HESI MILESTONE 3 EXAM 2023 -2024 ACTUAL EXAM QUESTIONS AND CORRECT ANSWERS(VERIFIED ANSWERS )WITH RATIONALES |GRADED A+ A nurse is planning discharge care for a male client with metastatic cancer. The client tells the nurse that he plans to return to work despite pain, fatigue, and impending death. Which goals is most important to include in this client's plan of care? A. Implements decisions about future hospices services within the next 3 months. B. Maintains pain level below 4 when implementing outpatient pain clinic strategies. C. Request home health care if independence become compromised for 5 days. D. Arranges for short term counseling if stressors impact work schedule for 2 weeks. - ANSWER -Answer B. Maintains pain level below 4 when implementing outpatient pain clinic strategies. Rationale An outpatient pain clinic (B) provides the interdisciplinary services needed to manage chronic pain. Although the client has a terminal disease and is being discharged home, hospice (A) and home health care (C) are not indicated at this time. Short term co unseling (D) may help the client cope with terminal cancer, but pain management is most important so that the client can continue to participate in his normal life activities as long as possible. A client with a liver abscess develops septic shock. A sepsis resuscitation bundle protocol is initiated and the client receives a bolus of IV fluids. Which parameter should the nurse monitor to assess effectiveness of the fluid bolus? A. Blood cultures. B. Oxygen saturation. C. White blood cell count. D. Mean arterial pressure (MAP) . - ANSWER -Answer D. Mean arterial pressure (MAP). Rationale The cornerstone of initial sepsis resuscitation is fluid volume administration to restore and then maintain mean arterial pressure (D) of at least 65 mmHg. (A, B, and C) are also important parameters to monitor in the overall management of septic shock, bu t (D) is the most direct measure of the effectiveness of fluid volume resuscitation. A client presents in the emergency room with right -sided facial asymmetry. The nurse asks the client to perform a series of movements that require use of the facial muscles. What symptoms suggest that the client has most likely experience a Bell's palsy ra ther than a stroke? A. Slow -onset of facial drooping associated with headaches. B. Inability to close the affected eye, raise brow, or smile. C. A flat nasolabial fold on the right resulting in facial asymmetry. D. Drooling is present on right side of the mouth, but not on the left. - ANSWER -Answer B. Inability to close the affected eye, raise brow, or smile. Rationale Because the motor functions controlling eye closure, brow movement, and smiling are all carried on the 7th cranial (facial) nerve, the combination of symptoms directly relating to an impairment of all branches of the facial nerve indicate that Bell's palsy has occurred (B). (A) is more indicative of stroke. (C and D) can occur with both Bell's palsy and stroke, so (B) is the definitive choice. While attempting to establish risk reduction strategies in a community, the nurse notes that the regional studies indicate a high number of persons with growth stunting and irreversible mental deficiencies (cretinism) due to hypothyroidism. The nurse shoul d seek funding to implement which screening measure? A. T4 levels in newborns. B. TSH levels in women over 45. C. T3 levels in school -aged children. D. Iodine levels in all persons over 60. - ANSWER -Answer A. T4 levels in newborns. Rationale Screening for low T4 levels in newborns (A) with follow -up treatment can reduce the risk for irreversible growth stunting and metal deficiencies (cretinism) caused by congenital hypothyroidism. (B, C, and D) do not reduce the risk for congenital hypothyroi dism, which is often the result of low iodine intake in women of child -bearing age. For the past 24 hours, an antidiarrheal agent, diphenoxylate, has been administered to a bedridden, older client with infectious gastroenteritis. Which finding requires the nurse to take further action? A. Loss of appetite. B. Serum K+ 4.0 mEq/L or mmol/L (SI). C. Loose, runny stools. D. Tented skin turgor. - ANSWER -Answer D. Tented skin turgor. Rationale Tented skin turgor (D) indicates dehydration, a serious complication following prolonged diarrhea that requires further intervention by the nurse. (A and C) are expected findings with infectious gastroenteritis. Serum potassium (normal value 3.5 to 5.0 mEq /L or mmol/L) is normal (B) and monitoring should be continued. An older woman who was recently diagnosed with end stage metastatic breast cancer is admitted because she is experiencing shortness of breath and confusion. The client refuses to eat and continuously asks to go home. Arterial blood gases indicate hypoxia. Which intervention is most important for the nurse to implement? A. Prepare for emergent oral intubation. B. Clarify end of life desires. C. Initiate comfort measures. D. Offer sips of favorite beverages. - ANSWER -Answer B. Clarify end of life desires. Rationale Clarifying end -of-life desires for this client who is terminally ill is the most important intervention and should be done first before any further interventions are implemented. Other measures can then be implemented as indicated.
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