HESI!!!!! PRACTICE!!!! PRACTICE!!!! PRACTICE!!!!!

B Rationale: Digoxin is a cardiac glycoside, which increases force of the heart contractions and decreases heart rate, which in turn increases cardiac output. Clear breath sounds bilaterally indicates that the medication was effective in increasing the cardiac output thus preventing pulmonary edema.

A 78-year-old client with congestive heart failure (CHF) receives digoxin 0.25 mg PO daily. Which observation by the nurse indicates that the medication has been effective? a. Systolic blood pressure readings range from 120 to 130 mm Hg b. Clear breath sounds bilaterally Correct Answer c. Jugular venous distention present with supine positioning d. Radial pulse volume of +4 bilaterally

yellow wound

A ____________ has soft necrotic tissue with a liquid to semiliquid slough and exudate ranging from creamy ivory to yellow-green.

red

A ____________wound has pink to bright or dark red healing, or is a chronic wound with granulating tissue; serosanguinous drainage may be noted.

A Rationale: Penicillins (PCN) have a 1% cross allergy with first-generation cephalosporins and lesser rate with second-generation. If a client has a known PCN allergy, then cephalosporin should be given with caution to these clients.

A health care provider (HCP) prescribed an antibiotic for a client. Which of the medications listed should be used with caution when given to a client with a penicillin (PCN) allergy? a. Cephalosporin b. Aminoglycosides c. Erythromycins d. Sulfonamides

C The generativity versus stagnation stage precedes integrity versus despair; Erikson theorized that how well people adapt to a present stage depends on how well they adapted to the immediately preceding stage. Industry versus inferiority is the stage of school-age children; it precedes identity versus role confusion, not integrity versus despair. Identity versus role confusion is the stage of adolescence; it precedes intimacy versus isolation, not integrity versus despair. Autonomy versus shame/doubt is the stage of early childhood; it precedes initiative versus guilt, not integrity versus despair.

An 85-year-old client is alert and able to participate in care. The nurse understands that, according to Erikson, a person's adjustment to the period of senescence will depend largely on adjustment to which developmental stage? A. Industry versus inferiority B. Identity versus role confusion C. Generativity versus stagnation D. Autonomy versus shame/doubt

gentamicin sulfate

Complications of ______________ therapy include ototoxicity, nephrotoxicity, and neurotoxicity. Determining and monitoring the client's hearing before initiation of this medication and as the treatment progresses is important.

D Rationale: Famotidine inhibits histamine at the histamine H2-receptor site, thus decreasing gastric secretions. In the treatment of GERD, it should be taken twice a day.

Famotidine 20 mg bid is prescribed for a client for gastroesophageal reflux disease (GERD). Which client statement indicates to the practical nurse (PN) that teaching was effective regarding use of this medication? a. "I will take the famotidine first thing in the morning." b. "I will take the famotidine as needed for GI discomfort." c. "I will take the famotidine at bedtime." d. "I will take the famotidine twice a day."

infections

Hemolytic streptococci, common in throat __________ can initiate an immune reaction that damages the glomeruli.

D Rationale: Antacids should not be taken within 2 hours of taking medication. Antacids will decrease the effects of phenytoin. Phenytoin can increase glucose levels. Do not discontinue medication abruptly as seizures could occur. Medicine may cause pink discoloration of urine.

Phenytoin is prescribed for a client who has a seizure disorder. Which statement by the client needs to be clarified by the practical nurse? a. "I should notify the health care provider if the color of my urine turns pink." b. "I should never stop taking this medication abruptly." c. "I should monitor my glucose levels closely since I am diabetic." d. "I should take the medicine with antacids if gastric upset occurs."

orthopneic

The ______________ position lowers the diaphragm and provides for maximum thoracic expansion.

C Papules are superficial and elevated up to 0.5 cm. Nodules and tumors are masses similar to papules but are elevated more than 0.5 cm and may infiltrate deeper into tissues. Erosions are characterized as loss of the epidermis layer; macules are nonpalpable, flat changes in skin color less than 1 cm in diameter; and vesicles are usually transparent, filled with serous fluid, and are a blisterlike elevation.

The nurse discovers several palpable elevated masses on a client's arms. Which term most accurately describes the assessment findings? A. Erosions B. Macules C. Papules D. Vesicles

D Rationale: Albuterol is a bronchodilator in the adrenergic category. Its actions and adverse effects are similar to adrenaline or epinephrine. The nurse should monitor the client for tachycardia. Enuresis or night bed-wetting is not an adverse effect. The client should be monitored for anxiety, not lethargy or depression.

The nurse has administered albuterol as an inhaled medication. The nurse should monitor the client for which possible adverse reaction? a. Enuresis b. Lethargy c. Depression d. Tachycardia

C Maintenance of a patent airway is always the priority, because airway obstruction impedes breathing and may result in death. Monitoring vital signs, observing for hemorrhage, and recording the intake and output is important; however, a patent airway is the priority.

What is the priority nursing intervention for a client during the immediate postoperative period? A. Monitoring vital signs B. Observing for hemorrhage C. Maintaining a patent airway D. Recording the intake and output

epidemiologist

The nurse __________ helps to devise an infection control strategy.

Pilocarpine

________________ a cholinergic agent, causes pupillary constriction (miosis), which facilitates outflow of aqueous humor, causing a decrease in intraocular pressure.

black

A ___________wound has black, gray, or brown adherent necrotic tissue; pus may be present.

D Because the client is feeling a loss of control, it is most important to include the client in revision of the plan of care. Getting a full report from the first nurse does not consider changes in the client or obtain the client's input. Planning nursing care is within the nurse's function and judgment, not the health care provider's; also, the client should be included. Telling the client of the change in staff responsibilities is an authoritarian approach and does not include the client in planning future care.

A terminally ill client is furious with one of the staff nurses. The client refuses the nurse's care and insists on doing self-care. A different nurse is assigned to care for the client. What should be the newly assigned nurse's initial step in revising the client's plan of care? A. Get a full report from the first nurse and adjust the plan accordingly. B. Ask the health care provider for a report on the client's condition and plan appropriately. C. Tell the client about the change in staff responsibilities and assess the client's reaction. D. Assess the client's present status and include the client in a discussion of revisions to the plan of care.

D Frequent swallowing may indicate bleeding in the posterior pharynx. Oral dryness causes thirst, not an increase in swallowing. Frequent swallowing is not a normal response to rhinoplasty or analgesics/anesthesia.

The nurse is caring for a client that underwent a rhinoplasty surgical procedure 5 hours ago. After administering pain medication, the nurse notes the client is swallowing frequently. The nurse understands that the cause of frequent swallowing is most likely caused from: A. A normal response to the analgesic B. Oral dryness caused by nasal packing C. An adverse reaction to anesthesia D. Bleeding posterior to the nasal packing

B Rationale: An anticipated side effect of nitrates is orthostatic hypotension. The PN should instruct the client to rise slowly when rising from a sitting or lying down position in order to prevent orthostatic hypotension.

A client diagnosed with angina has been prescribed nitrate isosorbide dinitrate. Which instruction should the practical nurse (PN) reinforce in this client's teaching? a. "Quit taking the medication if dizziness occurs." b. "Do not get up quickly. Always rise slowly." c. "Take the medication with food only." d. "Increase your intake of potassium-rich foods."

C Rationale: The objective of antacids is to neutralize gastric acids and keep a pH of 3.5 or above which is necessary for pepsinogen inactivity.

A client is prescribed an antacid for the treatment of peptic ulcer disease. What is the action of this medication that is effective in treating the client's ulcer? a. Decrease in the production of gastric secretions b. Production of an adherent barrier over the ulcer c. Maintenance of a gastric pH of 3.5 or above d. Decrease in the gastric motor activity

A Rationale: Ranitidine reduces the risk of ulcers associated with steroids. It does not decrease the risk of infection or reduce sodium retention. Ranitidine does not affect blood sugar changes associated with steroids.

A client taking long-term steroids also has ranitidine prescribed. The nurse provides which explanation as to why these drugs are given together? a. Ranitidine reduces the risk of ulcers associated with steroids. b. Ranitidine decreases the risk of infection associated with steroids. c. Ranitidine decreases blood sugar elevations associated with steroids. d. Ranitidine reduces sodium retention associated with steroid usage.

A The leg bones and muscles are used for weight bearing and are the strongest in the body. Using the knees for leverage while lifting the client shifts the stress of the transfer to the caregiver's legs. By using the strong muscles of the legs the back is protected from injury. Bending at the waist and then using the back for leverage is how many caregivers and people who must lift heavy objects sustain back injuries. The anatomical structure of the back is equipped only to bear the weight of the upper body. By leaning back, the client's weight is on the caregiver's arms, which are not equipped for heavy weight bearing. The caregiver's arms are not strong enough to lift the client. In the struggle to lift the client, the client and caregiver may be injured.

A nurse is teaching members of a health care team how to help disabled clients stand and transfer from the bed to a chair. To protect the caregivers from injury, the nurse teaches them to lift the client by first placing their arms under the client's axillae and next: A. Bending and then straightening their knees B. Bending at the waist and then straightening the back C. Placing one foot in front of the other and then leaning back D. Placing pressure against the client's axillae and then raising their arms

B The client on warfarin (Coumadin) with an INR of 7.5 should be assessed first by the nurse, because this is an elevated result. Normal is considered between 2 and 3. This result is not therapeutic, and the nurse should assess for bleeding and hemodynamic stability. The nurse should report the result to the primary healthcare provider and implement bleeding precautions. The other results are within normal ranges: hemoglobin for a male is 14-18 g/dL; serum calcium is 9.0-10.5 mg/dL; BUN is 5-20 mg/dL and creatinine is 0.7-1.5 mg/dL.

A nurse receives a shift report on four adult clients that are between the ages of 25-55. Which client should the nurse assess first? A. Male client with a hemoglobin of 15.9 B. Female client on warfarin (Coumadin) with an International Normalized Ratio (INR) of 7.5 C. Female client taking daily calcium supplements with a serum calcium level of 9.4 D. Male client with a blood urea nitrogen (BUN) of 20 and a creatinine of 1.1

D The best ways to prevent professional negligence (malpractice) are to attend continuing education programs and improve practice; additional education is advisable when one is working in specialty areas, such as emergency departments or intensive care areas. Insurance is helpful after an incident, but it will not prevent malpractice claims. Writing vague incident reports is not professional; incident reports should be detailed. Avoiding the issue by transferring to another department will not solve the problem. Each area of nursing practice requires expertise.

A nurse working in an emergency department is concerned about a recent increase in malpractice claims against nurses. What is the best way for the nurse to avoid being named in a lawsuit? A. Carry malpractice insurance. B. Write vague incident reports. C. Transfer to another department. D. Attend professional development programs.

A Sitting quietly with the client conveys the message that the nurse cares and accepts the client's feelings; this helps to establish trust. Telling the client that crying is not helpful negates feelings and the client's right to cry when upset. Distraction (suggesting that the client play a board game) closes the door on further communication of feelings. After a trusting relationship has been established, the nurse can help the client explore the problem in more depth.

A teenager begins to cry while talking with the nurse about the problem of not being able to make friends. What is the most therapeutic nursing intervention? A. Sitting quietly with the client. B. Telling the client that crying is not helpful. C. Suggesting that the client play a board game. D. Recommending how the client can change this situation.

B The cane should be used on the stronger (unaffected) side of the body to add strength, decrease dependence on the weaker (affected) side, and aid in balance during ambulation. Correct use of a cane does not involve alternating sides, using the cane on the affected (weaker) side, or using the side of the client's choice.

The nurse provides a client with left-sided weakness with instructions on how to safely use a cane. The nurse should demonstrate proper use of the cane by holding it on: A. Alternating sides. B. The right side. C. The side of the weakness. D. The side of the client's choice.

C To prevent footdrop (plantar flexion of the foot due to weakness or paralysis of the anterior muscles of the lower leg) in a client with a cast, the foot should be supported with 90 degrees of flexion. Bed rest can cause footdrop, and 45 degrees is not enough flexion to prevent footdrop . Applying an elastic stocking for support also will not prevent footdrop; a firmer support is required.

To prevent footdrop in a client with a leg cast, the nurse should: A. Encourage complete bed rest to promote healing of the foot. B. Place the foot in traction. C. Support the foot with 90 degrees of flexion. D. Place an elastic stocking on the foot to provide support.

D Immobilized clients are at high risk for the development of contractures. Contractures are characterized by permanent shortening of the muscle covering a joint. Osteoarthritis is a disease process of the weight-bearing joints due to wear and tear. Osteoporosis is a metabolic disease process in which the bones lose calcium. Muscle atrophy is a wasting and/or decrease in the strength and size of muscles due to a lack of physical activity or a neurological or musculoskeletal disorder.

While assessing an immobilized client, the nurse notes that the client has shortened muscles over a joint, preventing full extension. This condition is known as: A. Osteoarthritis B. Osteoporosis C. Muscle atrophy D. Contracture