HESI - Fundamental Skills
The new nurse is approached by a surveyor from the department of health. The surveyor asks the nurse about the best way to prevent the spread of infection. Which answer by the nurse is correct?
"Wash your hands before and after any client care."
A client is dying. Hesitatingly, his wife says to the nurse, I'd like to tell him how much I love him, but I don't want to upset him."Which is the correct respond by the nurse?
"You should share your feelings with him while you can."
The nurse teaches a client about wearing thigh-high anti embolism elastic stockings. Which instruction would be correct to include?
"You will need to apply them in the morning before you lower your legs from the bed to the floor."
A client is to receive a transfusion of packed red blood cells (PRBCs). Which solution would the nurse use to prime the blood intravenous (IV) tubing?
0.9% normal saline
Which goal of care are associated with the family health system model? Select all that apply.
1. Improving family health or well being 2. Providing assistance in family management of illness conditions 3. Achieving health outcomes related to the family's area of concern
Which disease process places a client at increased risk for infection? Select all that apply
1. Leukemia 2. Lymphoma 3. Emphysema
Which risk factor increases a client's risk for infection in the community? Select all that apply
1. Lifestyle 2. Occupation 3. Frequent traveling
Which interventions would the nurse perform while caring for an actively dying client? Select all that apply.
1. Provide client and family reassurance 2. Perform symptom management for the client
Arrange the order of critical thinking for an existing problem.
1. Recognizing the existing issue 2. Analyzing information about the issue 3. Evaluating the information 4. Making a conclusion
The nurse is measuring the body temperature of four clients in a clinical setting. Which client is in need of rewarming through cardiopulmonary bypass?
85.3'F - client B
Which critical thinking skill will help a student nurse avoid making assumptions about clients?
Analysis
The nurse records the client's weight and body mass index (BMI) at a healthy range, but the client states, "I wish as thin as my coworkers." Which culturally bound condition is the client at risk for?
Anorexia nervosa
The nurse is assessing a child who is accompanied by a parent and a stepbrother. Which kind of a family does this child belong to?
Blended family
Which activity demonstrates fine motor skills in infants aged 2 to 4 months?
Bringing objects from hand to mouth
A client with a diagnosis of malabsorption syndrome exhibits a symptom of spastic muscle spasms. Which electrolyte is responsible for this symptom?
Calcium
The nurse is helping a client and her or his family to set and meet goals. Which professional role is the nurse displaying?
Caregiver
The nurse applies a cold pack to relieve musculoskeletal pain. Which rationale explains the analgesic properties of cold therapy?
Causing local vasoconstriction, preventing edema and muscle spasms
When a client expresses anxiety about being given anesthesia, which team member should sit with the person and provide comfort during the induction?
Circulating nurse
How can the nurse evaluate the effectiveness of communication with a client?
Client feedback
The nurse should take which infection control measures when caring for a client admitted with a tentative diagnosis of infectious pulmonary tuberculosis (TB)?
Don an N95 respiratory mask before entering the room
Which information must be clearly documented in the medication administration record (MAR) before administering a medication? Select all that apply.
Dosage and route Client's full name Time to be administered Frequency of administration Full name of prescribed medication
Which workers would the nurse consider to be at high risk of developing dermatitis? Select all that apply.
Dry cleaners & Dye workers
The nurse is reviewing a client's plan of care. Which is the determining factor in the revision of the plan?
Effectiveness of the interventions
To prevent thrombophlebitis in the immediate postoperative period, which action is important for the nurse to include in the client's plan of care?
Encourage early mobility
Which would the nurse consider to be the center of decision-making when providing client care?
Ethics
Which professional standard is important for critical thinking?
Evaluation criteria
Which critical thinking skill in nursing practice requires the nurse to process knowledge and experience for choosing care strategies for clients?
Explanation
Which critical thinking skill is being used when the nurse applies knowledge and experience to client care?
Explanation
Which therapeutic communication technique is used when the nurse and a client have a conversation and the client begins to repeat the conversation to her or himself?
Focusing
A client who is in the advanced stages of illness asks the nurse to contact pastoral services for support. According to the Macmillan model, which is the correct nursing intervention in this situation?
Immediately involve pastoral services while caring for the client
Which skill in critical thinking requires the nurse to be orderly in data collection?
Interpretation
During a home visit, the nurse finds that a healthy older adult person is actively practicing laughing therapy to maintain good health without pressure or insistence from family members. Which inference about the client would the nurse make from these findings?
Intrinsically motivated
The nurse is assessing a middle-aged client whose children have left home in search of work. The client is trying to adjust to these family changes. Which family life-cycle stage is the client going through?
Launching children and moving on
Which action relates with the relevance strategy of the motivational learning model proposed by Keller?
Linking the person's needs, interests and motivates for learning
Which action would the nurse take to decrease the risk of transmission of vancomycin-resistant enterococci (VRE)?
Move the client to a private room
A client is being admitted to a medical unit with a diagnosis of pulmonary tuberculosis. Which type of room would the nurse assign this client?
Negative-airflow room
The nurse hired to work in a metropolitan hospital provides services for a culturally diverse population. One of the nurses on the unit says it is the nurses' responsibility to discourage these people from bringing all that alternative medicine stuff to their family members. Which response by the nurse is correct?
Nontraditional approaches to health care can be beneficial
Which key factor would the nurse consider when assessing how a client will cope with body image changes?
Perception of the change
The nurse changed a dressing on a client's wound with vancomycin-resistance enterococci (VRE). Which step would the nurse take to ensure proper disposal of the soiled dressing?
Place the dressing in a red bag/hazardous materials bag
Which step of the nursing process is directly affected if the nurse does not make a nursing diagnosis?
Planning
Which cation regulates intracellular osmolarity?
Potassium
Which stage of Piaget's theory of cognitive development would the nurse observe in a preschooler?
Pre operational
The nurse is caring for a child who has an external fixation device on the leg. Which is the nurse's priority goal when providing pin care?
Preventing infection
Which nursing practice is associated with a self-regulation skill?
Reflecting on one's experience
Which caring intervention helps provide comfort, dignity, respect and peace to a client?
Relieving pain and suffering
Which non pharmacological nursing intervention is effective in helping relieve postoperative pain?
Repositioning
Which therapeutic communication technique is a coping strategy to help the nurse and client adjust to stress?
Sharing humor
The nurse assesses bilateral +4 peripheral edema while assessing a client with heart failure and peripheral vascular disease. Which is the pathophysiological reason for the excessive edema?
Shift of fluid into the interstitial spaces
The home health care nurse visits a client who lives with her two grandchildren. Which term would nurse use to define this family form?
Skip-generation family
Which statement defines the term "family resiliency"?
The family has an ability to cope with stressors
A client who wakes up after a surgery spits out the oral airway placed during the recovery from anesthesia. What would this behavior indicate to the nurse?
Their gag reflex has returned
The nurse is providing restraint education to a group of nursing students. Which reason to use restraints is incorrect to teach?
To prevent an adult client from getting up at night when there is insufficient staffing on the unit
Which type of functional health pattern describes values and goals?
Value-belief pattern
Arrange in order the items of personal protective equipment (PPE) removed after seeing a client in droplet precautions
1. Gloves 2. Face shield 3. Gown 4. Mask
Which factors increases the risk of nurses making medication errors in the health care setting? Select all that apply.
1. Stress 2. Fatigue 3. Overwork
Why would the nurse establish moderately hard client-centered goals? Select all that apply
1. To prevent the client from quitting before the goal is achieved 2. To prevent the client from losing motivation toward achieving the goal
The nurse is reviewing the procedure for intervention if a fire occurs. Which interventions would the nurse include in the procedure if a fire occurs that relate to acronym RACE? Select all that apply
1. Activate the alarm 2. Remove all the clients from the area 3. Confine the fire by closing doors and windows
After reviewing a client's reports, the primary health care provider suggests palliative care for the client. Which conditions would qualify the client for this type of care? Select all that apply
1. Chronic renal failure 2. Congestive heart failure 3. Chronic obstructive lung disease
Which of these is an ethical issue related to the long-term care setting? Select all the apply.
Guardianship Power of attorney Advance directives Responsible party designation Do-not-resuscitate (DNR) ordrers Adherence to a patient's bill of rights
The nurse is teaching unlicensed assistant personnel about ways to prevent the spread of infection. The nurse decides to emphasize the need to break the cycle of infection. Which teaching would be priority?
Hand washing before and after providing client care