a nurse is performing a peripheral vascular assessment for a client when placing the bell on the stethoscope on the clients neck she hears the followi
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HESI Fundamentals Exam Test Bank

1. During a peripheral vascular assessment, a healthcare professional places the bell of the stethoscope on a client's neck and hears an audible vascular sound associated with turbulent blood flow. This sound indicates which of the following?

Correct answer: A

Rationale: The correct answer is A: Narrowed arterial lumen. Arterial bruits are abnormal sounds caused by turbulent blood flow through narrowed or occluded arteries. This turbulent flow creates a blowing sound, which is heard as an arterial bruit. Distended jugular veins (choice B) are typically associated with venous issues, not arterial abnormalities. Impaired ventricular contraction (choice C) and asynchronous closure of the aortic and pulmonic valve (choice D) are not directly related to the audible vascular sound described in the scenario.

2. A client is lying on the bathroom floor after a nurse responds to a call light. Which of the following actions should the nurse take first?

Correct answer: A

Rationale: The nurse's priority in this situation is to assess the client for injuries. Checking for injuries first is crucial to determine the extent of harm caused by the fall and to provide immediate care. Moving hazardous objects can wait until the client's safety is ensured. Notifying the provider and asking the client about how she felt prior to the fall are important but are secondary to assessing for injuries in this urgent scenario. It is essential to address immediate physical needs before investigating the cause of the fall or notifying other healthcare team members.

3. During a home safety assessment for a client receiving supplemental oxygen, which observation should the nurse identify as proper safety protocol?

Correct answer: A

Rationale: The correct answer is A. Using non-acetone nail polish remover is crucial for clients on supplemental oxygen as acetone is flammable and poses a safety risk. Acetone can react with oxygen, increasing the fire hazard. Choices B, C, and D are incorrect. Electric razors can generate sparks, which are dangerous near oxygen due to the risk of ignition. While cleaning oxygen equipment is important, the type of nail polish remover used is more critical for immediate safety. Wool blankets can create static electricity, increasing the risk of fire around oxygen due to its flammability.

4. A healthcare professional is reviewing the medical record of a client who has hypocalcemia. The healthcare professional should identify which of the following findings as a risk factor for the development of this electrolyte imbalance?

Correct answer: A

Rationale: Crohn’s disease is known to impair calcium absorption, which can lead to hypocalcemia. This condition affects the intestines and can disrupt the normal absorption of nutrients, including calcium. Postoperative status following appendectomy, history of bone cancer, and hyperthyroidism are typically not directly associated with a higher risk of developing hypocalcemia compared to Crohn’s disease.

5. A client recovering from lung cancer is advised to resume lower-intensity activities of daily living. Which of the following activities should the nurse recommend to the client?

Correct answer: A

Rationale: The correct answer is A: Washing dishes. Washing dishes is a lower-intensity activity that is suitable for a client recovering from lung cancer. This activity does not require significant physical exertion and allows the client to engage in a manageable task while still following the provider's instructions for lower-intensity activities. Choices B, C, and D involve more physical effort and may not be appropriate for a client recovering from lung cancer, as they require more energy and physical strain, which could hinder the recovery process.

Similar Questions

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A client has a new diagnosis of hypothyroidism. Which of the following interventions should the nurse include in the plan of care?
A client has a sodium level of 125 mEq/L. Which of the following findings should the nurse expect?
A caregiver of an immobile client requiring assistance with repositioning is being taught by a nurse on preventing back strain. Which statement by the caregiver indicates an understanding of the teaching?
To ensure client safety, a nurse manager is planning to observe a newly licensed nurse perform a straight catheterization on a client. In which of the following roles is a nurse manager functioning?

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