HESI RN Fundamentals II | Nurselytic

Questions 58

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HESI RN Fundamentals II Questions

Extract:


Question 1 of 5

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?

Correct Answer: C

Rationale: Addendum ensures accurate, timely documentation.

Question 2 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.

Question 3 of 5

The nurse is teaching a client about a newly prescribed medication. To confirm that the client is learning the critical information, which strategy is most important for the nurse to include during the instruction?

Correct Answer: A

Rationale: Feedback confirms understanding.

Extract:

History and physical
The client is a 52-year-old female with a history of obesity, type 2 diabetes mellitus, and hypertension. She is in the hospital for treatment of cellulitis of the right leg. The client has a peripherally inserted central catheter (PICC) in her right antecubital vein. She is currently on day 4 of her antibiotic course.
Nurses notes :
The client had a large, loose stool.
Laboratory Results
Laboratory Test Result Reference Range
Blood Glucose 104 mg/dL (5.8 mmol/L) 74 to 106 mg/dL. (4.1 to 5.9 mmol/L)

Orders:
• Vital signs every 4 hours
• Regular diet
• Cefazolin 1 g IV every 8 hours for 5 days
• Metformin 1,000 mg PO every 12 hours
• Point of care blood glucose check every 4 hours
Patient Data


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

Place the client on contact precautions
Collect stool for culture
Start a high fiber diet
Administer an oral steroid
Make the client NPO

Potential Condition

Osmotic diarrhea
Steatorrhea
Secretory diarrhea
Motility diarrhea

Parameter to Monitor

Urine sodium
Serum potassium
Respiratory rate
Heart rate
Serum ketones

Correct Answer:

Rationale: Condition:

Osmotic diarrhea

osmotic diarrhea. This type of diarrhea is often caused by an imbalance in the osmolality of the intestinal contents, which can be due to certain medications or dietary factors. In this case, the client's recent antibiotic therapy and diet might contribute to this condition.

Actions to Take:

Collect stool for culture – This can help determine if there is an infectious or bacterial component contributing to the diarrhea.

Start a high fiber diet – Increasing dietary fiber can help in managing diarrhea by increasing stool bulk and improving consistency.

Parameters to Monitor:

Serum potassium – Osmotic diarrhea can lead to electrolyte imbalances, and monitoring potassium levels helps to detect potential deficiencies.

Serum ketones – This can help to evaluate if the client is in a state of ketosis due to potential malabsorption or significant diarrhea.

Extract:


Question 5 of 5

The nurse is assessing a client who is having pain of the right upper abdominal area. To assess the quality of the client's abdominal pain, which approach should the nurse use?

Correct Answer: B

Rationale: Client description reveals pain characteristics.

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