100% satisfaction guarantee Immediately available after payment Both online and in PDF No strings attached
Previously searched by you
Evolve Elsevier Hesi Med Surg Actual Exam With 100 Real Exam Questions And Correct Answers With Rationales/ Evolve Hesi Medical Surgical Latest Exam 2024/2025 ||Complete A+ Guide$16.49
Evolve Elsevier Hesi Med Surg Actual Exam With 100 Real Exam Questions And Correct Answers With Rationales/ Evolve Hesi Medical Surgical Latest Exam 2024/2025 ||Complete A+ Guide
32 views 0 purchase
Course
EVOLVE ELSEVIER HESI MED SURG 2024
Institution
EVOLVE ELSEVIER HESI MED SURG 2024
Evolve Elsevier Hesi Med Surg Actual Exam With 100 Real Exam Questions And Correct Answers With Rationales/ Evolve Hesi Medical Surgical Latest Exam 2024/2025 ||Complete A+ Guide
Evolve Elsevier Hesi Med Surg Actual Exam With 100 Real
Exam Questions And Correct Answers With Rationales/
Evolve Hesi Medical Surgical Latest Exam 2024/2025
||Complete A+ Guide
1. When educating a client after a total laryngectomy, which instruction would
m m m m m m m m m m
m be most important for the nurse to include in the discharge teaching?
m m m m m m m m m m m
A. Recommend that the client carry suction equipment at all times.
m m m m m m m m m
B. Instruct the client to have writing materials with him at all times.
m m m m m m m m m m m
C. Tell the client to carry a medical alert card that explains his condition.
m m m m m m m m m m m m
D. Caution the client not to travel outside the United States alone.
m m m m m m m m m m
…Ans>> C mmm m
Rationale: Neck breathers carry a medical alert card that notifies health care per- sonnel
m m m m m m m m m m m m m
of the need to use mouth to stoma breathing in the event of a cardiac arrest in this client.
m m m m m m m m m m m m m m m m m m m
Mouth to mouth resuscitation will not establish a patent airway. Options A and D are not
m m m m m m m m m m m m m m m m
1 m/ m86
,necessary. There are many alternative means of communication for clients who have had a
m m m m m m m m m m m m m m
laryngectomy; dependence on writing messages is probably the least effective.
m m m m m m m m m m
2. The nurse receives the client's next scheduled bag of TPN labeled with the
m m m m m m m m m m m m
m additive NPH insulin. Which action should the nurse implement?
m m m m m m m m
A. Hang the solution at the current rate.
m m m m m m
B. Refrigerate the solution until needed. m m m m
C. Prepare the solution with new tubing.
m m m m m
D. Return the solution to the pharmacy.
m m m m m
…Ans>> D mm
Rationale: Only regular insulin is administered by the IV route, so the TPN solution
m m m m m m m m m m m m m
m containing NPH insulin should be returned to the pharmacy. Options A, B, and C are not
m m m m m m m m m m m m m m m
m indicated because the solution should not be administered.
m m m m m m m
3. A postoperative client receives a Schedule II opioid analgesic for pain.
m m m m m m m m m m
m Which assessment finding requires the most immediate intervention by the
m m m m m m m m m
m nurse?
A. Hypoactive bowel sounds with abdominal distention m m m m m
B. Client reports continued pain of 8 on a 10-point scale
m m m m m m m m m
C. Respiratory rate of 12 breaths/min, with O2 saturation of 85%
m m m m m m m m m
D. Client reports nausea after receiving the medication
m m m m m m
…Ans>> C mm
Rationale: Administration of a Schedule II opioid analgesic can result in respiratory
m m m m m m m m m m m
m depression, which requires immediate intervention by the nurse to prevent respira- tory
m m m m m m m m m m m
2 m/ m86
,m arrest. Options A, B, and D require action by the nurse but are of less priority than option
m m m m m m m m m m m m m m m m m
m C.
4. A client is placed on a mechanical ventilator following a cerebral hemor-
m m m m m m m m m m m
m rhage, and vecuronium bromide, 0.04 mg/kg every 12 hours IV, is
m m m m m m m m m m
prescribed. What is the priority nursing diagnosis for this client?
m m m m m m m m m m
A. Impaired communication related to paralysis of skeletal muscles
m m m m m m m
B. High risk for infection related to increased intracranial pressure
m m m m m m m m
C. Potential for injury related to impaired lung expansion
m m m m m m m
D. Social isolation related to inability to communicate
m m m m m m
…Ans>> A mm
3 m/ m86
, Rationale: To increase the client's tolerance of endotracheal intubation and/or me-
m m m m m m m m m m
m chanical ventilation, a skeletal muscle relaxant such as vecuronium is usually prescribed.
m m m m m m m m m m m
m Option A is a serious outcome because the client cannot communicate his or her needs.
m m m m m m m m m m m m m m
m Although this client might also experience option D, it is not a priority when compared
m m m m m m m m m m m m m m
m with option A. Infection is not related to increased intracranial pressure. The respirator will
m m m m m m m m m m m m m
m ensure that the lungs are expanded, so option C is incorrect.
m m m m m m m m m m
5. A family member was taught to suction a client's tracheostomy prior to the
m m m m m m m m m m m m
m client's discharge from the hospital. Which observation by the nurse indicates
m m m m m m m m m m
m that the family member is capable of correctly performing the suctioning
m m m m m m m m m m
m technique?
A. Turns on the continuous wall suction to 190 mm Hg.
m m m m m m m m m
B. Inserts the catheter until resistance or coughing occurs.
m m m m m m m
C. Withdraws the catheter while maintaining suctioning. m m m m m
D. Reclears the tracheostomy after suctioning the mouth.
m m m m m m
…Ans>> B mm m
Rationale: Option B indicates correct technique for performing suctioning. Suction
m m m m m m m m m
m pressure should be between 80 and 120 mm Hg, not 190 mm Hg. The catheter should be
m m m m m m m m m m m m m m m m
m withdrawn 1 to 2 cm at a time with intermittent, not continuous, suction. Option D
m m m m m m m m m m m m m m
m introduces pathogens unnecessarily into the tracheobronchial tree.
m m m m m m
6. A client is diagnosed with an acute small bowel obstruction. Which assess-
m m m m m m m m m m m
m ment finding requires the most immediate intervention by the nurse?
m m m m m m m m m
A. Fever of 102° F m m m
4 m/ m86
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller Ascorers. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $16.49. You're not tied to anything after your purchase.
