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Fundamentals HESI
1. A client with Parkinson's disease is being discharged. Which statement by the client indicates a need for further teaching?
- A. I will take my medication at the same time every day.
- B. I will increase my fiber intake to prevent constipation.
- C. I will perform range of motion exercises to maintain mobility.
- D. I will stop taking my medication if I feel better.
Correct answer: D
Rationale: The correct answer is D. Patients with Parkinson's disease should not stop taking their medication if they feel better, as doing so can worsen symptoms. It is crucial for patients to continue their prescribed medication regimen as directed by their healthcare provider. Choices A, B, and C are all appropriate actions that promote the well-being of a client with Parkinson's disease. Choice A emphasizes medication adherence, which is vital for symptom management. Choice B addresses a common issue in Parkinson's patients and shows an understanding of the importance of dietary management. Choice C highlights the significance of physical activity in maintaining mobility, which is essential for overall quality of life in Parkinson's disease.
2. A nurse delegates a position change to a nursing assistive personnel. The nurse instructs the assistive personnel (AP) to place the patient in the lateral position. Which finding by the nurse indicates a correct outcome?
- A. Patient is lying on side.
- B. Patient is lying on back.
- C. Patient is lying semiprone.
- D. Patient is lying on abdomen.
Correct answer: A
Rationale: The correct answer is A: 'Patient is lying on side.' In the side-lying (or lateral) position, the patient rests on the side with the major portion of body weight on the dependent hip and shoulder. Choice B, 'Patient is lying on back,' is incorrect as it describes a supine position. Choice C, 'Patient is lying semiprone,' is incorrect as it refers to a position where the patient is partially lying on the abdomen. Choice D, 'Patient is lying on abdomen,' is incorrect as it describes a prone position where the patient is lying face down.
3. A client is expressing anger about his diagnosis of colorectal cancer. Which of the following actions should the nurse take?
- A. Reassure the client that this is an expected response to grief.
- B. Ignore the client’s anger and continue with the plan of care.
- C. Tell the client that anger is not going to help his situation.
- D. Encourage the client to express his anger.
Correct answer: A
Rationale: When a client is expressing anger about a diagnosis, it is essential for the nurse to validate the client's feelings. Choice A is correct because reassuring the client that anger is an expected response to grief acknowledges the client's emotions and encourages expression, fostering a therapeutic relationship. This validation helps the client feel understood and supported during a challenging time. Choice B is incorrect as ignoring the client's anger can lead to feelings of neglect and hinder effective communication, which is crucial for providing holistic care. Choice C is inappropriate because telling the client that anger is not helpful dismisses the client's emotions and can further escalate the situation, potentially damaging the nurse-client relationship. Choice D is not the best option as it does not involve acknowledging the client's feelings or providing support and validation, which are vital in promoting emotional well-being and trust between the client and the nurse.
4. The nurse is providing discharge teaching to a client who has been prescribed digoxin (Lanoxin). Which statement by the client indicates a need for further teaching?
- A. I should take my pulse before taking the medication.
- B. I will take my medication at the same time every day.
- C. I should avoid taking antacids at the same time as this medication.
- D. I should eat foods high in potassium while taking this medication.
Correct answer: D
Rationale: The correct answer is D. Eating foods high in potassium can lead to hyperkalemia when taken with digoxin, indicating a need for further teaching. Choices A, B, and C are all correct statements that demonstrate understanding of digoxin therapy. Taking the pulse, maintaining a consistent dosing schedule, and avoiding antacids to prevent interactions with digoxin are all appropriate client responses.
5. A healthcare professional is planning to obtain the vital signs of a 2-year-old child who is experiencing diarrhea and who might have a right ear infection. Which of the following routes should the healthcare professional use to obtain the temperature?
- A. Temporal
- B. Oral
- C. Rectal
- D. Axillary
Correct answer: C
Rationale: In a 2-year-old child with diarrhea and a possible ear infection, rectal temperature measurement is the most accurate reflection of core body temperature. This method provides the most reliable reading, especially in young children, as it closely reflects the core body temperature. Oral temperature may not be accurate due to the child's recent diarrhea, which can affect oral readings. Axillary temperature may not be as accurate as rectal temperature in this case. Temporal temperature measurement, although non-invasive, may not provide the most accurate core body temperature reading, especially in a child with a potential ear infection.
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