MILESTONE HESI RETAKE QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES|AGRADE
Levels of Health Promotion - (answer)primary, secondary, tertiary
Application Examples of Levels of Promotion - (answer)primary- weight loss, diet,
smoking cessation
Secondary- papsmears, mammograms, testicular exams
Tertiary- medication therapy, surgical treatment, physical therapy, teaching foot
care education to diabetic care
Primary - (answer)promotes health and preventing development of disease
process or injury
Secondary - (answer)screening for early detection of disease
Tertiary - (answer)begins after illness is diagnosed and treatment. Aims to prevent
long-term consequences of chronic illnesses or disabilities
Nursing Assessments - (answer)Comprehensive- (Head to Toe) = Can be done
inpatient and through primary care (Physical assessment- annual exam)
Focused- Health and physical hx of specific problem.- ex. Sick visit
Emergency- crisis, life threatening. ex. airway, breathing, injury, disability,
exposure, med reconciliation
,Phases of Interview process - (answer)Pre-interaction, beginning, working (open
and close ended questions), closing
Data sources - (answer)Primary- individual patient
Secondary- chart info, family members
Purposes of Documentation - (answer)verbal communication, SBAR, written
document
Lifespan Nutritional Considerations - Nutrition: Pregnant Women - (answer)need
additional 300-500 cal/day (whole foods
Lifespan Nutritional Considerations - Nutrition: infants/children -
(answer)infants/children: whole milk for ages 2-5 fat intake-brain development
Lifespan Nutritional Considerations - Nutrition: Older - (answer)BMR declines,
Vitamin D supplements, Problems: decreased thirst, increase risk for
osteoarthritis, osteoporosis, dementia, obesity, social isolation
General Survey - (answer)mental note of overall health (hygiene/appearance).
Assessing pain: documentation, OLDCARTS/OPQRST. Aggravating and alleviating
factors, pain goal and funtional goal
Assessing Pain - Documentation - (answer)Acute vs. Chronic-Location
, Priority - (answer)Priority pain: stones (kidney, gallbladder, calcium and/or
struvite), myocardial infarcation (HA), burns and sickle cell
Heart Rate Elevated - (answer)above 100 beats per minute
Blood Pressure- Normal - (answer)above systolic- 120-129, diastolic- less than 80,
Blood Pressure- elevated - (answer)Hypertension: Stage 1: 130-139 or 80-89,
Stage Hypertension 2: more than 140, or greater than or equal to 90
When should BP be taken? - (answer)after patient rests for 5 minutues or 30
minutes after caffeine, smoking
Assessment of the Head and Neck - (answer)Inspect, palpate, auscultate
Infection - (answer)If nodes are palpable, warm, tender = infection
Assessment of the Ear - Techniques - (answer)Adults: up and back
Children: down and back
DETAILED ANSWERS WITH RATIONALES|AGRADE
Levels of Health Promotion - (answer)primary, secondary, tertiary
Application Examples of Levels of Promotion - (answer)primary- weight loss, diet,
smoking cessation
Secondary- papsmears, mammograms, testicular exams
Tertiary- medication therapy, surgical treatment, physical therapy, teaching foot
care education to diabetic care
Primary - (answer)promotes health and preventing development of disease
process or injury
Secondary - (answer)screening for early detection of disease
Tertiary - (answer)begins after illness is diagnosed and treatment. Aims to prevent
long-term consequences of chronic illnesses or disabilities
Nursing Assessments - (answer)Comprehensive- (Head to Toe) = Can be done
inpatient and through primary care (Physical assessment- annual exam)
Focused- Health and physical hx of specific problem.- ex. Sick visit
Emergency- crisis, life threatening. ex. airway, breathing, injury, disability,
exposure, med reconciliation
,Phases of Interview process - (answer)Pre-interaction, beginning, working (open
and close ended questions), closing
Data sources - (answer)Primary- individual patient
Secondary- chart info, family members
Purposes of Documentation - (answer)verbal communication, SBAR, written
document
Lifespan Nutritional Considerations - Nutrition: Pregnant Women - (answer)need
additional 300-500 cal/day (whole foods
Lifespan Nutritional Considerations - Nutrition: infants/children -
(answer)infants/children: whole milk for ages 2-5 fat intake-brain development
Lifespan Nutritional Considerations - Nutrition: Older - (answer)BMR declines,
Vitamin D supplements, Problems: decreased thirst, increase risk for
osteoarthritis, osteoporosis, dementia, obesity, social isolation
General Survey - (answer)mental note of overall health (hygiene/appearance).
Assessing pain: documentation, OLDCARTS/OPQRST. Aggravating and alleviating
factors, pain goal and funtional goal
Assessing Pain - Documentation - (answer)Acute vs. Chronic-Location
, Priority - (answer)Priority pain: stones (kidney, gallbladder, calcium and/or
struvite), myocardial infarcation (HA), burns and sickle cell
Heart Rate Elevated - (answer)above 100 beats per minute
Blood Pressure- Normal - (answer)above systolic- 120-129, diastolic- less than 80,
Blood Pressure- elevated - (answer)Hypertension: Stage 1: 130-139 or 80-89,
Stage Hypertension 2: more than 140, or greater than or equal to 90
When should BP be taken? - (answer)after patient rests for 5 minutues or 30
minutes after caffeine, smoking
Assessment of the Head and Neck - (answer)Inspect, palpate, auscultate
Infection - (answer)If nodes are palpable, warm, tender = infection
Assessment of the Ear - Techniques - (answer)Adults: up and back
Children: down and back
