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HESI EXAM 1 CAPSTONE: Questions & Answers: Guaranteed A+ Score Guide

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An angry client visits the primary healthcare provider’s office and requests a copy of their medical records. The client is angry after being placed on hold several times for over 10 minutes when re... questing an appointment. What should the nurse tell this client? You answered this question Incorrectly 1. All client appointment calls are transferred to the scheduling clerk. 2. The client will have to speak to the primary healthcare provider. 3. A copy of the record may be obtained within 24 hours of the request. 4. Medical records must stay within the facility unless requested by another primary healthcare provider. Rationale Strategies 3. Correct: The client has the right to the personal medical record. Generally, a period of time is required to get the record copied. The client may be charged for the copy. This assures the client that the request will receive attention. 1. Incorrect: This response dismisses the client's feelings and may only anger the client further. The response does not address the reason for the client's anger. The statement may be true; however, the client does have the right to request and receive a copy of the medical record. 2. Incorrect: The primary healthcare provider does not have to be contacted, as there should be policies in place to grant the request for a copy of the medical record. Also, telling the client to speak to the healthcare provider would not address the reason for the client's anger. This would dismiss the client's feelings. 4. Incorrect: The client has a right to the medical record. Records may also be requested by other providers with consent of the client. The client's feelings should be addressed and the client should be informed that the medical record will be provided as requested. Question: A nurse is planning to provide information regarding suicide to a high school assembly. What information should the nurse include? You answered this question Incorrectly 1. Do not keep secrets for the suicidal person. 2. Express concern for a person expressing thoughts of suicide. 3. Teens often don't mean what they say, so only take suicide seriously if grades are dropping as well. 1., 2., 4. & 5. Correct: If a person reveals that suicide is being considered, this should never be kept secret. Help should be sought for the person immediately. It is also important to be direct and non-secretive with suicidal clients. It is appropriate to express concern for their thoughts. The use of empathy, warmth and concern indicates to the client that their feelings are being understood and viewed as real, which helps to build trust with the client. Resources for assistance are important to include in all health teaching programs. The teens need to know what resources are readily available if someone is considering suicide. The client contemplating suicide should not be left alone. This is for the client's safety until further assistance can be obtained 3. Incorrect: Most clients who commit suicide have told at least one person that they were contemplating suicide before thy actually committed the act. Therefore, suicidal comments should be considered important risk factors that require evaluation, and all comments should be taken seriously. Anyone expressing suicidal feelings needs immediate attention. Question: The nurse should question which prescription for a client diagnosed with acute heart failure? You answered this question Correctly 1. 2 gram of sodium (Na) diet. 2. Digoxin 0.25 mg IV q 4 hours times 3 doses. 3. Furosemide 40 mg IVP stat. 4. Start IV with NS at 125 mL/hr. • Rationale • Strategies 4. Correct: The client is in fluid overload and does not need the normal saline (NS) at 125 mL/hr. NS is an isotonic solution. It goes in the vascular space and stays there without shifting out to the cells. This could cause additional overload in the vascular space as well as cause the BP to increase. The other prescriptions are acceptable. 1. Incorrect: This is an appropriate measure Na restricted diet will help to lower the serum Na and decrease H2O retention. This does not need questioning. 2. Incorrect: Digoxin is a digitalis glycoside. It slows conduction and strengthens the force of contraction of the heart. Therefore, this medication that increases cardiac contractility and reduces the heart rate does not need questioning. 3. Incorrect: Furosemide is a diuretic. It enhances renal excretion of Na and H2O and reduces systemic and pulmonary congestion. This medication prescription does not need questioning. Question: The nurse is preparing to administer nadolol to a hospitalized client. Which client data would indicate to the nurse that the medication should be held and the primary healthcare provider notified? You answered this question Incorrectly 1. Blood pressure 102/68 2. Glucose 118 3. UOP 440 mL over previous 8 hour shift. 4. Correct: This is a beta blocker. It slows the heart rate. If a client’s heart rate is less than 60 beats per minute, notify the primary healthcare provider and ask if the client should receive this medication. Administering a beta blocker to a client who has a heart rate less than 60 could possibly cause the client to develop symptomatic bradycardia and hypotension. 1. Incorrect: If the client’s BP drops below 90/60, this beta blocker should be held and the primary healthcare provider notified. The BP in this option is high enough to administer the medication, but the BP in clients on beta blockers should be monitored and the client should be taught about signs and symptoms of hypotension. 2. Incorrect: This is a normal glucose level. If the client is a diabetic, beta blockers can mask the signs of hypoglycemia. There diabetics on beta blockers should monitor their blood sugar carefully. 3. Incorrect: Urinary output is adequate. Beta blockers do not alter renal function. However, if pulse and BP are reduced too much, renal perfusion could ultimately be affected. Question: Which signs and symptoms would the nurse expect to see in a client who has taken prednisone for two months? You answered this question Correctly 2., 3. & 5. Correct: Decreased wound healing is a side effect with prolonged steroid use due to the immunosuppressive effects. All steroid medications, such as prednisone, can lead to sodium retention which then leads to dose related fluid retention. Hypertension is seen due to this fluid and sodium retention. Cushingoid appearance (moon face) is a side effect that is created from the abnormal redistribution of fat from prolonged steroid use. 1. Incorrect: Within one month after corticosteroid administration, weight gain is seen rather than weight loss. 4. Incorrect: Facial and body hair increase with prolonged steroid use. This excessive growth of body hair, known as hirsutism, is one of the numerous potential side effects of prednisone. Question: Which interventions should be included in the plan of care for an adult client with constipation? 1., 2., 3. & 4. Correct: Clients should have ample time for defecation. Rushing the client may lead to a client ignoring the urge. Since clients may be hesitant to have a bowel movement in the presence of others, privacy should be provided. (The nurse may need to stay with weak or disabled clients.) Increasing fluid intake will lead to softer stools. This makes defecation easier. Fiber deficiencies may contribute to constipation. Fiber in the diet adds bulk to the stools which help them pass more readily through the intestines. 5. Incorrect: Ignoring the urge to defecate may increase the risk of constipation. Trying to defecate after a meal when peristalsis is increased may be helpful; however, if the urge occurs at other times, the client should go to the bathroom at that time to prevent constipation. Question: A client asked the nurse what could have caused them to develop right sided heart failure? What would be the best response by the nurse? You answered this question Correctly 3. The inability of the mitral valve to close properly. 4. Narrowing of the aorta. 1. Correct: Yes, the right side of the heart pumps to the lungs. When the client has higher pressure in the pulmonary circuit from such things as emphysema, the pulmonary pressure can exceed the systemic pressure. The result is back flow to the right side of the heart and resulting right sided heart failure. 2. Incorrect: No, that’s left-sided heart failure. Hypertension increases afterload which can ultimately result in back flow to the left side of the heart and resulting left sided heart failure. 3. Incorrect: Not related to pulmonary hypertension. The mitral valve is located between the left atrium and left ventricle. If mild, there may be little or no obvious symptoms. However, if severe, left sided heart failure may occur. 4. Incorrect: Not related to pulmonary hypertension. Narrowing of the aorta makes it harder to get blood out of the left ventricle (high afterload). The resulting back flow of blood would result in left sided [Show More]

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