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HESI MILESTONE RETAKE EXAM QUESTIONS WITH ACTUAL CORRECT ANSWERS CURRENTLY TESTING

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The text provides a comprehensive overview of various nursing topics, including levels of health promotion, nursing assessments, lifespan nutritional considerations, pain assessment, assessment of different body systems, medication administration, wound care, fluid and electrolyte imbalances, and drug therapy. It covers a wide range of key concepts and practices essential for nursing professionals. Key Insights Levels of health promotion include primary, secondary, and tertiary prevention strategies. Nursing assessments can be comprehensive, focused, or emergency-based. Lifespan nutritional considerations vary for pregnant women, infants/children, and older adults. Pain assessment involves documentation, prioritization, and understanding different types of pain. Assessment techniques for various body systems include inspection, palpation, auscultation, and percussion.

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HESI MILESTONE RETAKE EXAM QUESTIONS WITH ACTUAL
CORRECT ANSWERS CURRENTLY TESTING




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



Assessment of the Ear - Techniques Part 2 - ANSWER-observe behavioral responses to speech, inspect
ear formation (size, shape & any malformation to the auricle, condition)

Perform whisper test & Rinne test. Pt plug one ear at a time

Perform weber test (evaluate unilateral hearing loss



Assessing the Chest - ANSWER-inspect, palpate, percuss, auscultate



Assessing Lung Sounds - Technique - ANSWER-IPPA- inspect, palpate, percuss, auscultate



Normal Lung Sounds - ANSWER-Normal: bronchial (heard anteriorly) over larynx and trachea
(INSPIRIATION slightly shorter than expiration),

Bronchiovesicular (heard anteriorly and posteriorly)INSPIRATION AND EXPIRATION EQUAL ,

Vesicular (heard both) lower lungs, low pitch, INSPIRATION GREATER THAN EXPIRATION)



Abnormal lung sounds: Rhonchi - ANSWER-low- heard mainly in expiration when pt is breathing out
(made up of one sound- whistle or whine and high pitch, musical instrument sound MULTIPLE sounds-
mainly heard in expiration CONDITION: PNEUMONIA



abnormal lung sounds: stridor - ANSWER-airway obstruction, high pitch whispering or gas (CROUP,
EMERGENCY, EPIGLOTTIS)



Abnormal lung sounds: Crackles - ANSWER-coarse(low pitch, wet sound)

fine (high pitch, doesnt clear w/cough, crackling of fire sound) CONDITION:RESPIRATORY
EDEMA/OBSTRUCTIVE DISEASE

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