appearance of an older clients eyes. Which
findingwarrants immediate
intervention?
conjunctival sacs are pale
A client with type 2 diabetes mellitus (DM) receives a new prescription
forsitagliptin (januvia) In
providing client teaching, the nurse should emphasize the importance
of reportingwhich problem to the
healthcare provider immediately?
Upper respiratory infection
When analyzing objective data obtained during a physical assessment,
what actionshould the nurse
perform first?
Compare the data against established norms
The nurse is assessing the reflexes of a 35 year old male client who
came to theclinic for his annual
physical exam. When the nurse strikes the patellar tendon, there is no
response.
What action should thenurse take next?
Record the patellar reflex as a zero
, A charge nurse overhears a practical nurse (PN) tell unlicensed
Assistive personnel(UAP) to apply
sequential Compression devices to the legs of a postoperative client.
What actionshould the charge
nurse take?
Advise that the PN should apply the devices rather than assign the
workto the UAP