HESI RN
RN Care Hope Mental Health HESI Questions
Extract:
Question 1 of 5
A client who is admitted with a closed head injury after a fall has a blood alcohol level (BAL) of 0.28 (28%) and is difficult to arouse. Which intervention during the first 6 hours following admission should the nurse identify as the priority?
Correct Answer: B
Rationale: Placing the client in a side-lying position with the head elevated prevents aspiration and maintains airway patency, critical for a client with altered consciousness.
Question 2 of 5
A client who is admitted with a closed head injury after a fall has a blood alcohol level (BAL) of 0.28 (28%) and is difficult to arouse. Which intervention during the first 6 hours following admission should the nurse identify as the priority?
Correct Answer: B
Rationale: Placing the client in a side-lying position with the head elevated prevents aspiration and maintains airway patency, critical for a client with altered consciousness.
Question 3 of 5
A client who refuses antipsychotic medications disrupts group activities, talks with nonsensical words, and wanders into client's rooms. The nurse decides that the client needs constant observation based on which of these assessment findings?
Correct Answer: B
Rationale: Wandering into client's rooms poses a safety risk to both the client and others, indicating a need for constant observation to prevent potential harm.
Question 4 of 5
An adolescent who is a heroin addict is admitted to the unit for detoxification. What intervention is most important for the nurse to initiate during the first 24 hours after admission?
Correct Answer: B
Rationale: Monitoring for wheezing and apnea is crucial during the first 24 hours of heroin detoxification to ensure respiratory stability, addressing immediate physiological risks.
Question 5 of 5
The nurse is caring for a client who is a refugee from another country and who is experiencing daily episodes of anxiety. The client communicates minimally with the nurse, looking away and appearing distressed. Which intervention is most important for the nurse to do first?
Correct Answer: D
Rationale: Inquiring respectfully about the events of departure is critical to understand potential traumatic experiences contributing to the client's anxiety.