HESI RN
HESI RN Fundamentals II Questions
Extract:
Question 1 of 5
A client who had emergency gallbladder surgery yesterday is getting ready for discharge. The client speaks very little English. When teaching wound care, which method should the nurse use to evaluate the client's understanding of self-care at home?
Correct Answer: A
Rationale: Demonstration confirms wound care competency.
Question 2 of 5
The nurse is caring for a client one week postsurgery. Which finding should the nurse expect to see if the surgical incision is healing properly?
Correct Answer: D
Rationale: Well-approximated edges indicate proper healing.
Question 3 of 5
The nurse educator is conducting a class for unlicensed assistive personnel (UAP). Which action indicates that a UAP understands gloving procedures?
Correct Answer: A
Rationale: New gloves per room prevent cross-contamination.
Extract:
History and Physical
The client is an 81-year-old male with a history of hypertension, heart failure, and seasonal allergies. He was admitted for pneumonia 3 days ago and is currently in the intermediate care unit. He lives with his daughter and her family. She reports that he is active and compliant with his medication regime. He walks the dog every morning and has no signs of cognitive decline at home.
Nurses' Notes
0800
Received report. The client is awake and alert. Upon assessment, found a 0.7 in by 1.6 in (2 cm by 4 cm) partial thickness abrasion behind the client's right ear where the strap holding the continuous positive airway pressure (CPAP) mask was positioned.
Orders
• Continuous positive airway pressure (CPAP) 10 cm H2O with supplemental oxygen 55%
• Adjust oxygen as needed to keep oxygen saturation greater than 91%
• Activity as tolerated
• Vital signs every 2 hours
• Diet as tolerated
• Lactated Ringers IV infusion at 90 mL/hr
Question 4 of 5
Complete the diagram by dragging from the choices area to specify which condition the client is most likely experiencing, two actions the nurse should take to address that condition, and two parameters the nurse should monitor to assess the client's progress.
Action to Take
Potential Condition
Parameter to Monitor
Correct Answer: Condition: Stage 1 pressure injury; Actions: Clean the area with sterile saline or wound cleanser and dry, Place a hydrocolloid dressing over the area; Parameters: Temperature, Skin integrity
Rationale: Cleaning and dressing prevent progression; temperature and skin monitor infection.
Extract:
Question 5 of 5
A client with a family history of cardiac disease is seeking information to control risk factors. Which lifestyle modification is most important for the nurse to encourage?
Correct Answer: B
Rationale: Smoking cessation significantly reduces cardiac risk.