HESI RN (NURSING)

39. Which nursing action for a patient with chronic obstructive pulmonary disease (COPD) could the nurse delegate to experienced unlicensed assistive personnel (UAP)? a. Obtain O2 saturation using pulse oximetry. b. Monitor for increased O2 need with exercise. c. Teach the patient about safe use of O2 at home. d. Adjust O2 to keep saturation in prescribed parameters. ANS: A UAP can obtain O2 saturation (after being trained and evaluated in the skill). The other actions require more educ...

A client who is admitted with emphysema is having difficulty breathing. In which position should the nurse place the client? A.High Fowler's position without a pillow behind the head B.Semi-Fowler's position with a single pillow behind the head C.Right side-lying position with the head of the bed elevated 45 degrees D.Sitting upright and forward with both arms supported on an over the bed table D Adequate lung expansion is dependent on deep breaths that allow the respiratory muscles to in...

An oriented patient has recently had surgery. Which action is best for the nurse to take to assess this patient’s pain? a. Assess the patient’s body language. b. Ask the patient to rate the level of pain. c. Observe the cardiac monitor for increased heart rate. d. Have the patient describe the effect of pain on the ability to cope. ANS: B One of the most subjective and therefore most useful characteristics for reporting pain is its severity. Therefore, the best way to assess a ...

An oriented patient has recently had surgery. Which action is best for the nurse to take to assess this patient’s pain? a. Assess the patient’s body language. b. Ask the patient to rate the level of pain. c. Observe the cardiac monitor for increased heart rate. d. Have the patient describe the effect of pain on the ability to cope. ANS: B One of the most subjective and therefore most useful characteristics for reporting pain is its severity. Therefore, the best way to assess a ...

A client who is admitted with emphysema is having difficulty breathing. In which position should the nurse place the client? A.High Fowler's position without a pillow behind the head B.Semi-Fowler's position with a single pillow behind the head C.Right side-lying position with the head of the bed elevated 45 degrees D.Sitting upright and forward with both arms supported on an over the bed table D Adequate lung expansion is dependent on deep breaths that allow the respiratory muscles to in...

37. Which assessment finding in a patient who has received omalizumab (Xolair) is most important to report immediately to the health care provider? a. Pain at injection site c. Peak flow reading 75% of normal b. Flushing and dizziness d. Respiratory rate 24 breaths/minute ANS: B Flushing and dizziness may indicate that the patient is experiencing an anaphylactic reaction, and immediate intervention is needed. The other information should also be reported, but do not indicate possibly life- th...

The nurse is caring for a client who has a fiberglass long leg cast on the right leg. Which nursing actions should be implemented in the cast care of this client? SATA a) Smelling the cast and feeling for the presence of hot spots on the cast. b) Checking neurovascular status of the right exposed foot and toes every four hours. c) Using a soft cotton-tipped 6-inch swab to help scratch beneath the cast. d) Placing the nurse's finger in the client's cast while performing cast care. e) Cov...

Enalapril maleate (Vasotec) is prescribed for a hospitalized client. Which assessment does the nurse perform as a priority before administering the medication? A) Checking the client's blood pressure B) checking the client's peripheral pulses C) checking the most recent potassium level D) checking the client's intake and output record for the last 24 hours A) Checking the client's blood pressure Rationale--enalapril maleate is an angiotensin-converting enzyme (ACE) inhibitor used to tr...

37. Which assessment finding in a patient who has received omalizumab (Xolair) is most important to report immediately to the health care provider? a. Pain at injection site c. Peak flow reading 75% of normal b. Flushing and dizziness d. Respiratory rate 24 breaths/minute ANS: B Flushing and dizziness may indicate that the patient is experiencing an anaphylactic reaction, and immediate intervention is needed. The other information should also be reported, but do not indicate possibly life- th...

HESI EXIT RN 2021 V1 160 QUESTIONS AND ANSWERS 1. Which information is a priority for the RN to reinforce to an older clientafter intravenous pylegraphy? A) Eat a light diet for the rest of the day B) Rest for the next 24 hours since the preparation and the test is tiring. C) During waking hours drink at least 1 8-ounce glass of fluid every hourfor the next 2 days D) Measure the urine output for the next day and immediately notify thehealth care provider if it should decrease. The ...