HESI HEALTH ASSESSMENT REAL EXAM 2023/2024 QUESTIONS AND 100% CORRECT ANSWERS

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While assessing a radial artery catheter, the client complains of numbness and pain distal to the insertion site. What interventions should the nurse implement? -- CORRECT ANSWER-Promptly remove the... arterial catheter from the radial artery. A client is admitted with an epidural hematoma that resulted from a skateboarding accident. To differentiate the vascular source of the intracranial bleeding, which finding should the nurse monitor? -- CORRECT ANSWER-Rapid onset of decreased level of consciousness. When preparing a client for discharge from the hospital following a cystectomy and a urinary diversion to treat bladder cancer, which instruction is most important for the nurse to include in the client's discharge teaching plan? -- CORRECT ANSWER-Report any signs of cloudy urine output. After repositioning an immobile client, the nurse observes an area of hyperemia. To assess for blanching, what action should the nurse take? -- CORRECT ANSWER-Apply light pressure over the area. The nurse enters a client's room and observes the client's wrist restraint secured as seen in the picture. What action should the nurse take? -- CORRECT ANSWERReposition the restraint tie onto the bedframe. A female client with acute respiratory distress syndrome (ARDS) is chemically paralyzed and sedated while she is on as assist-control ventilator using 50% FIO2. Which assessment finding warrants immediate intervention by the nurse? -- CORRECT ANSWER-Diminished left lower lobe sounds Rationale: Diminished lobe sounds indicate collapsed alveoli or tension pneumothorax, which required immediate chest tube insertion to re-inflate the lung. The development of atherosclerosis is a process of sequential events. Arrange the pathophysiological events in orders of occurrence. (Place the first event on top and the last on the bottom) -- CORRECT ANSWER-Arterial endothelium injury causes inflammation Macrophages consume low density lipoprotein (LDL), creating foam cells Foam cells release growth factors for smooth muscle cells Smooth muscle grows over fatty streaks creating fibrous plaques Vessel narrowing results in ischemia [Show More]

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