HESI RN Fundamentals II | Nurselytic

Questions 58

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HESI RN Fundamentals II Questions

Extract:


Question 1 of 5

A client is admitted to the rehabilitation unit following a cerebrovascular accident (CVA), which resulted in paralysis of the right arm. When the nurse enters the room, the client is struggling to put on a shirt, and curses at the nurse. Which response is best for the nurse to provide?

Correct Answer: B

Rationale: Empathy addresses client frustration.

Question 2 of 5

The nurse is caring for a client who is postoperative and receiving supplemental oxygen at 2 L/minute via nasal cannula. The oxygen saturation is 89%. Which action should the nurse implement?

Correct Answer: B

Rationale: Accurate oximeter placement ensures valid readings.

Question 3 of 5

The nurse observes a newly employed unlicensed assistive personnel (UAP) checking the temperature of an adult client using a tympanic thermometer. The UAP pulls the client's auricle up and back and prepares to insert the thermometer. Which action should the nurse implement?

Correct Answer: C

Rationale: Up-and-back auricle pull is correct for adults.

Question 4 of 5

A healthcare organization requires nurses to chart by exception. Which assessment should the nurse document?

Correct Answer: D

Rationale: Diminished lung sounds indicate abnormality.

Extract:

History and Physical
Client was involved in a multi-car collision six days ago. Sustained a liver laceration, right rib fracture and right femur fracture. The liver laceration was repaired. An intermedullary rod was placed to repair the femur fracture. Client is progressing.
Orders
Post-op day 2
• Physical therapy evaluation


Question 5 of 5

Complete the diagram by dragging from the choices area to specify which type of exercises the client needs, two actions the nurse should take to facilitate the exercises, and two parameters the nurse should monitor to assess the client's progress.

Action to Take

Concentric exercises
Isotonic exercises
Eccentric exercises
Isometric exercises

Potential Condition

Support the extremity during exercise routine
Teach family how to participate in exercise program
Teach client how to use resistive bands

Parameter to Monitor

Pain level
Ability to perform activities of daily living
Have client contract

Correct Answer: Condition: Isometric exercises; Actions: Support the extremity during exercise routine, Teach family how to participate in exercise program; Parameters: Pain level, Ability to perform activities of daily living

Rationale: Isometric exercises minimize stress; support and family aid compliance.

Similar Questions

The nurse is obtaining a systolic blood pressure by palpation. While inflating the cuff, the radial pulse is no longer palpable at 90 mm Hg. Which action should the nurse take?
After completing daily charting at 1400, the nurse realizes that a 0900 occurrence was not entered. Which is the best way for the nurse to enter computer documentation of the 0900 occurrence?
When assessing a client with a serum potassium level of 7.5 mEq/L (7.5 mmol/L), which intervention is most important for the nurse to implement?
The nurse is teaching the client to self administer a dose of low molecular weight heparin SUBQ. Which instruction should the nurse include?
The nurse observes the unlicensed assistive personnel (UAP) securing a client's wrist restraints to the bedside rails. Which action is most important for the nurse to implement?

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