a hospice nurse is caring for a client who has a terminal illness and reports severe pain after the nurse administers the prescribed opioid and benzod

HESI LPN

HESI Leadership and Management Test Bank

1. A hospice nurse is caring for a client who has a terminal illness and reports severe pain. After the nurse administers the prescribed opioid and benzodiazepine, the client becomes somnolent and difficult to arouse. Which of the following actions should the nurse take?

A. Withhold the benzodiazepine but continue the opioid
B. Contact the provider about replacing the opioid with an NSAID
C. Administer the benzodiazepine but withhold the opioid
D. Continue the medication dosages that relieve the client's pain

Correct answer: B

Rationale: The correct action for the nurse to take is to contact the provider about replacing the opioid with an NSAID. In this scenario, the client is experiencing excessive sedation after the administration of both opioid and benzodiazepine. Switching to a non-opioid analgesic like an NSAID can help manage pain effectively without causing additional sedation. Option A is incorrect because continuing the opioid may exacerbate sedation. Option C is incorrect as administering the benzodiazepine may further increase sedation. Option D is incorrect because maintaining the current medication dosages that are causing excessive sedation is not in the client's best interest.

2. What is the normal sodium level in the body?

A. 135 to 145 milliequivalents per liter.
B. 3 to 5 milliequivalents per liter.
C. 135 to 145 microequivalents per liter.
D. 3 to 5 microequivalents per liter.

Correct answer: A

Rationale: The correct answer is A: 135 to 145 milliequivalents per liter. The normal range for sodium levels in the body is expressed in milliequivalents per liter, not microequivalents. Choice B and D provide a significantly lower range which is not within the normal values for sodium. Choice C incorrectly states 'microequivalents' instead of the correct unit 'milliequivalents'. Therefore, A is the correct answer.

3. What does the mnemonic device ABCDE stand for?

A. Allergy, bleeding, chemicals, dietary, environment
B. Allergy, bleeding, cardio, diabetes, endocrine
C. Allergy, bleeding, cardio, digestive, endocrine
D. Allergy, bleeding, cortisone, diabetes, emboli

Correct answer: D

Rationale: The correct answer is D: 'Allergy, bleeding, cortisone, diabetes, emboli.' The ABCDE mnemonic is used in healthcare to help remember key assessment points. Choice A is incorrect as 'chemicals' and 'dietary' are not part of the ABCDE assessment. Choice B is incorrect as 'cardio' is not part of the ABCDE mnemonic. Choice C is incorrect as 'cardio' and 'digestive' are not part of the ABCDE mnemonic.

4. A nurse is preparing to complete an incident report regarding a medication error. Which of the following actions should the nurse plan to take?

A. Make a copy of the incident report for personal records
B. Identify the medication name and dosage administered to the client in the report
C. Obtain an order from the client's provider to complete the report
D. Include the time the medication error occurred in the report

Correct answer: B

Rationale: The correct answer is to identify the medication name and dosage administered to the client in the incident report. This information is crucial for accurate documentation and investigation of the medication error. Choice A is incorrect because incident reports are usually kept confidential and not for personal keeping. Choice C is incorrect as obtaining an order from the client's provider is not necessary to complete an incident report. Choice D, while important, is not the only essential information needed for the incident report.

5. How many calories per kilogram does an average full-term infant require when the infant is around 1-2 months old?

A. 140 calories per kilogram per day
B. 120 calories per kilogram per day
C. 100 calories per kilogram per day
D. 160 calories per kilogram per day

Correct answer: B

Rationale: An average full-term infant requires about 120 calories per kilogram per day at 1-2 months old. This amount is essential for their growth and development during this critical stage. Choices A, C, and D are incorrect as they provide calorie amounts that are either too high or too low for an average full-term infant at 1-2 months old, which could potentially lead to health issues or inadequate nutrition.