Evolve HESI practice Exam Save
Terms in this set (92)
A 73-year-old female client had a Place a pillow between your knees while lying in bed to prevent
hemiarthroplasty of the left hip hip dislocation.
yesterday due to a fracture
resulting from a fall. In reviewing
hip precautions with the client,
which instruction should the
nurse include in this client's
teaching plan?
An adult male client with a history It is important that you continue your medication while learning to
of hypertension tells the nurse meditate.
that he is tired of taking
antihypertensive medications and
is going to try spiritual meditation
instead. What should be the
nurse's first response?
,An African-American Inquire about the source and type of pain
grandmother tells the nurse that
her 4-year-old grandson is
suffering with "miseries." Based
on this statement, which focused
assessment should the nurse
conduct?
After completing an assessment determine the etiology of the problem
and determining that a client has
a problem, which action should
the nurse perform next?
An Arab-American woman, who D) Tell the surgeon that the son will decide after explanation of the
is a devout traditional Muslim, proposed surgery is provided.
lives with her married son's family,
which includes several adult Traditional Muslim women live in a patriarchal family where
children and their children. What decisions are made by men. Most likely, the son will make the
is the best plan to obtain consent decision for his mother, so
for surgery for this client?
At the beginning of the shift, the Immediately after the assessments are completed.
nurse assesses a client who is
admitted from the post-
anesthesia care unit (PACU).
When should the nurse
document the client's findings?
At the time of the first dressing It is OK if you don't want to talk about your surgery. I will be
change, the client refuses to look available when you are ready.
at her mastectomy incision. The
nurse tells the client that the (It displays sensitivity and understanding without judging the
incision is healing well, but the patient)
client refuses to talk about it.
What would be an appropriate
response to this client's silence?
, A client is in the radiology Give the missed dose at 1300 and change the schedule to
department at 0900 when the administer daily at 1300.
prescription levofloxacin
(Levaquin) 500 mg IV q24h is
scheduled to be administered.
The client returns to the unit at
1300. What is the best
intervention for the nurse to
implement?
A client is receiving a Initiate an alternate site for the IV infusion of the medication.
cephalosporin antibiotic IV and
complains of pain and irritation at
the infusion site. The nurse
observes erythema, swelling, and
a red streak along the vessel
above the IV access site. Which
action should the nurse take at
this time?
A client is to receive 10 mEq of 63 ml/hour.
KCl diluted in 250 ml of normal
saline over 4 hours. At what rate
should the nurse set the client's
intravenous infusion pump?
A client is to receive cimetidine 150
(Tagamet) 300 mg q6h IVPB. The
preparation arrives from the
pharmacy diluted in 50 ml of 0.9%
NaCl. The nurse plans to
administer the IVPB dose over 20
minutes. For how many ml/hr
should the infusion pump be set
to deliver the secondary
infusion?
Terms in this set (92)
A 73-year-old female client had a Place a pillow between your knees while lying in bed to prevent
hemiarthroplasty of the left hip hip dislocation.
yesterday due to a fracture
resulting from a fall. In reviewing
hip precautions with the client,
which instruction should the
nurse include in this client's
teaching plan?
An adult male client with a history It is important that you continue your medication while learning to
of hypertension tells the nurse meditate.
that he is tired of taking
antihypertensive medications and
is going to try spiritual meditation
instead. What should be the
nurse's first response?
,An African-American Inquire about the source and type of pain
grandmother tells the nurse that
her 4-year-old grandson is
suffering with "miseries." Based
on this statement, which focused
assessment should the nurse
conduct?
After completing an assessment determine the etiology of the problem
and determining that a client has
a problem, which action should
the nurse perform next?
An Arab-American woman, who D) Tell the surgeon that the son will decide after explanation of the
is a devout traditional Muslim, proposed surgery is provided.
lives with her married son's family,
which includes several adult Traditional Muslim women live in a patriarchal family where
children and their children. What decisions are made by men. Most likely, the son will make the
is the best plan to obtain consent decision for his mother, so
for surgery for this client?
At the beginning of the shift, the Immediately after the assessments are completed.
nurse assesses a client who is
admitted from the post-
anesthesia care unit (PACU).
When should the nurse
document the client's findings?
At the time of the first dressing It is OK if you don't want to talk about your surgery. I will be
change, the client refuses to look available when you are ready.
at her mastectomy incision. The
nurse tells the client that the (It displays sensitivity and understanding without judging the
incision is healing well, but the patient)
client refuses to talk about it.
What would be an appropriate
response to this client's silence?
, A client is in the radiology Give the missed dose at 1300 and change the schedule to
department at 0900 when the administer daily at 1300.
prescription levofloxacin
(Levaquin) 500 mg IV q24h is
scheduled to be administered.
The client returns to the unit at
1300. What is the best
intervention for the nurse to
implement?
A client is receiving a Initiate an alternate site for the IV infusion of the medication.
cephalosporin antibiotic IV and
complains of pain and irritation at
the infusion site. The nurse
observes erythema, swelling, and
a red streak along the vessel
above the IV access site. Which
action should the nurse take at
this time?
A client is to receive 10 mEq of 63 ml/hour.
KCl diluted in 250 ml of normal
saline over 4 hours. At what rate
should the nurse set the client's
intravenous infusion pump?
A client is to receive cimetidine 150
(Tagamet) 300 mg q6h IVPB. The
preparation arrives from the
pharmacy diluted in 50 ml of 0.9%
NaCl. The nurse plans to
administer the IVPB dose over 20
minutes. For how many ml/hr
should the infusion pump be set
to deliver the secondary
infusion?
