HESI EXIT V2 2021 160 Questions and Answers
1. After receiving IV fluids in the emergency department, an elderly client is admitted to the acute care
... [Show More] unit with a medical diagnosis of dehydration. Th e client is receiving 0.9% normal saline at 125 ml/hour via saline lock and has a bounding pulse, tachycardia, and pedal edema. When contacting the healthcare provider, the nurse anticipates a prescription what intervention? A) Remove the saline lock from the client’s arm. B) Increase the rate of the normal saline infusion. C) Decrease the rate of the normal saline infusion. D) Change the IV solution to 0.45% saline solution. 2. A client who is admitted to the care unit with syndrome of inappropriate antidiuretic hormone (SIADH) has developed osmotic demyelination. Which intervention should the nurse implement first? A) Patch one eye. B) Evaluate swallow. C) Reorient often. D) Range of motion. 3. The nurse is preparing a client who had a below-the-knee (BKA) amputation for discharge to home. Which recommendations should the nurse provide this client? (Select all that apply) A) Wash the stump with soap and water. B) Avoid range of motion exercise. C) Apply alcohol to the stump after bathing. D) Inspect skin for redness. E) Use a residual limb shrinker. 4. After 2 days treatment for dehydration, a child continues to vomit and have diarrhea. Normal saline is infusing and the child’s urine output is 50ml/hour. During morning assessment, the nurse determines that the child is lethargic and difficult to arouse. Which should the nurse implement? A) Increase the IV fluid flow rate. B) Review 24-hour intake and output. C) Obtain arterial blood gases. D) Perform a finger stick glucose test. 5. A client with bleeding esophageal varices receives vasopressin IV. What should the nurse monitor for during the IV infusion of this medication? A) Vasodilatation of the extremities. B) Chest pain and dysrhythmia. C) Hypotension and tachycardia. D) Decreasing GI cramping and nausea. 6. A male client with an antisocial personality disorder is admitted to an inpatient mental health unit for multiple substance dependency. When providing a history, the client justifies to the nurse his use of illicit drugs. Based on this pattern of behavior, this client’s history is most likely to include which finding? A) Multiple convictions for misdemeanors and Class B felonies. B) Delusions of....................................................................................CONTINUED [Show Less]