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Cat 4 Hesi Exit|161 Questions with complete solutions
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Cat 4 Hesi Exit|161 Questions withcomplete solutions
1- A 59-year-old male client is brought to the emergency room where he is
assessed to have a Glasgow Coma Scale of 3. Based on this assessment, how
should the nurse characterize the client's condition? - -He is in a coma, and
has a very poor prognosis
-2- At a community health fair, a 50-year-old woman tells the nurse that she
has an
annual physical exam that includes a clinical breast exam and an annual
mammogram. How should the nurse respond? - -Ask the woman if she also
performs monthly breast self- exams.
-Which assessment finding should indicate to the nurse that a client with
arterial
hypertension is experiencing a cardiac complication? - -Complaints of
shortness of breath on exertion
-A college student who is diagnosed with a vaginal infection and vulva
irritation
describes the vaginal discharge as having a "cottage cheese" appearance.
Which prescription should the nurse implement first? - -b. Instill the first
dose of nystatin (Mycostatin) vaginally per applicator
-A client in acute renal failure has serum potassium of 7.5 mEq/L. Based on
this
finding, the nurse should anticipate implementing which action? - -b.
Administer a retention enema of Kayexalate
-A client who had an intraosseous (IO) cannula placed by the healthcare
provider for an emergent fluid resuscitation is complaining of severe pain
and
,numbness below the IO sit. The skin around the site is pale and edematous.
What
action should the nurse takes first? - -a. Discontinue the IO infusion
-The nurse-manager of a perinatal unit is notified that one client from the
medical-surgical unit needs to be transferred to male room for new
admissions. Which client should the nurse recommend for transfer to the
antepartal unit? - -b. A 35-year-old with lupus erythematous
-A nurse is teaching a client postoperative breathing techniques using an
incentive spirometer (IS). What should the nurse encourage this client to do
to maintain sustained maximal inspiration? - -c. Inspire deeply and slowly
over 3 to 5 seconds
-The nurse plans to educate a client about the purpose for taking the
prescribed antipsychotic medication clozapine (Clozaril). Which statement
should the nurse provide? - -The medication will help you think more clearly"
-A male client with diabetes mellitus takes Novolin 70/30 insulin before
meals
and azithromycin (Zithromax) PO daily, using medication he brought from
home.
When the nurse delivers hisbreakfast tray, the client tells the nurse that he
took his
insulin but forgot to take his daily dose of the Zithromax an hour before
breakfast as
instructed. What action should the nurse implement? - -Instruct the client to
eat his breakfast and take the Zithromax two
hours after eating
-11-What instruction is most important for the nurse to provide a female
client who
,has just been diagnosed with trichomoniasis? - -Treat sexual partner (s)
concurrently
-A primigravida at term comes to the prenatal clinic and tells the nurse that
she
is having contractions every 5 min. The nurse monitors the client for one
hour,
using an external fetal monitor, and determines that the client's contractions
every 5
minutes. The nurse monitors the client for one hour, using an external fetal
monitor,
and determines that the client's contractions are 7 to 15 minutes apart,
lasting 20 to
30 seconds, with mild intensity by palpation. What action should the nurse
take? - -Send the client home and instruct her to call the clinic when her
contractions
occur 5 minutes apart for one hour
-Which instruction should the nurse provide to an elderly client who is taking
an
ACE inhibitor and a calcium channel blocker? - -Change the position slowly
-14- Assessment finding of a 3-hour-old newborn include: axillary
temperature of
97.7 F, heart rate of 140 beats/minute with a soft murmur, and irregular
respiratory
rate at 42 breaths/min. Based on these findings, what action should the
nurse
implement? - -Record the findings on the flow sheet
-15- A client admitted to the hospital for depression is escorted to a private
room.
Prior to leaving the room, what intervention is most important for the nurse
to
, implement? - -Search all personal belongings
-An experienced nurse tells the nurse-manager that working with a new
graduate is impossible because the new graduate will not listen to
suggestions. The
new graduate comes to the nurse-manager describing the senior nurse's
attitude as
challenging and offensive. What action is best for the nurse manager to
take? - -Ask the nurses to meet with the nurse-manager to identify ways of
working
together
-17- Which nursing diagnosis has the highest priority when planning care for
a client
in cardiogenic shock? - -Ineffective Tissue Perfusion
-A client who had a cerebral vascular accident (CVA)
Is paralyzed on the left side of the body and has developed a Stage II
pressure
ulcer on the left hip. Which nursing diagnosis describes this client's current
health
status? - -Impaired skin integrity related to altered circulation and pressure
-The nurse offers diet teaching to a female college student who was
diagnosed
with iron-deficiency anemia following her voluntary adoption of a lacto-
vegetarian
diet. What nutrients should the nurse suggest this client eat to best meet her
nutritional needs while allowing her to adhere to a lacto-vegetarian diet? - -
Combine several legumes and grains such as beans and rice to form
complete proteins
-The nurse is triaging clients from a train wreck. A client has multiple open
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