HESI RN Exit Exam Version 2/ Latest 2022/ Questions & Answers

Document Content and Description Below

After receiving IV fluids in the emergency department, an elderly client is admitted to the acute care unit with a medical diagnosis of dehydration. The client is receiving 0.9% normal saline at 125 m... L/hour via saline lock and has a bounding pulse, tachycardia, and pedal edema. When contacting the healthcare provider, the nurse anticipates a prescription what intervention? A. Remove the saline lock from the client's arm B. Increase the rate of the normal saline infusion C. Decrease the rate of the normal saline infusion D. Change the IV solution to 0.45% saline solution (ANS- A. Remove the saline lock from the client's arm A client who is admitted to the care unit with syndrome of inappropriate antidiuretic hormone (SIADH) has developed osmotic demyelination. Which intervention should the nurse implement first? A. Patch one eye B. Evaluate swallow C. Reorient often D. Range of motion (ANS- B. Evaluate swallow The nurse is preparing a client who had a below the knee (BKA) amputation for discharge to home. Which recommendations should the nurse provide this client? SATA A. Wash the stump with soap and water B. Avoid range of motion exercise C. Apply alcohol to the stump after bathing D. Inspect skin for redness E. Use a residual limb shrinker (ANS- A. Wash the stump with soap and water D. Inspect skin for redness E. Use a residual limb shrinker After 2 days treatment for dehydration, a child continues to vomit and have diarrhea. Normal saline is infusing, and the child's urine output is 50 mL/hour. During morning assessment, the nurse determines that the child is lethargic and difficult to arouse. Which action should the nurse implement? A. Perform a fingerstick glucose test. B. Obtain arterial blood gases. C. Increase the IV fluid flow rate. D. Review 24 hour intake and output. (ANS- A. Perform a fingerstick glucose test. Rationale: A fingerstick glucose test (A) is indicated to determine if a change in level of consciousness is related to a low glucose, which is a common finding with fluid and electrolyte loss and can be quickly corrected. Arterial blood gases (B) may be indicated to assess oxygenation, but first the glucose level should be assessed. The child's urine output is adequate, so increasing the IV fluid rate (C) is not indicated. Knowing the last 24 hour fluid volume totals (D) does not address the immediate problem. [Show More]

Last updated: 1 year ago

Preview 1 out of 58 pages