Hesi Milestone 2 Actual Exam 3 Latest Versions (V1,V2 And V3) Each Version Contains
100 Questions With Detailed Answers
Anxiety Suicide Risks: - ANSRestless, difficulty concentrating, irritability
- "Have you had any suicidal thoughts since starting bupropion?"
Arterial Insufficency - ANS- mostly men
- legs mostly affected
arterial insufficiency symptoms - ANS-weak pedal pulses
-shiny and cool skin
-intermittent claudication
- aching/cramping
- induced fatigue
Asthma Triggers: - ANSDust, mites, roaches, cloth, pets, horses, detergents, soaps, food, mold,
pollens, seasonal
Bizarre social behavior - ANS- assess physical needs, suicide risk, ensure safety at all time
- sit w/ client, silence, tell when leaving
- limit stimuli / 1-1 interaction
,Boggy Uterus Actions - ANS- massage and administer uterotonic to increase uterine
contraction.
- give oxytocin
Cancer intractable pain plan of care - ANSo Pain, other symptoms and side effects are
managed based on the
best available evidence, with attention to disease-specific pain and symptoms, which are
skillfully and
systematically applied. ??????
Cardiomyopathy care plan - ANS○ Medications- digoxin, diuretics, antidysrhythmic,
antihypertensive
medications
○ Surgery- septal myectomy, septal ablation, implanted devices (CRT, ICD, LVAD, pacemaker),
heart
transplantation
Chronic Kidney Disease = metabolic acidosis - ANSkidneys fail, no longer reabsorb HCO3
(bicarb), serum
bicarbonate decrease = acidosis occurs
** sodium bicarb administration
,Cirrhosis ascites dyspnea- S/S - ANSencephalopathy
portal hypertension
esophageal varices
hemorrhage
Chemo Side Effects - ANSo Nausea/vomiting (24-48 hr, can be delayed up to 1 week
24 hour- Jaundice - ANSPhysiologic jaundice occurs from a normal reduction in red blood
cells. Pathologic
jaundice occurs within first 24 hours of life OR persists beyond 7 days
A client with anorexia has her friend bring her several cookbooks so she can plan a party when
she is
discharged. What nursing intervention is appropriate in addressing this behavior? -
ANSDiscuss activities
that don't involve food that can take place after discharge. Discuss the cookbooks with the
treatment team,
and if the treatment plan so indicates, take the books from the client.
A nurse is preparing a client for the termination phase of the nurse-client relationship. The
nurse prepares to
implement which nursing task appropriate for this phase? - ANSMaking appropriate referrals
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, ABG findings - ANSpH: 7.35 - 7.45
PCO2: 35 - 45 mmHg
HCO3: 22 - 26 mmHg
Acute Pancreatitis assessment - ANSHistory, ETOH abuse, severe LUQ pain, tachy, restless,
decrease bowel,
jaundice, grey turner or Cullen signs, increase serum amylase/lipase or WBC, hyperlipidemia
Acute renal failure priority - ANSo Maintain fluids
o Avoid fluid excess
o Renal replacement therapy
o Reduce metabolic rate
o Promote pulmonary function
Acute Respiratory distress priority findings - ANSo Hypoxia
o Intercostal retractions
o Crackles
o BNP levels
(alveoli collapse because small airways are narrowed due to interstitial fluid and bronchial
obstruction)
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