BSN 266 HESI (Latest UPDATES STUDY) Exam Reviews Questions and Verified Answers 100 Correct Grade A
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BSN 266
BSN 266 HESI (Latest UPDATES STUDY) Exam Reviews Questions and Verified Answers 100 Correct Grade A
BSN 266 HESI
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1. A client who underwent cardiac stent placement four days ago arrives to the
emergency department reporting a sudden
onset of chest pressure and
shortness of ...
BSN 266 HESI
Study online at https://quizlet.com/_dfm7mq
1. A client who underwent cardiac stent place- D
ment four days ago arrives to the
emergency department reporting a sudden
onset of chest pressure and
shortness of breath. Which action should the
nurse take next?
a. Listen for extra heart sounds, murmurs, and
rhythm with the bell of
the stethoscope.
b. Evaluate upper and lower extremities for
perfusion, pulse volume,
and pitting edema.
c. Verify troponin level assessments are
scheduled every 3-6 hours
for a series of three.
d. Obtain a 12- lead electrocardiogram and
begin continuous cardiac
monitoring.
2. A client with type 2 diabetes mellitus arrives B
to the clinic reporting episodes of
weakness and palpitations. Which finding
should the nurse recognize as a
possible complication?
a. anxiety and sighing
b. myalgia in wrists and hands
c. hyperactive bowel sounds
d. dark yellow urine
3. 4While completing a health assessment for a C
client with migraine headaches, Explanation: The nurse
the nurse assesses bilateral weakness in the should gather additional
clients hand grips. The client assessment data about the
reports joint pain and trouble twisting a door pain and
knob due to weaknesses. Which weakness to better under-
action should the nurses take in response to stand the client's con-
these figures? dition and to determine if
a. Implement fall precautions to reduce the there is an
clients risk of injury. underlying issue or if the
, BSN 266 HESI
Study online at https://quizlet.com/_dfm7mq
b. Explain that relief of the migraine pain will symptoms are related to
reduce related the migraine headaches.
symptoms.
c. Gather additional assessment data about
the pain and weakness.
d. Consult with the occupational therapist for
a functional assessment
4. 5. A client who has developed acute kidney B
injury (AKI) due to aminoglycoside Explanation: During the di-
antibiotics has moved from the oliguric phase uretic phase of AKI, the
to the diuretic phase of AKI. Which client may experience in-
parameters are most important for the nurse creased urine
to plan to carefully monitor? output, which can lead
a. Uremic irritation of mucous membranes to hypovolemia and elec-
and skin surfaces. trolyte imbalances. Moni-
b. Hypovolemia and electrocardiographic toring for
(ECG) changes. hypovolemia and ECG
c. Side effects of total parental nutrition (TPN) changes can help detect
and Intralipids. any complications or wors-
d. Elevated creatinine and blood urea nitrogen ening of the
(BUN). client's condition.
5. 6. The nurse is caring for a client diagnosed B
with psoriasis vulgaris who is Explanation: Overexposure
receiving psoralen and ultraviolet A light to PUVA treatment can
(PUVA) treatment. Which assessment cause skin irritation, ten-
finding indicates that the client has been over- derness,
exposed to the treatment? and erythema. If the client
a. Thick skin plaques topped by silvery white exhibits these symptoms,
scales the nurse should notify the
b. Tenderness upon palpation and generalized healthcare provider for pos-
erythema sible treatment modifica-
c. Brown, rough, greasy, wart-like papules on tions.
the face
d. Requires sunglasses because sunlight
hurts eyes
6.
, BSN 266 HESI
Study online at https://quizlet.com/_dfm7mq
7. An adult client who had a gastric bypass C
surgery 2 weeks ago, is admitted with Explanation: The
possible anastomosis leakage. The client's vital signs in-
client's abdomen is tender to touch, and dicate possible sepsis or
the systemic infection. Strict
vital signs are temperature 101* F (38 3* C). IV fluid replacement is im-
heart rate 130 beats/minute, portant to maintain ade-
respiratory rate 26 breaths/minute, and blood quate circulation, support
pressure 100/50 mmHg. Which blood
intervention is most important for the nurse to pressure, and treat poten-
include in the client's plan of care? tial sepsis. The other inter-
a. Encourage regular turning. ventions are also essential
b. Monitor skin for breakdown. but not
c. Strict IV fluid replacement. as critical as fluid replace-
d. Assess wound drainage daily. ment in this situation.
7. 8. A client who was recently diagnosed with D
Raynaud's disease is concerned Explanation: For clients
about pain management. Which nursing in- with Raynaud's dis-
structions should the nurse provide? ease, cold temperatures
a. Painful areas should be rubbed gently until can trigger painful
the pain subsides. episodes. Instructing the
b. Return appointments will be needed for IV client to wear gloves when
pain medications. handling cold items can
c. Enrolling in a pain clinic can provide relief help
alternatives. protect against these
d. Wearing gloves when handling cold items episodes and manage
guards against painful pain.
spasms.
8. 9. A client with newly diagnosed Crohn's dis- d
ease asks the nurse about dietary Explanation: Individuals
restrictions. How should the nurse respond? with Crohn's disease
a. Explain that the need to restrict fluids is the often have specific trigger
primary limitation. foods that
b. Advise the client to limit foods that are high exacerbate their symp-
in calcium and iron. toms. The nurse should de-
c. Instruct the client to avoid foods with scribe the use of an elimi-
gluten, such as wheat bread. nation diet to
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