Exam (elaborations)
NURS 420 HESI Study Module 10 Physiological Health Problems - Latest Version with 100%Verified Solutions
- Course
- NURS 420
- Institution
- Columbia College (CC )
QUESTIONS AND ANSWERS
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NURS 420 HESI Study Module 10 PhysiologicalHealth Problems - Latest Version with
100%Verified Solutions
Hesi Study Module 10 Physiological Health
Problems Questions
1.ID: 383719769
A nurse is assigned to care for four clients on the medical-surgical unit. Which client should the
nurse seefirst on the shift assessment?
A client admitted with pneumonia with a fever of 100° F and some diaphoresis Incorrect
A client with congestive heart failure with clear lung sounds on the previous shift
A client with new-onset of shortness of breath (SOB) and a history of pulmonary edema
Correct
A client undergoing long-term corticosteroid therapy with mild bruising on the anterior
surfaces of
the arms
,Rationale: The client who should be seen first is the one with SOB and a history of pulmonary
edema. Inlight of such a history, SOB could indicate that fluid-volume overload has once again
developed. The client with a fever and who is diaphoretic is at risk for insufficient fluid volume
as a result of loss of fluid through the skin, but this client is not the priority.
,Test-Taking Strategy: Use the process of elimination and focus on the subject of the question, the
client who should be seen first. Recall the rule of assessment of the ABCs — airway, breathing, and
circulation
— which means that the client experiencing SOB should take precedence over the other clients
on the unit. This client’s condition could progress to respiratory arrest if the client were not
assessed immediately on the basis of the signs and symptoms. Read each option and think
about the client in most critical condition and review the disorders to determine which clients
have the most critical needs.If you had difficulty with this question, review the various disease
processes presented in this question.
Reference: Ignatavicius, D., & Workman, M. (2010). Medical-surgical nursing: Patient-centered
collaborative care. (6th ed., p. 176). St. Louis: Saunders.
Level of Cognitive Ability: Analyzing
, Client Needs: Physiological Integrity
Integrated Process: Nursing
Process/AssessmentContent Area:
Delegating/Prioritizing
Awarded 0.0 points out of 1.0 possible
points.2.ID: 383719781
A client with gastroenteritis who has been vomiting and has diarrhea is admitted to the hospital
with a diagnosis of dehydration. For which clinical manifestations that correlate with this fluid
imbalance wouldthe nurse assess the client? Select all that apply.
Decreased pulse
Decreased urine output Correct
Increased blood pressure
Increased respiratory rate Correct
Decreased respiratory depth
Rationale: A client with dehydration has an increased depth and rate of respirations. The
diminished fluidvolume is perceived by the body as a decreased oxygen level (hypoxia), and
increased respiration is an attempt to maintain oxygen delivery. Other assessment findings in
insufficient fluid volume are decreased urine volume, increased pulse, weight loss, poor skin
turgor, dry mucous membranes, concentrated urine with increased specific gravity, increased
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