Nurse Amy

1 An 8-year-old child is receiving . digoxin (Lanoxin) for congestive heart failure (CHF). In assessing the child, the nurse finds that her apical heart rate is 80 beats/min, she complains of being slightly nauseated, and her serum digoxin level is 1.2 ng/mL. What action should the nurse take? A.Because the child's heart rate and digoxin level are within normal range, assess for the cause of the nausea. B.Hold the next dose of digoxin until the health care provider can be notified ...

. Following routine colonoscopy screening, a client is told that he had several polyps removed. The client began crying stating, “I just can't deal with cancer. I'm too young.” The nurse responds:A) “Don't worry. We have some great cancer doctors on staff. I'm sure chemo will help you fight it.”B) “Maybe if you're lucky, they have stopped it from metastasizing to your liver.”C) “A simple intestinal surgery will cure you.”D) “Most colon polyps are not cancerous....

2. A nurse hangs a 500-mL bag of intravenous (IV) fluid for an assigned client. One hour later the client complains of chest tightness, is dyspneic and apprehensive, and has an irregular pulse. The IV bag has 100 mL remaining. Which of the following actions should the nurse take first? Removing the IV Sitting the client up in bed Shutting off the IV infusion Correct Slowing the rate of infusion Rationale: The client’s symptoms are indicative of speed shock, which results from the rapid...

1. A healthcare provider prescribes cephalexin monohydrate (Keflex) for a client with a postoperative infection. It is most important for the nurse to assess for what additional drug allergy before administering this prescription? A) Penicillins. B) Aminoglycosides. C) Erythromycins. D) Sulfonamides. A) Penicillins. Cross-allergies exist between penicillins (A) and cephalosporins, such as cephalexin monohydrate (Keflex), so checking for penicillin allergy is a wise precaution before ad...

Pediatrics Retake Exam 1. A nurse is preparing to assess a 4-year old child’s visual acuity. Which of the following actions should the nurse plan first? • Use a tumbling E chart for the assessment • Position the child 4.6 meters (15 feet) from the chart • Assess both eyes together first, then each eye separately • Test the child without glasses before testing with glasses 2. A nurse is providing discharge teaching to a parent of a child who has juvenile idiopathic arthritis and...

RN HESI Pediatrics Retake Exam Question 1 A nurse is preparing for the admission of a child with a diagnosis of acute-stage Kawasaki disease. On assessment of the child, the nurse expects to note which clinical manifestation of the acute stage of the disease? Conjunctival hyperemia Question 2 Which signs and symptoms would lead a nurse to suspect a child has tetralogy of Fallot? Select all that apply. Murmur History of squatting Cyanosis Tachypnea Question 3 A nurse is caring f...

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 aller...

1. The nurse is caring for a client who had an emergency cesarean section, with her husband in attendance the day before. The baby’s Apgar was 9/9. The woman and her partner had attended childbirth education classes and had anticipated having a water birth with family present. Which of the following comments by the nurse is appropriate?

HESI RN OB 1. The nurse is caring for a client who had an emergency cesarean section, with her husband in attendance the day before. The baby’s Apgar was 9/9. The woman and her partner had attended childbirth education classes and had anticipated having a water birth with family present. Which of the following comments by the nurse is appropriate? a) “Sometimes babies just don’t deliver the way we expect them to.” b) “With all of your preparations, it must have been disappointi...

1. A client with paranoia is admitted to the mental health unit and immediately goes to the corner of the room and sits quietly without communicating. In approaching the client, what intervention should the nurse implement first? • Explain the nurse's role to the client. 2. Client treated with lithium for bipolar develops diarrhea, vomiting and drowsiness, what action should the nurse do • Notify HCP of the symptoms prior to the next admin of the drug 3. A mental health worker (MHW) ...

HESI RN MENTAL HEALTH A male client with bipolar disorder who began taking lithium carbonate five days ago is complaining of excessive thirst, and the RN finds him attempting to drink water from the bathroom sink faucet. Which intervention should the RN implement? A. Report the client's serum lithium level to the HCP. B. Encourage the client to suck on hard candy to relieve the symptoms. C. No action is needed since polydipsia is a common side effect. D. Tell the client that drinking f...

HESI RN MENTAL HEALTH Middle age female with no previous mental illness and the family states that she is having paranoid thoughts, pt states: "I want to find out why people are stalking me". Therapeutic response: "it sounds like this experience is frightening for you" Pt is mad at mom for turning him in and wants mom to bring belongings and does not want to talk to her. What action does the nurse need to take before the visit? Discuss methods of clear communication Duty to warn que...

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 aller...

1 | P a g e HESI RN MED SURG 1. A client with a productive cough has obtained a sputum specimen for culture as instructed. What is the best initial nursing action? Answer: Administer the first dose of prescribed antibiotic therapy 2. A client is brought to the Emergency Department by ambulation in cardiac arrest with cardiopulmonary resuscitation (CPR) in progress. The client isintubated and receiving 100% oxygen per self‐inflating (ambu) bag. The nurse determines that the client is cya...

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 aller...

HESI RN MED SURG 1. The nurse is assessing a 48-year-old client with a history of smoking during a routine clinic visit. The client, who exercises regularly, reports having pain in the calf during exercise that disappears at rest. Which of the following findings requires further evaluation? 1. Heart rate 57 bpm. 2. SpO2 of 94% on room air. 3. Blood pressure 134/82. 4. Ankle-brachial index of 0.65. An Ankle-Brachial Index of 0.65 suggests moderate arterial vascular disease in a client who...

HESI RN Gerontology A frail, elderly client is admitted to the unit with a diagnosis of pneumonia. Which finding is most important for the registered nurse (RN) to report to the healthcare provider? A. Fever and chills B. Confusion and dehydration C. Crackles in the lung fields D. Nausea and vomiting B. Confusion and dehydration Rationale: Confusion and dehydration (B) are findings of inadequate oxygenation and perfusion in this frail elderly client. (A), (C) and (D) are all common w...

2021 HESI RN Fundamentals v1 1.A policy requiring the removal of acrylic nails by all nursing personnel was implemented 6 months ago. Which assessment measure best determines if the intended outcome of the policy is being achieved. a. Number of staff induced injury b. Client satisfaction survey c. Health care-associated infection rate. d. Rate of needle-stick injuries by nurse. 2.The nurse is preparing to assist a newly admitted client with personal hygiene measures. The client...the cli...

2021 HESI RN Fundamentals v1 1. A policy requiring the removal of acrylic nails by all nursing personnel was implemented 6 months ago. Which assessment measure best determines if the intended outcome of the policy is being achieved. a. Number of staff induced injury b. Client satisfaction survey c. Health care-associated infection rate. d. Rate of needle-stick injuries by nurse. 2. The nurse is preparing to assist a newly admitted client with personal hygiene measures. The client...the ...

HESI RN FUNDAMENTALS The nurse is caring for a 14-year-old boy in Buck traction for a slipped capital femoral epiphysis (SCFE). Which of the following would the nurse include when completing a neurovascular assessment of the affected leg? Select all that apply. a) Sensation b) Capillary refill c) Color d) Vital signs e) Pulse c)Color a)Sensation e)Pulse b)Capillary refill Explanation: A neurovascular assessment includes assessing for color, movement, sensation, edema, and quality o...