hesi foundation of nursing
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When administering a new medication to a client, the nurse logs in the electronic medication administration record (eMAR). Which action should the nurse take next?
- Remove the medication from the unit dose packaging while verifying the dose
- Reconcile the medication to be administered with the initial client prescription
- Scan the medication barcode to document administration on the eMAR
- Verify client's identification by scanning the barcode on the armband
Explanation
Correct Answer: D) Verify client's identification by scanning the barcode on the armband
After logging into the eMAR, the next critical step before administering any medication is to verify the client's identity using at least two identifiers — in this case, by scanning the barcode on the client's armband.
This is a fundamental patient safety practice that ensures the right medication is being given to the right patient, preventing potentially life-threatening medication errors. Scanning the medication barcode comes after patient identification is confirmed. Removing medication from packaging before verifying the client's identity is premature.
Reconciling with the initial prescription is an earlier step in the medication verification process that occurs before reaching the bedside.
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.
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 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.
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 diagnosed with primary open angle glaucoma received a prescription for miotic eye drops. Which instruction should the nurse plan to include in this client's teaching?
- "Administer the medication directly on the cornea."
- "Squeeze your eye closed after administering the drops."
- "Wash your hands after each administration of eye drops."
- "Do not allow the dropper bottle to touch the eye."
Explanation
Correct Answer: D) "Do not allow the dropper bottle to touch the eye."
A critical instruction for any eye drop administration is that the dropper tip must never touch the eye, eyelid, or any surface. Contact with the eye contaminates the dropper tip, which can introduce bacteria into the bottle and lead to serious ocular infections. This is the most important safety teaching point for eye drop administration.
Option A is incorrect — eye drops should be instilled into the conjunctival sac (lower eyelid), not directly onto the cornea, as this can cause irritation and discomfort. Option B is incorrect — the client should gently close the eye and apply light pressure to the inner corner (nasolacrimal duct) to prevent systemic absorption, not squeeze the eye tightly.
Option C is correct practice but washing hands before administration is more critical than after, and this is not the priority teaching point specific to miotic drops.
A client is being admitted to the unit with a varicella zoster virus infection. Which room should the charge nurse assign to the client?
- A private room with both standard and droplet precautions
- A private room with both contact and airborne precautions
- A semi-private room with a roommate who has the same diagnosis and contact precautions
- A semi-private room with a roommate who has the same diagnosis and airborne precautions
Explanation
Correct Answer: B) A private room with both contact and airborne precautions
Varicella zoster (chickenpox) requires both contact and airborne precautions because it is transmitted through direct contact with the lesions as well as through airborne droplet nuclei that can remain suspended in the air for extended periods.
The client must be placed in a private room with negative pressure airflow to prevent airborne transmission to other patients and staff. Standard and droplet precautions alone are insufficient for varicella.
A semi-private room is inappropriate regardless of the roommate's diagnosis, as airborne pathogens can spread beyond shared spaces and immunocompromised individuals nearby remain at risk.
Which action should the nurse implement when inserting an indwelling catheter for an uncircumcised male client?
- Advance the catheter before inflating balloon
- Position the sterile field even with the nurse's hips
- Clean the urinary meatus before retracting the foreskin
- Use a swab to wipe the meatus in back-and-forth motions
Explanation
Correct Answer: A) Advance the catheter until urine flows and then advance 1-2 inches more before inflating the balloon
When inserting an indwelling urinary catheter, the balloon must never be inflated until urine return is confirmed and the catheter has been advanced an additional 1–2 inches to ensure the balloon is fully inside the bladder and not in the urethra. Inflating the balloon in the urethra causes severe pain and urethral injury.
For an uncircumcised male, the foreskin must be retracted before cleaning — not after — to properly expose and clean the urinary meatus. Cleaning should be performed in a circular motion from the meatus outward, not back-and-forth which would introduce bacteria. The sterile field should be positioned at thigh level, not at the nurse's hips, to maintain sterility and proper technique.
When initiating oxygen per mask to a client who is short of breath, the nurse hears a loud hissing sound after inserting the flowmeter into the wall outlet. Which should the nurse do next?
- Attach the flowmeter to a humidification canister
- Assess the position of the mask on the client's face
- Adjust the flow rate to the prescribed liters per minute
- Release and reinsert the flowmeter in the wall outlet
Explanation
Correct Answer: D) Release and reinsert the flowmeter in the wall outlet
A loud hissing sound after inserting the flowmeter into the wall outlet indicates that the flowmeter is not properly seated or sealed in the outlet, causing oxygen to leak. The correct action is to release and reinsert the flowmeter to ensure a proper airtight connection before proceeding.
If the flowmeter is not correctly connected, the client will not receive the intended oxygen flow rate, compromising their respiratory status. Attaching a humidification canister and adjusting the flow rate are subsequent steps that come after ensuring a proper connection. Assessing the mask position is relevant but does not address the source of the hissing sound at the wall outlet.
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