hesi hiv case study quizlet

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HESI 700 Exit Practice Test Flashcards Quizlet

Medicine (16415d), cape cod community college.

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Hesi 700 exit practice test, 85 studiers today, add to folder, 5 (3 reviews), practice questions for this set, students also studied study guides, medsurg-hesi, tamos456 preview, ma week 20 quiz, kim12318 preview, peripheral vascular system overvie..., dewrose810 preview, elbow and forearm traumatic, maggles105 p, learn 1 / 7 study with learn, have a meconium aspirator available at delivery, choose matching term, the unit clerk reports to the charge nurse that a healthcare provider has written several, prescriptions that are illegible and it appears the healthcare provider used several unapproved, abbreviations in the prescriptions. what actions should the charge nurse take, following an open reduction of the tibia, the nurse notes bleeding on the client's cast. which, action should the nurse implement, terms in this set (785), we have an expert-written solution to this problem, following discharge teaching, a male client with, duodenal ulcer tells the nurse the he will drink, plenty of dairy products, such as milk, to help coat, and protect his ulcer. what is the best follow-up, action by the nurse, a. remind the client that it is also important to, switch to decaffeinated coffee and tea., b. suggest that the client also plan to eat frequent, small meals to reduce discomfort, c. review with the client the need to avoid foods, that are rich in milk and cream., d. reinforce this teaching by asking the client to list, a dairy food that he might select., review with the client the need to avoid foods that are rich in milk and cream, rationale: diets rich in milk and cream stimulate gastric acid secretion and should be avoided., a 154 pound client with diabetic ketoacidosis is receiving an iv of normal saline 100 ml with, regular insulin 100 units. the healthcare provider prescribes a rate of 0 units/kg/hour. to deliver, the correct dosage, the nurse should set the infusion pump to infuse how many ml/hour enter, numeric value only, artificial rupture of the membrane of a laboring reveals meconium-stained fluid, what is... the, a- clean the perineal are to prevent infection, b- assess the mother's blood pressure to check for signs of preeclampsia, c- assess the mother temperature to check for development of sepsis., d- have a meconium aspirator available at delivery., don't know, an adolescent with major depressive disorder has, been taking duloxetine (cymbalta) for the past 12, days. which assessment finding requires immediate, a. describes life without purpose, b. complains of nausea and loss of appetite, c. states is often fatigued and drowsy, d. exhibits an increase in sweating., describes life without purpose, rationale: cymbalta is a selective serotonin and norepinephrine reuptake inhibitor that is known to, increase the risk of suicidal thinking in adolescents and young adults with major depressive, disorder. b, c and d are side effects, a 60-year-old female client with a positive family, history of ovarian cancer has developed an, abdominal mass and is being evaluated for, possible ovarian cancer. her papanicolau (pap), smear results are negative. what information should, the nurse include in the client's teaching plan, a. further evaluation involving surgery may be, b. a pelvic exam is also needed before cancer is, c. pap smear evaluation should be continued every, d. one additional negative pap smear in six months, further evaluation involving surgery may be needed, rationale: an abdominal mass in a client with a family history for ovarian cancer should be, evaluated carefully, a client who recently underwent a tracheostomy is, being prepared for discharge to home. which, instructions is most important for the nurse to, include in the discharge plan, a. explain how to use communication tools., b. teach tracheal suctioning techniques, c. encourage self-care and independence., d. demonstrate how to clean tracheostomy site., teach tracheal suctioning techniques, rationale: suctioning helps to clear secretions and maintain an open airway, which is critical., in assessing an adult client with a partial rebreather, mask, the nurse notes that the oxygen reservoir, bag does not deflate completely during inspiration, and the client's respiratory rate is 14 breaths /, minute. what action should the nurse implement, a. encourage the client to take deep breaths, b. remove the mask to deflate the bag, c. increase the liter flow of oxygen, d. document the assessment data, document the assessment data, rational: reservoir bag should not deflate completely during inspiration and the client's respiratory, rate is within normal limits., during shift report, the central electrocardiogram, (ekg) monitoring system alarms. which client alarm, should the nurse investigate first, a. respiratory apnea of 30 seconds, b. oxygen saturation rate of 88%, c. eight premature ventricular beats every minute, d. disconnected monitor signal for the last 6, respiratory apnea of 30 seconds, rationale: the priority is the client whose alarm indicating respiratory apnea that should be, assessed first., during a home visit, the nurse observed an elderly, client with diabetes slip and fall. what action, should the nurse take first, a. give the client 4 ounces of orange juice, b. call 911 to summon emergency assistance, c. check the client for lacerations or fractures, d. asses clients blood sugar level, check the client for lacerations or fractures, rationale: after the client falls, the nurse should immediately assess for the possibility of injuries and, provide first aid as needed, a client who is taking an oral dose of a tetracycline, complains of gastrointestinal upset. what snack, should the nurse instruct the client to take with the, tetracycline, a. fruit-flavored yogurt., b. cheese and crackers., c. cold cereal with skim milk., d. toasted wheat bread and jelly, toasted wheat bread and jelly, rationale: dairy products decrease the effect of tetracycline, so the nurse instructs the client to eat, a snack such as toast, which contains no dairy products and may decrease gi symptoms., following a lumbar puncture, a client voices several, complaints. what complaint indicated to the nurse, that the client is experiencing a complication, a. "i am having pain in my lower back when i move, my legs", b. "my throat hurts when i swallow", c. "i feel sick to my stomach and am going to throw, up", d. i have a headache that gets worse when i sit up", "i have a headache that gets worse when i sit up", rationale: a post-lumbar puncture headache, ranging from mild to severe, may occur as a result of, leakage of cerebrospinal fluid at the puncture site. this complication is usually managed by, bedrest, analgesic, and hydration., an elderly client seems confused and reports the, onset of nausea, dysuria, and urgency with, incontinence. which action should the nurse, a. auscultate for renal bruits, b. obtain a clean catch mid-stream specimen, c. use a dipstick to measure for urinary ketone, d. begin to strain the client's urine., obtain a clean catch mid-stream specimen, rationale: this elderly is experiencing symptoms of urinary tract infection. the nurse should obtain a, clean catch mid-stream specimen to determine the causative agent so an anti-infective agent can, be prescribed., the nurse is assisting the mother of a child with, phenylketonuria (pku) to select foods that are in, keeping with the child's dietary restrictions. which, foods are contraindicated for this child, a. wheat products, b. foods sweetened with aspartame., c. high fat foods, d. high calories foods., foods sweetened with aspartame, rationale: aspartame should not be consumed by a child with pku because ut is converted to, phenylalanine in the body. additionally, milk and milk products are contraindicated for children with, before preparing a client for the first surgical case, of the day, a part-time scrub nurse asks the, circulating nurse if a 3 minute surgical hand scrub is, adequate preparation for this client. which, response should the circulating nurse provide, a. ask a more experience nurse to perform that, scrub since it is the first time of the day, b. validate the nurse is implementing the or policy, for surgical hand scrub, c. inform the nurse that hand scrubs should be 3, minutes between cases., d. direct the nurse to continue the surgical hand, scrub for a 5-minute duration., direct the nurse to continue the surgical hand scrub for a 5 minute duration, rationale: the surgical hand scrub should last for 5 to 10 mints, so the nurse should be directed to, continue the vigorous scrub using a reliable agent for the total duration of 5 mints. it is not, necessary to reassign staff (a). the length of the hand scrub and subsequent scrubs during the day, require the same process for the same amount of time, (b and c), which breakfast selection indicates that the client, understands the nurse's instructions about the, dietary management of osteoporosis, a. egg whites, toast and coffee., b. bran muffin, mixed fruits, and orange juice., c. granola and grapefruit juice, d. bagel with jelly and skim milk., bagel with jelly and skim milk, rationale: d includes dairy products which contain calcium and does not include any foods that, inhibit calcium absorption. the primary dietary implication of osteoporosis is the need for increased, calcium and reduction in foods that decrease calcium absorption, such as caffeine and excessive, the mother of an adolescent tells the clinic nurse,, "my son has athlete's foot, i have been applying, triple antibiotic ointment for two days, but there has, been no improvement." what instruction should the, nurse provide, a. antibiotics take two weeks to become effective, against infections such as athlete's foot., b. continue using the ointment for a full week, even, after the symptoms disappear., c. applying too much ointment can deter its, effectiveness. apply a thin layer to prevent, maceration., d. stop using the ointment and encourage, complete drying of the feet and wearing clean, stop using the ointment and encourage complete drying of the feet and wearing clean socks., rationale: athlete's foot (tinea pedi) is a fungal infection that afflicts the feet and causes scaliness, and cracking of the skin between the toes and on the soles of the feet. the feet should be, ventilated, dried well after bathing, and clean socks should be placed on the feet after bathing., antifungal ointments may be prescribed, but antibiotic ointments are not useful., a 26-year-old female client is admitted to the, hospital for treatment of a simple goiter, and, levothyroxine sodium (synthroid) is prescribed., which symptoms indicate to the nurse that the, prescribed dosage is too high for this client the, client experiences, a. palpitations and shortness of breath, b. bradycardia and constipation, c. lethargy and lack of appetite, d. muscle cramping and dry, flushed skin, palpitations and shortness of breath, rationale: an overdose of thyroid preparation generally manifests symptoms of an agitated state, such as tremors, palpitations, shortness of breath, tachycardia, increased appetite, agitation,, sweating and diarrhea., a client with a history of heart failure presents to, the clinic with a nausea, vomiting, yellow vision and, palpitations. which finding is most important for the, nurse to assess to the client, a. determine the client's level of orientation and, b. assess distal pulses and signs of peripheral, c. obtain a list of medications taken for cardiac, d. ask the client about exposure to environmental, obtain a list of medications taken for cardiac history, rationale: the client is presenting with signs of digitalis toxicity. a list of medication, which is likely, to include digoxin (lanoxin) for heart failure, can direct further assessment in validating digitalis, toxicity with serum labels greater than 2 mg/ml that is contributing to client's presenting clinical, the healthcare provider prescribes an iv solution, of isoproterenol (isuprel) 1 mg in 250 ml of d5w at, 300 mcg/hour. the nurse should program the, infusion pump to deliver how many ml/hour (enter, numeric value only.), rationale: convert mg to mcg and use the formula d/h x q. 300 mcg/hour / 1,000 mcg x 250 ml =, 3/1 x 25 = 75 ml/hour, the pathophysiological mechanism are responsible, for ascites related to liver failure (select all that, a. bleeding that results from a decreased, production of the body's clotting factors, b. fluid shifts from intravascular to interstitial area, due to decreased serum protein, c. increased hydrostatic pressure in portal, circulation increases fluid shifts into abdomen, d. increased circulating aldosterone levels that, increase sodium and water retention, e. decreased absorption of fatty acids in the, duodenum leading to abdominal distention., b. fluid shifts from intravascular to interstitial area due to decreased serum protein, c. increased hydrostatic pressure in portal circulation increases fluid shifts into abdomen, d. increased circulating aldosterone levels that increase sodium and water retention, rationale: when liver fail production of albumin is reduced. since albumin is the primary serum, protein creating intravascular osmotic pressure, decreased serum protein allows a fluids shift into, the interstitial space. pressure increases in the portal circulation © when venous return from the, upper gi tract cannot flow freely into sclerosed liver, which cause a pressure gradient to further, increase fluid shifts into the abdomen. a failing liver ineffectively inactivates steroidal hormones,, such as aldosterone resulting in sodium and water retention., a female client reports that her hair is becoming, coarse and breaking off, that the outer part of her, eyebrows have disappeared, and that her eyes are, all puffy. which follow-up question is best for the, nurse to ask, a. "is there a history of female baldness in your, family", b. "are you under any unusual stress at home or, work", c. "do you work with hazardous chemicals", d. "have you noticed any changes in your, fingernails", have you noticed any changes in your fingernails, rationale: the pattern of reported manifestations is suggestive of hypothyroidism, after a third hospitalization 6 months ago, a client is, admitted to the hospital with ascites and, malnutrition. the client is drowsy but responding to, verbal stimuli and reports recently spitting up, blood. what assessment finding warrants, immediate intervention by the nurse, a. bruises on arms and legs, b. round and tight abdomen, c. pitting edema in lower legs, d. capillary refill of 8 seconds, capillary refill of 8 seconds, rationale: the client is bleeding and hypovolemia is likely. capillary refill is greater than 3 to 5, seconds indicates poor perfusion and requires immediate attention, after the nurse witnesses a preoperative client sign, the surgical consent form, the nurse signs the form, as a witness. what are the legal implications of the, nurse's signature on the client's surgical consent, form (select all that apply), a. the client voluntarily grants permission for the, procedure to be done, b. the surgeon has explained to the client why the, surgery is necessary., c. the client is competent to sign the consent, without impairment of judgment, d. the client understands the risks and benefits, associated with the procedure, e. after considering alternatives to surgery, the, client elects to have the procedure., a. the client voluntarily grants permission for the procedure to be done, c. the client is competent to sign the consent without impairment of judgment, d. the client understands the risks and benefits associated with the procedure, rationale: inform consent is required for any invasive procedure. the nurse's signature as a witness, to the client's signature on surgical consent indicates that the client voluntary gives consent for the, scheduled procedure. c is competent to give consent, and d and understand the risk and benefits, of the procedure., following surgery, a male client with antisocial, personality disorder frequently requests that a, specific nurse be assigned to his care and is, belligerent when another nurse is assigned. what, action should the charge nurse implement, a. ask the client to explain why he constantly, request the nurse, b. encourage the client to verbalize his feelings, about the nurse, c. reassure the client that his request will be met, whenever possible., d. advise the client that assignments are not based, on client requests, advise the client that assignments are not based on clients requests, rationale: those with antisocial personality disorders are manipulative in order to meet their own, needs. the charge nurse must set limits on this behavior. the client's superficial charm and, emotional maturity prevent effective therapeutic communication and (a and b) will be used to the, client's advantage. c encourage further manipulative behavior., when caring for a client who has acute respiratory, distress syndrome (ards), the nurse elevates the, head of the bed 30 degrees. what is the reason for, this intervention, a. to reduce abdominal pressure on the diaphragm, b. to promote retraction of the intercostal, accessory muscle of respiration, c. to promote bronchodilation and effective airway, d. to decrease pressure on the medullary center, which stimulates breathing, to reduce abdominal pressure on the diaphragm, rationale: a semi-sitting position is the best position for matching ventilation and perfusion and for, decreasing abdominal pressure on the diaphragm, so that the client can maximize breathing, when assessing a mildly obese 35-year-old female, client, the nurse is unable to locate the gallbladder, when palpating below the liver margin at the lateral, border of the rectus abdominal muscle. what is the, most likely explanation for failure to locate the, gallbladder by palpation, a. the client is too obese, b. palpating in the wrong abdominal quadrant, c. the gallbladder is normal, d. deeper palpation technique is needed, the gallbladder is normal, rationale: a normal healthy gallbladder is not palpable, a woman with an anxiety disorder calls her, obstetrician's office and tells the nurse of increased, anxiety since the normal vaginal delivery of her son, three weeks ago. since she is breastfeeding, she, stopped taking her antianxiety medications, but, thinks she may need to start taking them again, because of her increased anxiety. what response is, best for the nurse to provide this woman, a. describe the transmission of drugs to the infant, through breast milk, b. encourage her to use stress relieving, alternatives, such as deep breathing exercises, c. inform her that some antianxiety medications are, safe to take while breastfeeding, d. explain that anxiety is a normal response for the, mother of a 3-week-old., inform her that some antianxiety medications are safe to take while breastfeeding, rationale: there are several antianxiety medications that are not contraindicated for breastfeeding, mothers. the woman is apparently aware that drugs can be transmitted through breast milk, so a is, not helpful. (b) might be helpful, but the client's history suggest that nonpharmacological methods, of anxiety management do not produce the best outcome. (d) the mother's history places her at, risk for severe anxiety., an older male client with a history of type 1, diabetes has not felt well the past few days and, arrives at the clinic with abdominal cramping and, vomiting. he is lethargic, moderately, confused,, and cannot remember when he took his last dose, of insulin or ate last. what action should the nurse, implement first, a. obtain a serum potassium level, b. administer the client's usual dose of insulin, c. assess pupillary response to light, d. start an intravenous (iv) infusion of normal saline, start an intravenous (iv) infusion of normal saline, rationale: the nurse should first start an intravenous infusion of normal saline to replace the fluids, and electrolytes because the client has been vomiting, and it is unclear when he last ate or took, insulin. the symptoms of confusion, lethargy, vomiting, and abdominal cramping are all suggestive, of hyperglycemia, which also contributes to diuresis and fluid electrolyte imbalance., which intervention should the nurse include in a, long-term plan of care for a client with chronic, obstructive pulmonary disease (copd), a. reduce risks factors for infection, b. administer high flow oxygen during sleep, c. limit fluid intake to reduce secretions, d. use diaphragmatic breathing to achieve better, reduce risks factors for infection, rationale: interventions aimed at reducing the risk factors of infections should be included in the, plan of care copd client are at particular risk for respiratory infection. prevention and early, detection of infections are necessary., which location should the nurse choose as the, best for beginning a screening program for, hypothyroidism, a. a business and professional women's group., b. an african-american senior citizens center, c. a daycare center in a hispanic neighborhood, d. an after-school center for native-american, a business and professional women's group, rationale: the population at highest risk is a so this is the group that would benefit the most for a, screening program of hypothyroidism and occurs between 35 and 60 years of age and is most, common in females., a female client has been taking a high dose of, prednisone, a corticosteroid, for several months., after stopping the medication abruptly, the client, reports feeling "very tired". which nursing, intervention is most important for the nurse to, a. measure vital signs, b. auscultate breath sounds, c. palpate the abdomen, d. observe the skin for bruising, measure vital signs, rationale: abrupt withdrawal of an exogenous corticosteroids can precipitate adrenal insufficiency, and hypoglycemia, hypokalemia, and circulatory collapse can occur. is most important for the, nurse to assess vital sign to impending shock., a male client reports the onset of numbness and, tingling in his fingers and around his mouth. which, lab is important for the nurse to review before, contacting the health care provider, a. capillary glucose, b. urine specific gravity, c. serum calcium, d. white blood cell count, serum calcium, rationale: numbness and tingling of the fingers and around the mouth, along with muscle cramps, are signs of hypocalcemia, what explanation is best for the nurse to provide a, client who asks the purpose of using the log-rolling, technique for turning, a. working together can decrease the risk for back, b. the technique is intended to maintain straight, spinal alignment., c. using two or three people increases client safety., d. turning instead of pulling reduces the likelihood, of skin damage, the technique is intended to maintain straight spinal alignment., rationale: the main rationale for use of the long-rolling technique is to maintain the client's spine, straight alignment., a client receiving chemotherapy has severe, neutropenia. which snack is best for the nurse to, recommend to the client, a. plain yogurt with sweetened with raw honey, b. peanuts in the shell, roasted or un-roasted., c. aged farmer's cheese with celery sticks, d. baked apples topped with dried raisins, baked apples topped with dried raisins, rationale: a patient with chemotherapy-induced severe neutropenia is at high risk for infection. a, low bacteria diet is required d is a healthy snack for a client receiving chemotherapy. a, b and c, have a high bacterial count and should be avoided..

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Course : medicine (16415d)

University : cape cod community college.

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