HESI Remediation Safety and Infection

For which families should the nurse include information related to safe sleeping habits as a priority during a scheduled health maintenance visit for a toddler-age child? Select all that apply.

Asian American Correct3 African American Correct4 Hispanic American

A client is admitted to the psychiatric unit for severe depression with the potential for suicide. What is the most therapeutic nursing intervention when the client becomes more energized and communicative?

Continuing to assess the client at regular intervals

What should transmission-based precautions for a client with salmonellosis include?

Correct1 Wearing a gown if soiling is likely

Which parental statements indicate correct understanding for the prevention of sunburn for a toddler-age client? Select all that apply.

Correct1 "I will keep my child indoors between 10 AM and 2 PM." Correct2 "I will make sure my child wears a baseball cap while outside." "I will be sure to reapply sunscreen if my child sweats more than usual." Correct5 "I will make sure my child wears cotton clothing with a tight weave while outside."

A nurse in the pediatric clinic is teaching a mother how to care for her infant who has eczema. What is most important for the nurse to teach the mother?

Preventing secondary infections

A child with beta-thalassemia (Cooley anemia) is admitted to the ambulatory care unit for a transfusion. What instruction should the nurse include in the plan of care?

Protect from infections

During resuscitation of a critically injured client in a bomb blast, the nurse finds the client is breathing spontaneously. Which nursing intervention would the nurse perform in this situation?

Providing non-rebreather mask

The nurse is teaching a client about adequate hand hygiene. What component of hand washing should the nurse include that is most important for removing microorganisms?

Friction

A primary healthcare provider prescribes carboprost to be administered to a postpartum client with intractable vaginal bleeding. Which prior condition noted in the client's history should alert the nurse to question this prescription?

History of Asthma

A group of clients who work in a uranium mine are admitted to the emergency department after a radioactive explosion. What is the priority nursing intervention in this situation after collaborating with the emergency response team?

Removing client's clothes and showering clients immediately

A nurse is caring for a client with a chronic venous stasis ulcer. A negative-pressure wound treatment device has been prescribed to hasten wound healing. Which nursing action is most appropriate when caring for this client?

Replace the wound sponge every 48 hours

A nurse is educating the parents of preschool-aged children about emergency treatments of poisoning. Which statement made by a parent indicates a need for further education?

"I will immediately start treatment at home by using gastrointestinal decontamination."

A client who is about to have a blood transfusion asks the nurse, "Which type of hepatitis is most frequently transmitted thru food?" The nurse should respond, "The type of hepatitis associated with food is hepatitis:

A

A client is being discharged from the hospital with an indwelling urinary catheter. The client asks about the best way to prevent infection and keep the catheter clean. Which would be appropriate for the nurse to include in the client teaching?

Correct4 Replace the drainage bag with a new bag once a week

A nurse is teaching a group of parents about communicable diseases. What information about chickenpox should the nurse include?

"Chickenpox is communicable until the vesicles have dried."

A client is scheduled for a vacuum aspiration abortion to terminate an unwanted pregnancy. What information should the nurse's teaching plan include?

A temperature of 100.4° F (38° C) or higher should be reported immediately.

Which nursing action is accurate when terminating exposure for a toddler-age client who presents to the emergency department (ED) after eating a lily?

Emptying the mouth

For how long should a nurse maintain isolation of a child with bacterial meningitis?

For 48 hours after antibiotic therapy begins

While assessing an older adult with decreased perception of touch, the nurse provides instructions to the client to reduce the risk associated with falling. Which statements made by the nurse are beneficial to the client? Select all that apply.

"Look where your feet are placed while walking." Correct4 "Wear shoes that give good support while walking." Correct5 "If you are unable to change your position frequently request assistance."

When planning a citywide national homeland security (Canada: Public Health Agency of Canada's Centre for Emergency Preparedness) disaster preparedness drill, a nurse is assigned to the triage committee. Place the following criteria in an order that reflects the most efficient triage plan for an actual mass casualty incident (MCI).

Correct 1. Tension pneumothorax Correct 2. Compound fracture of femur Correct 3. Laceration of thigh muscle Correct 4. Severe wrist sprain Correct 5. Crushing head injury

A client is on a ventilator. A nurse asks another nurse, "What should be done when condensation resulting from humidity collects in the ventilator tubing?" What is the nurse's best response?

Correct2 "Empty the fluid from the tubing."

A client is admitted to the hospital with a tentative diagnosis of urinary retention related to benign prostatic hyperplasia. The primary healthcare provider notes a secondary diagnosis of delirium related to urosepsis and prescribes the insertion of an indwelling urinary retention catheter. Which nursing action is most important at this time?

Determine whether any unsafe behavior patterns exis

Which individual would be an appropriate member of a critical incident stress debriefing (CISD) team for a group of staff nurses? Select all that apply.

Staff Nurse Physician trained in critical debriefing Advanced practice mental health nurse

A client who attempted suicide by slashing the wrists is transferred from the emergency department to a mental health unit. What important nursing interventions must be implemented when the client arrives on the unit? Select all that apply.

Obtaining vital signs Correct2 Assessing for suicidal thoughts Correct3 Instituting continuous monitoring Correct4 Initiating a therapeutic relationship Correct5 Inspecting the bandages for bleeding

The disaster management team is evaluating the damage that can happen due to a disaster. They also attempt to limit the influence of the disaster on the health community's function. Which phases of disaster management would the nurse state represents these actions? Select all that apply.

Mitigation Preparedness

A cognitively impaired older adult is brought to the emergency department for treatment of a cut on the forehead. Based on the following assessment information, the nurse concludes that the individual's priority need is what?

Assessment for possible physical abuse

A client is admitted to the hospital for the implantation of radon seeds in the oral cavity. Which intervention is most important when the nurse is caring for this client after the procedure?

Correct2 Administering nursing care in a short period

A client critically injured in a bomb blast is admitted to an emergency unit. Which order should the nurse follow to perform initial assessment to manage immediate threats in the client?

Correct 1. Establishing a patent airway by positioning, suctioning, and oxygen as needed Correct 2. Assessing breathing sounds and respiratory effort The priority intervention in any injured client who survived bomb blast is to establish a patent airway. Establishing a patent airway is done by positioning, suctioning, and administering oxygen as needed. After the patent airway is established, assessing breathing sounds and respiratory effort to determine ventilation is the next priority. When effective ventilation is ensured, the priority shifts to circulation. Circulation is assessed by monitoring vital signs such as blood pressure and heart rate. After assessing circulation, evaluating the client's level of consciousness using the GCS is the next priority. The final component of assessment is removing all clothing for a complete physical assessment.

What would be the priority to maintain the hospital environment when a large number of clients walk into the emergency room asking to be treated for minor injuries sustained from the detonation of a car bomb?

Initiate a decontamination process

What should the mental health nurse keep in mind when preparing to meet with a group of staff nurses who cared for victims of a disaster that occurred in the community? Select all that apply.

Organize the chairs in a circle Correct2 Plan to meet for 1 to 3 hours Ensure food and beverages are available