HESI MILESTONE 2 EXAM | 100%
COORECTLY ANSWERED AND GRADED
A+ | LATEST 2024/2025 GUIDE
The nurse is assessing a middle-aged adult who is diagnosed
with osteoarthritis. Which factor in this client's history is a
contributor to osteoarthritis?
- Correct Answer - Long distance runner since high school.
A client with a small bowel obstruction is experiencing frequent
vomiting. Which instructions are most important for the nurse to
provide to the UAP who is completing morning care for this client?
- Correct Answer - Maintain a quiet environment
The nurse is caring for a client with a small bowel obstruction. The
client is vomiting foul smelling fecal-like material. Which action
should the nurse implement?
- Correct Answer - Give IV fluids with electrolytes.
,The nurse is assessing a client with a small bowel obstruction
who was hospitalized 24 hours ago. Which assessment finding
should the nurse report immediately to the healthcare provider?
- Correct Answer - Rebound tenderness in the upper quadrants
The nurse is developing the plan of care for a client with
pneumonia and includes the nursing diagnosis of "Ineffective
airway clearance related to thick pulmonary secretions." Which
intervention is most important for the nurse to include in the
client's plan of care?
- Correct Answer - Increase fluid intake to 3,000 ml/daily
Pneumonia Treatment/Prevention
- Correct Answer - oxygen therapy, hydration, bed rest,
positioning to facilitate breathing, deep breathing, humidified air,
chest physiotherapy, suctioning prn,
A patient with chronic obstructive pulmonary disease (COPD) is
receiving oxygen with a Venturi mask at a rate of 3 L/min. Prior to
initiating oxygen therapy, the patient appeared anxious with gray
skin, a respiratory rate of 24 breaths/min, and an oxygen
,saturation of 87%. After 15 minutes of oxygen therapy, the nurse
observes the patient resting with closed eyes, pink coloration, a
respiratory rate of 12 breaths/min, and an oxygen saturation of
95%. Which action by the nurse is correct?
- Correct Answer - Decrease the oxygen to 2 L/min to improve
respiratory rate
What are the nutritional needs of this client throughout recovery?
- Correct Answer - Acute phase: NPO, IV fluids
• Recovery phase: no fiber or foods that irritate the bowel
• Maintenance phase: high-fiber diet with bulk-forming laxatives
A client is admitted to the hospital with a diagnosis of severe
acute diverticulitis. Which nursing intervention has the highest
priority
- Correct Answer - Place the client on NPO status.
A nurse is caring for a client who has heart failure and has been
taking digoxin 0.25 mg daily. The client refuses breakfast and
, reports nausea. Which of the following actions should the nurse
take first?
- Correct Answer - Check the client's vital signs.
The healthcare provider prescribes digitalis (Digoxin) for a client
diagnosed with congestive heart failure. Which intervention
should the nurse implement prior to administering the digoxin?
- Correct Answer - Assess the serum potassium level
A 77-year-old female client is admitted to the hospital. She is
confused and has had no appetite for several days. She has been
nauseated and vomited several times prior to admission. She is
currently complaining of a headache. Her pulse rate is 43
beats/min. The nurse is most concerned about the client's history
related to what medication?
- Correct Answer - Digitalis (Lanoxin)
The nurse is administering a dose of digoxin to a patient with
heart failure (HF). The nurse would become concerned with the
possibility of digitalis toxicity if the patient reported which
symptom?
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