EAQ Questions HESI review
• The home health nurse provides education to a client with cancer of the tongue who will begin gastrostomy feeding at home. Which statement by the client indicates teaching by the nurse is effective
Before I start the procedure, I will measure the residual volume"
• A client in active labor starts screaming, "The baby is coming! Do something!" What is the nurse's primary action?
Checking the perineal area for the presenting part
• A client returns to work as a carpenter after surgery for carpal tunnel syndrome of the right hand. What instructions should the nurse give to help prevent further problems with the hands when the client returns to work
o "Do stretching exercises during breaks"
• A nurse is educating a group of teenage girls about dietary sources of iron. Which statement by one of the teenagers indicates to the nurse the need for more instructions
o "We need 8 mg of iron each day"
• A nurse provides dietary instructions to a client with calcium oxalate kidney stones. Which instructions should the nurse give to the client
o "You should limit your sodium intake"
• One week after an above-the-knee amputation, a client refuses to go to physical therapy and tells the nurse. "I'll never be a whole person again!" What Is the nurses best response
o "You've lost a part of yourself. That must be very difficult for you"
• An infant is to be discharged after surgery for pyloric stenosis. What instructions should the nurse giver the parents
o "hold the baby while continuing to feed a regular formula slowly and burp frequently"
• The mother of a 4 month old infant weighing 11 lb (5 kg) asks the nurse how much formula is required per day now that her baby has been weaned form the breast. The recommended caloric intake is 108 kcal/kgm and the formula contains 20 kcal/oz (20kcal/30 mL) how much formula should the nurse tell the mother to give her infant each day.
o 27 oz (810 mL)
• Metformin 2 g by mouth is prescribed for a client with type 2 diabetes. Each tablet contains 500 mg. How many tablets should the nurse administer?
o 2g (1000mg/1g)= 2000mg o 2000 mg (1tablet/500 mg) = 2000 mg (1 tablet/500 mg)= o 4 TABLETS !
• A client has an IV of d5W 250 mL to which 100 mg of morphine is added. The healthcare provider prescribes 14 mg of morphine per hour for end of life palliative treatment of a client. At how many mL per hour should the nurse set the IV pump?
o 35 mL/hr o 250/100= 2.5 X 14 = 35
• A client tells the nurse, "I keep reverting to my old habit of drinking soda, although I have stopped drinking as much" What stage of health behavior change has the client reached
o Action stage
• A client experiencing a tremendously stressful situation says, "My baby was diagnosed with terminal cancer 2 months ago. I either crying or walking around like I'm in a dream. I can't believe this is happening. What did we do to deserve something so horrible? The doctors can transplant almost every human organ, but they can't stop my baby from dying. I'm so angry. Most days I just want to take my child and run away." The nurse determines that the client is mainly expressing what?
o Anticipatory grief
• Which herbal therapies would be beneficial to a client with menstrual cramping?
o Catnip, Fennel, Black haw
• The nurse is caring for four clients admitted at the same time under mass casualty conditions. Based on this data, which client should be given the highest priority for treatment
o Client that is reported with shock
• A client presents with chief complaints of unexplained weight gain and back pain from compression fracture of the vertebrae. On assessment, there is truncal obesity with excessively thin extremities, a moon-shaped face, a buffalo hump, thin hair, and adult acne. The symptoms described are suggestive of what disease.
o Cushings disease
An adolescent girl is concerned about her body image after amputation of a leg for bone cancer. After the nurse has obtained the girls consent, what nursing action is most therapeutic
o Encourage her peers to visit
• During discharge planning the of an infant with spina bifida express concern about skin care and ask the nurse what can be done to avoid problems. What is the best response by the nurse.
o Frequent diaper changes with cleansing are needed
• During change of shift report the night nurse indicates that a client cannot tolerate the prescribed intermittent tube feedings. Which action should the receiving nurse take first.
o Gather more data from the night nurse about the technique used
• A nurse is giving discharge instructions to the parents of a 5 year old who is recovering from surgery. What food should the nurse recommend that will ensure maintenance of a positive nitrogen balance
o Hamburger on a bun
• How can a nurse best soothe a hospitalized infant who appears to be in pain
o Holding the infant
• A nurse is assessing a client with major depression. Which clinical manifestation reflects a disturbance in affect related to depression
o Hopelessness
• The nurse is caring for a client with rheumatoid arthritis. When should the nurse expect the client to experience the most pain and limited movement of the joints
o In the morning on awakening
• After an open reduction and internal fixation of a fractured hip, the nurse is helping a client to get out of bed into a chair. What should the nurse do to best accomplish this transfer
o Instruct the client to bear most of the weight on the unaffected leg and pivot the chair
• Mebendazole is prescribed for a 3 year old child with a pinworm infestation. What information will the nurse include when teaching the parents about this medication
o It may cause transient diarrhea
• A client visits the prenatal clinic bc her period is late. Her last period was April 5. Testing confirms that is preggo.According to Nägele's rule, what should the nurse provide as the expected date of birth
o January 12 o Add 7 days and 9 months
• A nurse is planning the discharge of a 9 year old child who has undergone tonsillectomy. The nurse informs the patient that their child may have a mouth odor, slight ear pain, and a low-grade fever for a few days. In addition to prescribed analgesic, what should the nurse recommend to ease their child's pain?
o Light-colored ice pops
• A client is visiting the prenatal clinic for the first time. While giving the nursing history the client states that her last period started June 1. What is her expected date of birth according to Nägaels rule?
o March 17
• The nurse is triaging clients arriving at the hospital after a large-scale disaster. Which condition is most likely to be categorized with a black tag
o Massive head trauma
• A client with a 20-year history of excessive alcohol use has developed jaundice and ascites and is admitted to the hospital. What is the priority nursing action during the first 48 hours after the clients admission
o Monitor vital signs
• The nurse is educating the parents of a preschooler on various poisonous plants that children may be exposed to. Which plants does the nurse mention as poisonous
o Plum, azalea, Foxglove
• A nurse educates a group of parents about how to teach their children to safely cross roads and walk in parking lots. Which age group of the children is the nurse referring to?
o Preschoolers
• A 29 weeks pregnant client reports dull backache pain and abdominal cramps. Which condition does the nurse suspect
o Preterm labor
• A client has an above-the-knee amputation to the left leg because of arterial insuffienciey. To prevent a hip flexion contracture, in what position should the nurse periodically place this client
o Prone position
• A client is experiencing stomatitis as a result of chemotherapy. Which action should the nurse take when caring for this client.
o Provide frequent saline mouthwashes
• A nurse instructs a client with viral hepatitis about the type of diet that should be ingested. Which lunch selected by the client indicates understanding about dietary principles associated with this diagnosis
o Salad, sliced chicken sandwich, gelatin dessert
• A child with meningitis suddenly assumes an opisthotonic position, in what position should the nurse position the child.
o Side-lying
• Which finding indicates the development of a complication resulting from bilateral cephalohematomas
o Skin color
• A community healthcare nurse is conducting a survey about homeless children in the community. Which findings helps the nurse distinguish absolute homelessness from relative homelessness
o The children do not have a physical shelter and may sleep outdoors or in vehicles
• An adolescent at 10 weeks' gestation visits prenatal clinic for the first time. The nutrition interview indicates that her dietary intake consists mainly of soft drinks, candy, French fries, and potato chips. Why does the nurse consider this dies inadequate?
o The nutritional composition of the diet places her at risk for a low-birth weight infant
A nurse is caring for a n 18 month old toddler. What findings is the nurse likely to notic
o The toddler can hold urine for a period of 1 to 2 hours
• The parents of a 6 year old child with celiac disease tell the school nurse their child becomes dejected because she is not able to eat snack foods like the rest of her class and friends. What snack can the nurse recommend that is safe for the child to eat
o Tortilla chips
• An adult client is brought to the ER after an accident. The client has limitations in mental function related to Down syndrome. How can the nurse best assess the clients pain level
o Using wrongs, "Pain faces"
• On a 6 week postpartum visit a new mother tells the nurse she wants to feed her baby whole milk after 2 months because she will be returning to work and can no longer breast feed. The nurse plans to teach the mother that she should switch to formula feeding because whole milk does not meet the infants nutritional requirements for what
o Vitamin C and Iron
• A client with osteoporosis is encouraged to drink milk. The client refuses the milk, explaining that it causes gas and bloating. Which food should the nurse suggest that is rich in calcium and digested easily by clients who do not tolerate milk
o Yogurt