During the infusion of a second unit of packed red blood cells, the client's temperature
increases from 99 to 101.6 f. which intervention should the nurse implement? Correct Answer-Stop the transfusion start a saline
An elderly female client with osteoarthritis reports increasing pain and stiff...
Exit Hesi 700-799 questions with correct answers
During the infusion of a second unit of packed red blood cells, the
client's temperature
increases from 99 to 101.6 f. which intervention should the nurse
implement? Correct Answer-Stop the transfusion start a saline
An elderly female client with osteoarthritis reports increasing pain and
stiffness in her
right knee and asks how to reduce these symptoms. In responding to the
client, the nurse
recognizes what pathology as the cause of her symptoms? Correct
Answer-Destruction of joint cartilage.
When caring for a client with traumatic brain injury (TBI) who had a
craniotomy for
increased intracranial pressure (ICP), the nurse assesses the client using
the Glasgow coma
scale (GCS) every two hours. For the past 8 hours the client's GCS score
has been 14. What does
this GCS finding indicate? Correct Answer-Neurologically stable
without indications of an increased ICP
A 46-year-old male client who had a myocardial infarction 24-hours ago
comes to the
nurse's station fully dressed and wanting to go home. He tells the nurse
that he is feeling much
,better at this time. Based on this behavior, which nursing problem
should the nurse formulate? Correct Answer-Ineffective coping related
to denial
In assessing a client 48 hours following a fracture, the nurse observes
ecchymosis at the
fracture site, and recognizes that hematoma formation at the bone
fragment site has occurred.
What action should the nurse implement? Correct Answer-• Document
the extend of the bruising in the medical record
A client is admitted for cellulitis surrounding an insect bite on the lower,
right arm and
intravenous (IV) antibiotic therapy is prescribed. Which action should
the nurse implement
before performing venipuncture? Correct Answer-• Lower the left arm
below the level of the heart
Which assessment finding of a postmenopausal woman necessitates a
referral by the
nurse to the healthcare provider for evaluation of thyroid functioning?
Correct Answer-• Cold sensitivity
A client with hyperthyroidism is admitted to the postoperative after
subtotal
thyroidectomy. Which of the client's serum laboratory values requires
intervention by
, the nurse? Correct Answer-• Total calcium 5.0 mg/dl
A female client on the mental health unit frequently asks the nurse when
she can
be discharged. Then, becoming more anxious, she begins to pace the
hallway. What
intervention is implemented first? Correct Answer-• Explore the client's
reasons for wanting to be discharged.
The nurse is assessing a primigravida a 39-weeks gestation during a
weekly prenatal visit.
Which finding is most important for the nurse to report to the healthcare
provider? Correct Answer-• Fetal heart rate of 200 beats/minute
A female client receives a prescription for alendronate sodium
(Fosamax) to treat her
newly diagnose osteoporosis. What instruction should the nurse include
in the client's
teaching plan? Correct Answer-• Take on an empty stomach with a full
glass of water
The nurse is assessing a female client's BP b/c she reported feeling
dizzy. The blood
pressure cuff is inflated to 140 mm hg and as soon as the cuff is deflated,
a knockoff
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