HESI PN106 Fundamentals 44047 Fall 2025 at Nightingale College
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The client is a 42-year-old female who had a cholecystectomy. Patient Data Nurses' Notes0900 Returned to room from postanesthesia care unit (PACU). Situation-background-assessment-recommendation (SBAR) communication reveals the client has had no urine output during the anesthesia recovery period. Last void was 8 hours ago. Client positioned in bed. Warm blanket applied for comfort. IV fluids infusing. 1045 Client requesting pain medication and informs has the urge to void. Wishes to use bedpan. Voided 75 mL. 1130 Client reporting continues to have the urge to void and feels "wet". Placed on bedpan. Voided 50 mL. Bladder focused assessment. Palpated and feels full. Bladder scanner applied and revealed 600 mL residual urine. The practical nurse (PN) is planning care for the client. Which condition the client is most likely experiencing, two actions the PN should take to address that condition, and two parameters the PN should monitor to assess the client's progress.
- A. Condition: Urinary Retention Actions to Take: ●Insert an indwelling urinary catheter ●Increase the IV fluid rate Parameters to Monitor: ●Residual urine ●Amount of urine output
- B. Condition: Overflow Urinary Incontinence Actions to Take: ●Request a prescription for a straight catheter ●Assist the client to the bathroom for voiding Parameters to Monitor: ●Frequency of voiding ●IV fluid intake
- C. Condition: Functional Urinary Incontinence Actions to Take: ●Insert an indwelling urinary catheter ●Request a prescription for straight catheter Parameters to Monitor: ●Pain medication effects ●Frequency of voiding
- D. Condition: Urinary Tract Obstruction Actions to Take: ●Increase the IV fluid rate ●Request a prescription for a straight catheter Parameters to Monitor: ●Residual urine ●Pain medication effects
Explanation
Urinary retention is the most likely condition based on the client's symptoms: absence of urine output, the urge to void, and a full bladder with a significant amount of residual urine. Inserting an indwelling catheter will help relieve the retention, and increasing the IV fluids will help promote urine production. Monitoring residual urine and urine output will be crucial to assess progress.
A male client who was treated for a draining, infected wound and placed on contact precautions while hospitalized is being discharged to his home where he lives with his wife and adolescent son. Which information should the practical nurse (PN) reinforce with the family?
- A. Use paper plates and disposable utensils for the client's meals and snacks.
- B. Require family members and visitors to wear a mask and gown when visiting the client.
- C. Have the client stay in a room separate from the family with the door closed.
- D. Place soiled dressings in a plastic bag that can be tightly secured for disposal.
Explanation
When a client is discharged after treatment for an infected wound, proper disposal of soiled dressings is essential to prevent the spread of infection. The PN should instruct the family to place soiled dressings in a plastic bag that can be tightly secured for disposal. This practice ensures that infectious material is contained and reduces the risk of transmission to others in the household. Proper disposal methods are part of standard infection control practices after contact precautions.
Patient Data History and Physical The client is 34-year-old male with a history of hypertension. He takes an angiotensin converting enzymes (ACE) inhibitor to manage. Nurses' Notes 1000 The client is here for his annual visit. He says that he has been eating a strict paleo diet for the past 8 months. His body mass index (BMI) was 32 kg/m2 last year, and it is now 29 kg/m2 (normal 18 to 24.9 kg/m2). He informs that he also is exercising at least 30 minutes 5 times per week. His blood pressure has decreased from 154/91 mm Hg at the last visit to 119/66 mm Hg 1030 Instructed on adjusting intake to include calcium rich, vitamin D foods in diel. Client reports he understands the need for these food as deficits can impact bone health. 1630 Client was called at home with abnormal laboratory results and new prescriptions. Says does not want to take supplements at this time but understands instruction given in the office on foods that have high levels of calcium and vitamin D. Healthcare provider (HCP) aware that client declines oral supplementation. Client will have follow-up laboratory blood tests in one month to evaluate adjusted Laboratory Results 1600 Laboratory Test Result Reference Range Calcium 7.7 mg/dL 9 to 10.5 mg/dL (1.9 mmol/L) (2.25 to 2.62 mmol/L) Vitamin D 16.5 pg/ml (39.6 pmol/L) 18 to 64 pg/mL (43.2 to 153.6 pmol/L) White blood cell (WBC) 8,000 uL (8 x 10/L) 5,000 to 10,000/pL (5 to 10 × 10°/L) Flow Sheet . Blood pressure 119/66 mm Hg Orders 1030 . WBC count · Calcium level · Vitamin D level 1600 . Calcium 500 mg twice a day PO, take with meals or one hour after · Vitamin D over the counter chewable, take per label Review of history and physical, flow sheet, prescriptions, laboratory results, and nurse's notes. Select the 2 findings that require immediate follow-up.
|
1600 |
||
|
Laboratory Test |
Result |
Reference Range |
|
Calcium |
7.7 mg/dL |
9 to 10.5 mg/dL |
|
(1.9 mmol/L) |
(2.25 to 2.62 |
|
|
mmol/L) |
||
|
Vitamin D |
16.5 pg/ml (39.6 pmol/L) |
18 to 64 pg/mL (43.2 to 153.6 |
|
pmol/L) |
||
|
White blood cell (WBC) |
8,000 uL (8 x 10/L) |
5,000 to 10,000/pL (5 to 10 × 10°/L) |
- A Calcium level
- B Exercise regime
- C White blood cell (WBC) results
- D Blood pressure
- E Body mass index (BMI)
- F Vitamin D level
Explanation
Correct Answer Is:
A. Calcium level F. Vitamin D level
A. Calcium level The client's calcium level is 7.7 mg/dL, which is below the normal reference range (9 to 10.5 mg/dL). This is concerning because calcium plays a crucial role in bone health and muscle function. A low calcium level could lead to complications such as bone fragility or muscle spasms. Immediate follow-up is needed to address this deficiency.
F. Vitamin D level The client's vitamin D level is 16.5 pg/mL, which is also below the normal reference range (18 to 64 pg/mL). Vitamin D is essential for calcium absorption and bone health, and a deficiency can lead to bone demineralization and muscle weakness. The client's low vitamin D level should be followed up promptly to prevent further health complications.
The practical nurse (PN) is caring for a client with obstructive sleep apnea (OSA). The PN should recognize the client is at greater risk for the development of which complication?
- A. Peptic ulcer disease.
- B. Hypertension.
- C. Fibromyalgia.
- D. Hypothyroidism.
Explanation
Obstructive sleep apnea (OSA) increases the risk of developing hypertension due to the repeated episodes of airway obstruction, which lead to intermittent hypoxia and increased sympathetic nervous system activity. This causes a rise in blood pressure, particularly during sleep, and over time can contribute to the development of chronic hypertension. The risk is compounded by factors such as obesity and a lack of proper sleep, which are common in individuals with OSA.
The practical nurse (PN) is working in a surgical preoperative area and reviewing a signed consent form. The form reads "Amputation of the right lower leg," but the client's left leg is labeled for amputation. The client has already received the preoperative medication from the anesthesiologist. Which should be the PN's next action?
- A. Contact the healthcare provider to reschedule the surgery.
- B. Obtain verbal consent from the client's nearest relative or significant other.
- C. Transport the client to the surgery suite since medications were administered.
- D. Cross out the error and initial the form to ensure the correct surgery.
Explanation
The PN should immediately contact the healthcare provider to address the error on the consent form and ensure that the correct surgery is performed. Since the form incorrectly states "amputation of the right lower leg" while the left leg is labeled for amputation, this is a critical issue that must be resolved before proceeding. The healthcare provider should be informed, and the surgery should be rescheduled if necessary to ensure proper documentation and patient safety.
The spouse of a client who has just been diagnosed with stage 5 metastatic cancer shouted, "This is absurd! I want to talk to the doctor right now!" The practical nurse (PN) should consider which stage of the grieving process in order to respond best to the spouse's comment? Options:
- A. Conversion reaction.
- B. Bargaining.
- C. Anger.
- D. Intellectualization.
Explanation
The spouse’s reaction of shouting, "This is absurd! I want to talk to the doctor right now!" reflects a typical emotional response of anger. Anger is one of the stages in the grieving process, as described by Elisabeth Kübler-Ross in her model of the five stages of grief. In this stage, individuals may feel intense frustration or rage, often directed at the situation, healthcare providers, or loved ones, as they struggle to accept the diagnosis. The spouse’s outburst is a clear demonstration of anger in response to the overwhelming news of a serious illness.
The practical nurse (PN) is measuring the vital signs of an older adult. When attempting to measure the client's radial pulse rate, the PN palpates the pulse but is unable to feel the pulse long enough to count the rate. Which action should the PN take?
- A. Attempt to palpate the ulnar pulse on the same arm.
- B. Reduce pressure at the site to prevent occlusion.
- C. Elevate the hand to increase the pulse strength.
- D. Notify the charge nurse of the absence of the pulse.
Explanation
When palpating the radial pulse, the PN may inadvertently apply too much pressure, which can occlude the pulse, making it difficult to feel long enough to count. By reducing the pressure at the site, the blood flow will be better felt, and the pulse can be more easily assessed. This is the most appropriate action to take when having difficulty palpating the radial pulse.
How should the practical nurse (PN) administer an oral dose of a multivitamin liquid to a 2-month-old infant?
- A. Give medicine slowly in middle of the mouth.
- B. Mix the medicine with the infant's formula.
- C. Give medicine on one side of the mouth.
- D. Mix medicine in applesauce and feed to infant.
Explanation
For an infant, the best method is to administer the medication on one side of the mouth, between the cheek and gums. This approach helps to avoid the risk of aspiration by preventing the liquid from entering the airway. It also reduces the chance of triggering the infant's gag reflex, which could cause discomfort or even choking. Administering the medicine on the side of the mouth allows for better control of the dosage and facilitates swallowing. This method is recommended because it is safe and ensures the infant is more likely to swallow the medication rather than spit it out.
The practical nurse (PN) is assisting an older client to ambulate to a chair. Which statement should the PN enter as computer documentation that describes the best evaluation of the client's response to the nursing intervention?
- A. Up in the room for 5 minutes. Call bell within reach. Respirations 22 breaths/minute.
- B. Assisted with ambulation. In chair for 20 minutes. Heart rate 70 beats/minute.
- C. Up to the chair. Tolerating well. Blood pressure 120/80 mm Hg.
- D. Ambulated to the chair. No concerns voiced. Temperature 98.2°F (36.7°C).
Explanation
The best evaluation of the client's response to the nursing intervention would include the completion of the task (ambulated to the chair), the client's tolerance (no concerns voiced), and any relevant vital signs, in this case, the temperature (which is within the normal range). This statement provides a comprehensive assessment of the client’s physical condition and response to the intervention.
NPO. Ice chips only PRN. Ondansetron (Zofran) 3 mg IM q4 hours PRN vomiting. 0.9 % sodium chloride solution 1,000 ml per infusion pump at 120 ml/hour. Serum electrolytes q AM. After reviewing the medication administration record (MAR) prescriptions above, the practical nurse (PN) retrieves "Ondansetron Injection, USP 4 mg/2 mL" from the unit's automated medication dispensing system, for a client who is vomiting. When preparing to administer the medication, the PN scans the vial's bar code at the bedside and a dosage pop-up appears on the computer screen. Which action should the PN take?
- A Rescan the vial label until the system accepts bar code.
- B Prepare another dosage that matches the vial label 4 mg/2 mL.
- C Enter 3 mg (1.5 mL) as the prepared dose for administration.
- D Call the pharmacy to report a dose discrepancy in the pop-up.
Explanation
The medication prescription specifies a dose of 3 mg of Ondansetron, but the vial contains 4 mg in 2 mL. To administer the correct dose of 3 mg, the PN should prepare 1.5 mL of the solution. The system may have a pop-up dosage discrepancy because it is calculating the full vial concentration, but the PN should manually enter the correct dose (3 mg or 1.5 mL) to ensure the patient receives the proper amount of medication.
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