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Hesi Herzing University -Foundations Hesi Exam Questions With Complete Solutions.
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Hesi Herzing University -Foundations Hesi Exam Questions With Complete Solutions.
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Foundations Hesi Exam Questions With Complete SolutionsA 16-year-old client has a blood pressure reading of 119/75.
What is the approximate pulse pressure? Correct Answer Ans:
44 Rationale
The difference between the systolic and diastolic pressure is
called the pulse pressure. The given blood pressure is 119/75.
The difference between 119 and 75 is 44.
A 50-year-old client being seen for a routine physical asks why
a stool specimen for occult blood testing has been prescribed
when there is no history of health problems. What is an
appropriate nursing response?
"You will need to ask your healthcare provider; it is not part of
the usual tests for people your age."
"There must be concern of a family history of colon cancer; that
is a primary reason for an occult blood stool test."
"It is performed routinely starting at your age as part of an
assessment for colon cancer."
"There must have been a positive finding after a digital rectal
examination performed by your healthcare provider." Correct
Answer Ans: C Rationale
The primary reason for a stool specimen for guaiac occult blood
testing is that it is part of a routine examination for colon cancer
in any client over the age of 40. Age, family history of polyps,
and a positive finding after a digital rectal examination are
,factors related to colon cancer and secondary reasons for the
occult blood test (guaiac test).
A 50-year-old client with a 30-year history of smoking reports a
chronic cough and shortness of breath related to chronic
obstructive pulmonary disease (COPD). The clinical data on
admission are as follows: a heart rate of 100, a blood pressure of
138/82, a respiratory rate of 32, a tympanic temperature 36.8 °C,
and an oxygen saturation of 80%. Which vital signs obtained by
the nurse during the therapy indicates a positive outcome? Select
all that apply.
Radial pulse: 70
Temperature: 37 °C
Respiratory rate: 14
Blood pressure: 110/70
Oxygen saturation: 92% Correct Answer Ans:C,D,E Rationale
The respiratory rate ranges in older adults from 12 to 20
breaths/min and this range may be elevated in clients with
chronic obstructive pulmonary disease (COPD). Thus a rate
decrease to 14 breaths/min indicates a positive outcome. COPD
may also cause high blood pressure. Thus, a blood pressure of
110/70 obtained during therapy indicates a positive outcome.
The normal oxygen saturation rate should be 95 to 100%. An
oxygen saturation increase from 88% to 92% indicates a positive
outcome of the therapy. The radial pulse indicates a positive
outcome of the therapy if the client has a history of heart
,disease. A body temperature reading of 36.8 °C is considered
normal and not a sign of COPD.
A client arrives at a health clinic stating, "I am here to have my
tuberculin skin test read." The nurse notes that there is a 7-mm
indurated area at the injection site. Which statement made by the
nurse correctly describes this result?
"The result indicates that you have active tuberculosis."
"The result indicates that you are infected with the tuberculosis
organism."
"The result indicates that there are no tuberculin antibodies in
your system."
"The result indicates that you have a secondary infection related
to the tuberculin organism." Correct Answer Ans: B Rationale
An indurated area 5 mm or larger noted 48 to 72 hours after the
tuberculin test indicates that the person is infected with the
tuberculin organism. A positive tuberculin skin test
accompanied by fever, coughing, weakness, and positive chest
x-ray are manifestations of active tuberculosis. The other
choices are incorrect.
A client complains of pain in the ear. While examining the
client, a nurse finds swelling in front of the left ear. Which
lymph node does the nurse expect to be involved?
Mastoid
, Occipital
Submental
Pre-auricular Correct Answer Ans: D Rationale
The pre-auricular lymph node is located in front of the ear and in
this situation would be edematous. The mastoid or posterior
auricular lymph node is present behind the ear. The occipital
lymph nodes are located in the back of the head, near the
occipital bone of the skull. Submental lymph nodes are located
below the chin.
A client complains of rapid, involuntary movement of the eyes
after a minor eye injury. A nurse assesses the client and finds
that it is a disorder of the cranial nerves. Which condition does
the nurse suspect?
Cataract
Glaucoma
Nystagmus
Strabismus Correct Answer Ans: C Rationale
Nystagmus is a condition defined by rapid, involuntary,
rhythmical oscillation of the eyes. This condition is caused by
local injury to the eye muscles and supporting structures. A
cataract is a condition in which the opacity of the lens will be
increased; this disorder is commonly related to age. Glaucoma is
intraocular structural damage resulting from elevated intraocular
pressure. Strabismus is a congenital condition in which both
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