hesi foundation of nursing
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The healthcare provider prescribes streptomycin 200 mg intramuscularly every 12 hours. The vial is labeled "Streptomycin 1 gram/2.5 mL." How many milliliters should the nurse administer? (Enter numerical value only. If rounding is required, round to the nearest tenth.)
Explanation
Correct Answer: 0.5 mL
Using the dose calculation formula: Desired dose ÷ Available dose × Volume = Amount to administer. The desired dose is 200 mg. The available dose is 1 gram (1000 mg) per 2.5 mL. Therefore: 200 mg ÷ 1000 mg × 2.5 mL = 0.2 × 2.5 = 0.5 mL. The nurse should administer 0.5 mL intramuscularly.
A 36-year-old female presents to the clinic reporting difficulty sleeping that began 2 years ago following her father's death. She has no medical problems, takes an oral contraceptive and a multivitamin daily, does not smoke, and drinks 1 to 2 glasses of wine every evening. Which recommendations could the nurse give to help the client achieve better sleep? Select all that apply.
- Avoid alcohol in the evening
- Take an analgesic before bed
- Watch television in bed to fall asleep
- Try to go to bed and awaken at the same time every day
- Avoid naps
- Eat a heavy meal before bed
- Exercise in the evening
Explanation
Correct Answers: A) Avoid alcohol in the evening, D) Try to go to bed and awaken at the same time every day, and E) Avoid naps
This client's insomnia likely has both a psychological trigger (grief following her father's death) and a behavioral contributor (nightly alcohol use). Although alcohol may initially induce drowsiness, it disrupts sleep architecture and reduces sleep quality — making avoiding alcohol in the evening a key recommendation.
Maintaining a consistent sleep and wake schedule reinforces the body's circadian rhythm and is one of the most evidence-based interventions for insomnia. Avoiding daytime naps helps build sleep pressure at night, making it easier to fall and stay asleep. Taking an analgesic is not indicated as the client has no pain complaints.
Watching television in bed is counterproductive as it associates the bed with wakefulness rather than sleep — a violation of good sleep hygiene. Eating a heavy meal before bed can cause discomfort and disrupt sleep. Exercising in the evening can be stimulating and may delay sleep onset for some individuals, making earlier in the day the preferred time for exercise.
The nurse educator is conducting a class for unlicensed assistive personnel (UAP). Which action indicates that a UAP understands gloving procedures?
- Uses sterile gloves when handling body fluids
- Keeps a pair of gloves in uniform pocket
- Dons sterile gloves when caring for clients with HIV
- Puts on new gloves when entering a client's room
Explanation
Correct Answer: A) Uses sterile gloves when handling body fluids
Standard infection control practice requires the use of gloves when handling body fluids to protect both the healthcare worker and the client from transmission of infectious organisms. Using gloves when handling body fluids demonstrates correct understanding of gloving procedures and standard precautions.
Keeping gloves in a uniform pocket is incorrect — gloves stored in pockets become contaminated and are not appropriate for use. Sterile gloves are not required for routine care of clients with HIV — clean gloves are sufficient for standard precautions, as HIV is not transmitted through casual contact.
Putting on new gloves simply when entering a client's room without a specific indication is not a recommended practice and wastes resources.
The nurse educators on a cardiovascular unit of a healthcare facility are creating a social media project that addresses improving outcomes for clients with heart failure. Which action should the nurses implement to protect client privacy?
- Respect all copyright laws when adding website content
- May use information from the client's relatives instead
- Implement full disclosure policy especially when giving examples
- Remove client identifying information of those who participate
Explanation
Correct Answer: D) Remove client identifying information of those who participate
When creating any public-facing project such as a social media initiative, protecting client privacy requires the removal of all identifying information — including name, date of birth, medical record number, diagnosis details, photographs, or any combination of details that could identify a specific individual.
This is consistent with HIPAA regulations, which strictly prohibit the disclosure of protected health information (PHI) without explicit written consent. Using information from relatives does not eliminate privacy concerns. A full disclosure policy would actually increase the risk of privacy violations. Copyright compliance is important for content creation but does not address client privacy specifically.
A 75-year-old male presents to the emergency department with poorly controlled diabetes. He has been experiencing polyuria, nausea and vomiting, confusion, and unstable blood sugars. He was stabilized in the ED and transferred to the medical unit. He has a history of moderate obesity, insulin dependent diabetes, smoking one pack per day for 40 years, and mobility issues requiring a walker. The nurse reviews the client's data. Which potential condition, actions to take, and parameters to monitor are most appropriate for this client? Select all that apply.
Actions to Take:
Potential Condition:
Parameters to Monitor:
- Administer an enema
- Contact adult protective services
- Offload coccyx and other bony prominences
- Cleanse and dress wound
- Immediately begin a bowel training program
- Bowel obstruction
- Altered nutrition
- Pressure injury
- Elder abuse
- Documentation of skin prevention measures
- Wound status
- Incontinence episodes
- Family dynamics
- Vital signs
Explanation
This client is at high risk for a pressure injury due to multiple compounding risk factors including advanced age (75 years), obesity, immobility requiring a walker, poorly controlled diabetes which impairs circulation and wound healing, and a long history of smoking which reduces tissue oxygenation.
The priority potential condition is a pressure injury. The appropriate nursing actions are to offload the coccyx and other bony prominences to relieve pressure and prevent further tissue damage, and to cleanse and dress any existing wound to promote healing and prevent infection.
The most relevant parameters to monitor are documentation of skin prevention measures to ensure consistent preventive care is being implemented, and wound status to track healing progress or detect deterioration.
Elder abuse and bowel obstruction are not supported by the clinical data provided. Vital signs, while always important, are not the most specific parameters for monitoring pressure injury progress in this scenario.
The palliative care nurse receives a consult for a terminally ill client in the intensive care unit. The client is weak, mouth breathing, and refusing anything to eat or drink. Which intervention should the nurse include in the plan of care?
- Record the client's daily weight
- Maintain in high Fowler's position
- Report any change in urine color
- Keep mucous membranes moist
Explanation
Correct Answer: D) Keep mucous membranes moist
In palliative and end-of-life care, the priority is comfort and symptom management rather than curative treatment. A terminally ill client who is mouth breathing and refusing food and fluids is at high risk for dry, cracked mucous membranes, which cause significant discomfort.
Keeping mucous membranes moist through frequent oral care is a direct comfort measure that alleviates suffering. Recording daily weight is focused on monitoring fluid status and nutritional changes, which is not a priority in end-of-life comfort care.
High Fowler's position is not specifically indicated and may not be the most comfortable position for a weak, terminally ill client. Reporting changes in urine color is a monitoring intervention inconsistent with the palliative focus on comfort rather than clinical intervention.
A 75-year-old male presents to the emergency department with poorly controlled diabetes. He has been experiencing polyuria, nausea and vomiting, confusion, and unstable blood sugars. He was stabilized in the ED and transferred to the medical unit. He has a history of moderate obesity, insulin dependent diabetes, smoking one pack per day for 40 years, and mobility issues requiring a walker. The nurse reviews the client's data. Which potential condition, actions to take, and parameters to monitor are most appropriate for this client? Select all that apply.
- Administer an enema
- Contact adult protective services
- Offload coccyx and other bony prominences
- Cleanse and dress wound
- Immediately begin a bowel training program
- Bowel obstruction
- Altered nutrition
- Pressure injury
- Elder abuse
- Documentation of skin prevention measures
- Wound status
- Incontinence episodes
- Family dynamics
- Vital signs
Explanation
Correct Answers: Actions to Take: C) Offload coccyx and other bony prominences and D) Cleanse and dress wound | Potential Condition: C) Pressure injury | Parameters to Monitor: A) Documentation of skin prevention measures and B) Wound status
This client is at high risk for a pressure injury due to multiple compounding risk factors including advanced age (75 years), obesity, immobility requiring a walker, poorly controlled diabetes which impairs circulation and wound healing, and a long history of smoking which reduces tissue oxygenation.
The priority potential condition is a pressure injury. The appropriate nursing actions are to offload the coccyx and other bony prominences to relieve pressure and prevent further tissue damage, and to cleanse and dress any existing wound to promote healing and prevent infection.
The most relevant parameters to monitor are documentation of skin prevention measures to ensure consistent preventive care is being implemented, and wound status to track healing progress or detect deterioration.
Elder abuse and bowel obstruction are not supported by the clinical data provided. Vital signs, while always important, are not the most specific parameters for monitoring pressure injury progress in this scenario.
A client with atrial fibrillation receives a prescription for a loading dose of digoxin 0.5 mg PO. The medication is available in 125 mcg tablets. How many tablets should the nurse administer? (Enter numerical value only.)
Explanation
Correct Answer: 4 tablets
First, convert units to ensure consistency: 0.5 mg = 500 mcg. Then apply the dose calculation formula: Desired dose ÷ Available dose = Number of tablets. 500 mcg ÷ 125 mcg per tablet = 4 tablets. The nurse should administer 4 tablets to deliver the prescribed 0.5 mg loading dose of digoxin.
The nurse is obtaining a systolic blood pressure by palpation. While inflating the cuff, the radial pulse is no longer palpable at 90 mm Hg. Which action should the nurse take?
- Release the manometer valve immediately
- Inflate blood pressure cuff to 120 mm Hg
- Document the absence of the radial pulse
- Record a palpable systolic pressure of 90 mm Hg
Explanation
Correct Answer: B) Inflate blood pressure cuff to 120 mm Hg
When obtaining a systolic blood pressure by palpation, the nurse inflates the cuff until the radial pulse is no longer palpable — this point estimates the systolic pressure. However, the cuff should be inflated an additional 30 mm Hg beyond the point where the pulse disappears to ensure an accurate reading and avoid underestimating the systolic pressure.
Since the pulse disappeared at 90 mm Hg, the cuff should be inflated to 120 mm Hg (90 + 30). Releasing the valve immediately would give an inaccurate reading. Documenting the absence of the radial pulse is incorrect — this is an expected and normal part of the palpation technique. Recording 90 mm Hg as the systolic pressure at this point would be premature and inaccurate.
A client on a mechanical soft diet is experiencing constipation and asks the nurse for a glass of prune juice. After auscultating decreased bowel sounds, which action should the nurse implement?
- Advance to a regular diet
- Offer to warm the prune juice
- Initiate bowel training protocol
- Restrict oral fluid intake
Explanation
Correct Answer: B) Offer to warm the prune juice
Prune juice is a natural laxative that contains sorbitol and fiber, making it an appropriate and non-invasive first intervention for constipation. Warming the prune juice can further stimulate peristalsis and bowel motility, which is especially helpful given the finding of decreased bowel sounds. This is a safe, appropriate nursing action that addresses the client's request and supports bowel function without overstepping dietary orders.
Advancing to a regular diet requires a physician's order and is not within the nurse's independent scope. Initiating a bowel training protocol is a more involved intervention not warranted as the first step. Restricting oral fluid intake would worsen constipation, as adequate hydration is essential for normal bowel function.
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