ATI RN
hesi health assessment test bank 2023 Questions
Question 1 of 5
What nursing interventions are important for a client in Buck's traction?
Correct Answer: C
Rationale: Step 1: Nutrition is important for overall health and healing in a client in Buck's traction. Step 2: Elimination is necessary to prevent complications such as constipation. Step 3: Comfort measures help alleviate pain and promote well-being. Step 4: Safety measures ensure the client's well-being during traction. Step 5: ROM exercises are not recommended to prevent displacement of traction. Transportation and isotonic exercises are not directly related to Buck's traction care.
Question 2 of 5
A 45-year-old man arrives at the clinic and tells the nurse that he has been experiencing severe chest pain. Upon assessment, the nurse notes that his pain radiates to his left arm. The nurse's priority action would be:
Correct Answer: B
Rationale: The correct answer is B: Assess vital signs and oxygen saturation levels. This is the priority action because the patient's symptoms suggest a possible cardiac event. Assessing vital signs and oxygen saturation levels can provide crucial information on the patient's condition and help determine the urgency of the situation. Administering pain medication (choice A) should not be done before assessing the patient's vital signs. Having the patient walk around (choice C) could worsen the situation if it is indeed a cardiac event. Ordering an EKG (choice D) is important but should come after assessing vital signs to guide further evaluation and treatment.
Question 3 of 5
What is the most appropriate nursing intervention for a client with severe pain after surgery?
Correct Answer: A
Rationale: The correct answer is A: Administer pain medication. This is the most appropriate nursing intervention because severe pain post-surgery requires immediate relief to ensure the client's comfort and aid in recovery. Pain medication helps manage pain effectively, improving the client's overall well-being and promoting healing. Monitoring vital signs (choice B) is important but secondary to pain relief in this scenario. Administering IV fluids (choice C) may be necessary for hydration but does not directly address the pain. Administering corticosteroids (choice D) is not typically indicated for severe pain post-surgery.
Question 4 of 5
For which condition might blood be drawn to check uric acid levels?
Correct Answer: B
Rationale: The correct answer is B: gout. Uric acid levels are typically checked for gout, a type of arthritis caused by the buildup of uric acid crystals in the joints. This condition directly relates to uric acid levels in the blood. Asthma (choice A), diverticulitis (choice C), and meningitis (choice D) do not typically require checking uric acid levels. Asthma is a respiratory condition, diverticulitis is a gastrointestinal condition, and meningitis is an inflammation of the protective membranes covering the brain and spinal cord.
Question 5 of 5
A woman has come to the clinic to seek help for a substance use problem. She admits to using cocaine just before coming to the clinic. Which of the following describes what the nurse may find when examining this woman?
Correct Answer: A
Rationale: The correct answer is A. Cocaine is a stimulant drug that typically leads to symptoms such as dilated pupils, pacing, and psychomotor agitation. Dilated pupils occur due to increased catecholamines. Pacing and psychomotor agitation are common behaviors associated with cocaine use. Unsteady gait and aggressiveness (Option B) are more characteristic of alcohol intoxication. Pupil constriction, lethargy, apathy, and dysphoria (Option C) are typical symptoms of opioid use. Constricted pupils, euphoria, and decreased temperature (Option D) are more indicative of opioid use as well.