HESI RN
HESI Community Health
1. A client with a history of alcohol abuse is admitted with acute pancreatitis. Which laboratory result requires immediate intervention?
- A. Amylase of 120 U/L.
- B. Lipase of 150 U/L.
- C. Calcium of 8.5 mg/dL.
- D. Blood glucose of 250 mg/dL.
Correct answer: D
Rationale: The correct answer is D, 'Blood glucose of 250 mg/dL.' In a client with acute pancreatitis, elevated blood glucose levels can indicate poor control of diabetes or stress response from the acute illness. Immediate intervention is necessary to prevent complications like worsening pancreatitis, infections, or other metabolic issues. Choices A and B, 'Amylase of 120 U/L' and 'Lipase of 150 U/L,' are commonly elevated in pancreatitis but do not require immediate intervention unless significantly elevated. Choice C, 'Calcium of 8.5 mg/dL,' is within the normal range and not a priority in this scenario.
2. When developing a presentation on injury prevention for high school students in a health education class, which topic is most important for the nurse to include?
- A. Sports-related injuries
- B. Substance abuse
- C. Seat belt safety
- D. Pregnancy prevention
Correct answer: C
Rationale: The correct answer is C: Seat belt safety. This topic is crucial as it can significantly reduce the risk of injury or death in car accidents, which is a common cause of severe injuries among high school students. While sports-related injuries, substance abuse, and pregnancy prevention are important topics, seat belt safety directly addresses a preventable cause of injuries that can have immediate life-saving effects.
3. A teenage boy with a history of recurring atopic dermatitis (eczema) tells the school nurse that he wants to play high school football. Which action should the nurse take?
- A. encourage the teenager to join the swim team instead of the football team
- B. notify the parents of the problems associated with perspiration for those with eczema
- C. tell the teenager to shower with a non-perfumed soap immediately after practice
- D. inform the football coach of the teenager's skin condition and its manifestations
Correct answer: C
Rationale: The correct action for the nurse to take is to advise the teenager to shower with a non-perfumed soap immediately after practice. This recommendation can help reduce the risk of eczema flare-ups by removing sweat and irritants from the skin. Choice A is incorrect as it does not address the specific concerns related to eczema and football. Choice B, notifying the parents of perspiration problems, is not as direct as instructing the teenager on proper skincare. Choice D, informing the football coach, is not the most immediate and relevant action to address the teenager's individual needs.
4. During a home visit, the nurse observes that an elderly client has numerous bruises on her arms and appears fearful of her caregiver. What should the nurse do first?
- A. report the findings to adult protective services
- B. ask the client how she got the bruises
- C. document the observations in the client's medical record
- D. discuss the observations with the caregiver
Correct answer: B
Rationale: The initial step for the nurse should be to ask the client how she got the bruises. This approach allows the nurse to directly assess the situation, gather information from the client, and potentially uncover signs of abuse. Reporting to adult protective services should come after obtaining more details from the client to ensure appropriate action. Documenting the observations is important but should follow gathering information from the client. Discussing the observations with the caregiver may not be appropriate as the caregiver could be the source of abuse, and involving them first may jeopardize the client's safety.
5. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen therapy. Which finding indicates that the therapy is effective?
- A. The client is able to expectorate secretions easily.
- B. The client's oxygen saturation is 92%.
- C. The client's respiratory rate is 20 breaths per minute.
- D. The client's arterial blood gases show a pH of 7.35.
Correct answer: C
Rationale: In a client with COPD receiving oxygen therapy, an effective response is indicated by a respiratory rate of 20 breaths per minute. This suggests that the client is effectively oxygenating while maintaining an appropriate respiratory rate. Choices A, B, and D are incorrect because expectorating secretions easily, having an oxygen saturation of 92%, and arterial blood gases showing a pH of 7.35 are not specific indicators of the effectiveness of oxygen therapy in COPD. Oxygen saturation of 92% may still be suboptimal in COPD, and arterial blood gases showing a pH of 7.35 may not necessarily reflect the overall effectiveness of oxygen therapy.
Similar Questions
Access More Features
HESI RN Basic
$69.99/ 30 days
- 5,000 Questions with answers
- All HESI courses Coverage
- 30 days access
HESI RN Premium
$149.99/ 90 days
- 5,000 Questions with answers
- All HESI courses Coverage
- 30 days access