HESI RN Adult Health (D444)
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Free HESI RN Adult Health (D444) Questions
An older male client comes to the outpatient clinic complaining of pain in his left calf. The nurse notices a reddened area on the calf of his right leg that is warm to the touch, and the nurse suspects that the client may have thrombophlebitis. Which additional assessment is most important for the nurse to perform
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Measure the client's calf circumference.
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Auscultate the client's breath sounds.
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Observe for ecchymosis and petechiae.
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Obtain the client's blood pressure.
Explanation
Correct Answer B. Auscultate the client’s breath sounds
Explanation:
The presence of localized redness, warmth, and pain in the calf raises concern for deep vein thrombosis (DVT). A critical complication of DVT is pulmonary embolism (PE), which can be life-threatening. The earliest signs of PE often involve changes in respiratory status, such as sudden shortness of breath, tachypnea, or abnormal breath sounds. Therefore, assessing breath sounds promptly can help detect early signs of PE and guide urgent intervention.
Why Other Options Are Incorrect:
A. Measure the client’s calf circumference
This can help confirm localized swelling from DVT, but it is not as urgent as assessing for signs of a potentially life-threatening PE.
C. Observe for ecchymosis and petechiae
These findings are more often associated with bleeding disorders or platelet abnormalities, not typically with DVT.
D. Obtain the client’s blood pressure
Blood pressure measurement is routine but will not specifically help identify immediate life-threatening complications from DVT like PE.
This is an 11-month-old male with a 2-day history of fussiness, increased nasal secretions, and cough. The baby is 24.3 lb. (11 kg). He was born at 34 weeks gestation and spent several weeks in the neonatal intensive care unit for poor feeding.
He is currently up to date on vaccinations and is meeting appropriate developmental milestones. The parents deny that he takes any medications at home.
Review H and P and flow sheet.
Select which assessment findings indicate that the baby has an increased fluid requirement. Select all that apply.
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Temperature 103 °F (39.4 °C)
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Blood pressure 89/51 mmHg
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Respiratory rate 55 breaths/min
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Copious, clear secretions from both nostrils
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Oxygen saturation 95%
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Wet diaper with 12 mL of urine
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Heart rate 159 bpm
Explanation
Correct Answers:
A. Temperature 103 °F (39.4 °C), C. Respiratory rate 55 breaths/min, D. Copious, clear secretions from both nostrils, H. Heart rate 159 bpm
Explanation of Correct Answers
A. Temperature 103 °F (39.4 °C)
Fever significantly increases insensible water loss through the skin and respiratory tract. Infants with elevated temperatures require additional fluid intake to prevent dehydration. The higher the fever, the greater the metabolic and fluid demands.
C. Respiratory rate 55 breaths/min
Tachypnea accelerates insensible fluid loss through the lungs. An increased respiratory rate in an infant not only reflects illness severity but also raises fluid requirements because of greater water vapor exhalation.
D. Copious, clear secretions from both nostrils
Excessive nasal secretions contribute to fluid loss, especially in small infants who have limited reserves. Even though secretions are not as dramatic as fever or tachypnea, persistent drainage adds to fluid requirements.
H. Heart rate 159 bpm
Tachycardia indicates stress and increased metabolic demand. It can also reflect early fluid deficit. A higher heart rate increases overall energy and fluid needs, making adequate hydration critical in preventing worsening instability.
Why Other Options Are Wrong
B. Blood pressure 89/51 mmHg
This is within the normal range for an 11-month-old infant. It does not signal fluid deficit or increased fluid needs by itself.
F. Oxygen saturation 95%
An oxygen level of 95% is adequate for an infant with a mild respiratory illness. It does not independently point to increased fluid requirements.
G. Wet diaper with 12 mL of urine
For an 11-kg child, expected urine output is about 11 mL/hr or more. A wet diaper shows output, even though the volume is low, but in this scenario, tachycardia, fever, and tachypnea are stronger indicators of increased fluid needs than urine volume.
An older client is being admitted to a short-term rehabilitation facility after a long hospitalization. The nurse is performing a functional assessment with the client. Which action should the nurse implement?
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Encourage the client to lie as still as possible during the assessment
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Question the client about the frequency of falls in recent months
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Assist the client with values clarification about end-of-life care options.
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Ask the client how often episodes of sundowning are experienced.
Explanation
Correct Answer:
B. Question the client about the frequency of falls in recent months
Explanation
A functional assessment evaluates an older adult’s ability to perform activities of daily living (ADLs) and instrumental ADLs safely and independently. One of the most important risk factors for loss of independence and injury in older adults is falls. Asking about recent falls helps determine mobility status, balance, and safety needs, which directly impacts rehabilitation planning and discharge goals.
Why Other Options Are Wrong
A. Encourage the client to lie as still as possible during the assessment
This prevents accurate assessment of mobility and function, which are central to a rehabilitation-focused functional assessment
C. Assist the client with values clarification about end-of-life care options
This relates to advance care planning, which is important but not the priority in a short-term rehab admission focused on recovery and regaining function.
D. Ask the client how often episodes of sundowning are experienced
Sundowning is related to dementia, but unless the client has a history of cognitive impairment, it is not the primary focus of a functional assessment for rehabilitation.
A client in the emergency department is bleeding profusely from a gunshot wound to the abdomen. What action should the nurse immediately take to promote maintenance of the client's blood pressure above a systolic pressure of 90 mm Hg
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Place the client in a 45-degree Trendelenburg position to promote cerebral blood flow.
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Turn the client prone to place pressure on the abdominal wound to help staunch the bleeding.
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Maintain the client in a supine position to reduce diaphragmatic pressure and visualize the wound.
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Put the client on the right side to apply pressure to the liver and spleen to stop hemorrhaging.
Explanation
Correct Answer C. Maintain the client in a supine position to reduce diaphragmatic pressure and visualize the wound
Explanation:
In a trauma patient with active abdominal bleeding, keeping the client supine helps maintain venous return and systemic perfusion, supports adequate blood pressure, and allows quick assessment and intervention for hemorrhage control. This position also prevents additional compromise to breathing and circulation.
Why Other Options Are Incorrect:
A. Place the client in a 45-degree Trendelenburg position to promote cerebral blood flow
This position is no longer recommended for shock management; it can impair breathing and does not effectively improve cerebral perfusion.
B. Turn the client prone to place pressure on the abdominal wound to help staunch the bleeding
The prone position hinders breathing, CPR access, and assessment; it is unsafe in trauma care.
D. Put the client on the right side to apply pressure to the liver and spleen to stop hemorrhaging
Side positioning will not control internal bleeding and may further compromise circulation and organ function.
A client with psoriasis returns to the clinic reporting the persistence of several silvery, scaly areas on the elbows and palms that frequently burn and sometimes bleed. Which prescription should the nurse teach the client to use for the skin condition
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Topical analgesics
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Colloidal oatmeal-based lotion
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Topical antifungal
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Topical corticosteroids
Explanation
Correct Answer D. Topical corticosteroids
Explanation:
Topical corticosteroids are the primary treatment for localized psoriasis because they suppress inflammation, slow the rapid turnover of epidermal cells, and reduce redness, itching, and scaling. These medications help shrink and clear psoriatic plaques while relieving discomfort and preventing bleeding from fissures. For persistent plaques on elbows and palms, moderate- to high-potency corticosteroids are often prescribed, and when used correctly, they significantly improve the skin's appearance and symptoms.
Why the other options are incorrect:
A. Topical analgesics
Topical analgesics may temporarily relieve pain or burning, but they do not address the inflammation or abnormal keratinocyte proliferation that causes psoriasis plaques. They are not considered a primary or disease-modifying treatment for this condition.
B. Colloidal oatmeal-based lotion
Colloidal oatmeal preparations can help soothe dry or itchy skin, but they have no therapeutic effect on the inflammatory process of psoriasis. They may be used as an adjunct to keep skin moisturized but will not reduce scaling or plaque size.
C. Topical antifungal
Antifungal medications are designed to treat infections caused by fungi, such as tinea (ringworm) or candidiasis. Psoriasis is an autoimmune-related skin condition, not a fungal infection, so antifungal creams have no benefit for its management.
When developing a discharge teaching plan for a client after the insertion of a permanent pacemaker, the nurse writes a goal of "The client will verbalize symptoms of pacemaker failure." Which behavior indicates that the goal has been met
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The client demonstrates the procedures to change the rate of the pacemaker using a magnet.
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The client carries a card in his wallet stating the type and serial number of the pacemaker.
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The client tells the nurse that it is important to report redness and tenderness at the insertion site.
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The client states that changes in the pulse and feelings of dizziness are significant changes.
Explanation
Correct Answer D. The client states that changes in the pulse and feelings of dizziness are significant changes.
Explanation:
Symptoms of pacemaker failure often include bradycardia, irregular pulse, dizziness, syncope, and fatigue due to inadequate cardiac output. By verbalizing that changes in pulse and dizziness are significant, the client demonstrates an understanding of early warning signs that the pacemaker is not functioning properly. This directly meets the discharge goal related to recognizing pacemaker malfunction.
Why Other Options Are Incorrect:
A. The client demonstrates the procedures to change the rate of the pacemaker using a magnet
Clients should not alter pacemaker function themselves unless specifically instructed by a cardiologist in rare emergency situations. This does not reflect knowledge of symptoms of malfunction.
B. The client carries a card in his wallet stating the type and serial number of the pacemaker
Carrying identification is important for medical safety but is unrelated to recognizing symptoms of pacemaker failure.
C. The client tells the nurse that it is important to report redness and tenderness at the insertion site
This demonstrates understanding of infection signs, not pacemaker malfunction. While important, it does not meet the goal of identifying symptoms of device failure.
A healthcare provider prescribes transdermal fentanyl 25 mcg/h every 72 hours. During the first 24 hours after starting the fentanyl, the nurse recognizes the need to take which action
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Titrate the dose until pain is tolerable.
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Manage pain with an analgesic by a different route.
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Assess the client for anticholinergic side effects.
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Instruct the client to take the medication with food.
Explanation
Correct Answer B. Manage pain with an analgesic by a different route.
Explanation:
Transdermal fentanyl patches have a delayed onset of action, typically requiring several hours to achieve therapeutic plasma levels, with full analgesic effects not reached until about 12–24 hours after application. Therefore, during the first day, breakthrough pain should be managed with an alternative analgesic by a different route (oral, IV, or subcutaneous) until the patch reaches its full effectiveness.
Why the Other Options Are Incorrect:
A. Titrate the dose until pain is tolerable.
Fentanyl patch dosing is not titrated every few hours. Dose adjustments are made cautiously and usually only after 72 hours, based on the patient’s response and safety considerations.
C. Assess the client for anticholinergic side effects.
Fentanyl primarily causes opioid-related effects such as respiratory depression, constipation, and sedation—not significant anticholinergic effects.
D. Instruct the client to take the medication with food.
This teaching is not relevant for a transdermal medication, as it bypasses the gastrointestinal tract. Food intake does not affect fentanyl absorption through the skin.
An older woman who has difficulty hearing is being discharged from day surgery following a cataract extraction and lens implantation. Which intervention is most important for the nurse to implement to help ensure the client's compliance with self-care?
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Have the client vocalize the instructions provided
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Provide written instructions for eye drop administration
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Speak clearly and face the client for lip reading
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Ensure that someone will stay with the client for 24 hours
Explanation
Correct Answer:
A. Have the client vocalize the instructions provided
Explanation
Having the client repeat or vocalize the instructions back to the nurse ensures understanding and retention of critical information. This "teach-back" method confirms comprehension, especially important for an older adult with hearing difficulties. It allows the nurse to identify any gaps in understanding and correct them before discharge, which supports safe and effective self-care at home.
Why Other Options Are Wrong
B. Provide written instructions for eye drop administration
Written instructions are useful but do not confirm comprehension. A client may misinterpret or overlook details, so this is not as reliable as immediate verbal confirmation.
C. Speak clearly and face the client for lip reading
While this aids communication during teaching, it does not guarantee that the client retained the instructions or will comply correctly after discharge.
D. Ensure that someone will stay with the client for 24 hours
Having support is important for safety after anesthesia, but it does not ensure that the client understands or can follow through with essential self-care tasks such as medication administration.
An older client is taken to the clinic by the spouse, who appears extremely worried. The spouse reports to the nurse that the client started to not make any sense and asked to visit a brother who has been dead for many years. Which action(s) should the nurse take? (Select all that apply.)
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Obtain the client's tympanic temperature measurement
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Review the client's current food and medication allergies.
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Ask if the client is experiencing any pain with urination
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Encourage increasing the intake of high protein foods
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Determine if the client has recently experienced a fall.
Explanation
Correct Answers:
A. Obtain the client's tympanic temperature measurement, C. Ask if the client is experiencing any pain with urination, E. Determine if the client has recently experienced a fall
Explanation of Correct Answers
A. Obtain the client's tympanic temperature measurement
Fever may indicate infection, which is a common cause of acute confusion or delirium in older adults.
C. Ask if the client is experiencing any pain with urination
Urinary tract infections are a frequent, reversible cause of acute confusion in older clients and should always be assessed.
E. Determine if the client has recently experienced a fall
Falls could cause head trauma, leading to confusion or hallucinations. Evaluating for recent falls is essential in this context.
Why the Other Options Are Wrong
B. Review the client's current food and medication allergies
Important for safe care, but allergies are not typically a cause of acute confusion unless a reaction is suspected. It does not address the immediate concern.
D. Encourage increasing the intake of high protein foods
Nutritional advice is not a priority when the client is experiencing acute changes in mental status. The nurse must first investigate urgent, reversible causes.
A patient uses triamcinolone (Kenalog), a corticosteroid ointment, to manage pruritus caused by a chronic skin rash. The patient calls the nurse to report erythema with purulent exudate at the site. What action should the nurse implement
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Advise the patient to apply plastic wrap over the ointment to promote healing
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Instruct the patient to continue the ointment until all erythema is relieved
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Explain that the patient needs to complete all prescribed doses of the medication
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Schedule an appointment for the patient to see the doctor
Explanation
Correct Answer D. Schedule an appointment for the patient to see the doctor
Explanation:
Purulent exudate and erythema at the site suggest a secondary bacterial infection, which requires medical evaluation. Continuing corticosteroid use without addressing the infection can worsen the condition, as steroids suppress local immune response. The safest action is to promptly schedule an appointment so the provider can assess the site and initiate appropriate antibiotic therapy if needed. Early treatment prevents the spread of infection and complications.
Why Other Options Are Incorrect:
A. Advise the patient to apply plastic wrap over the ointment to promote healing
Occlusive dressings such as plastic wrap can trap moisture and heat, creating an ideal environment for bacterial growth, which can worsen the infection.
B. Instruct the patient to continue the ointment until all erythema is relieved
Corticosteroids reduce inflammation but do not treat bacterial infections. Continuing without addressing the infection delays proper care and increases the risk of worsening symptoms.
C. Explain that the patient needs to complete all prescribed doses of the medication
Topical corticosteroids are not given as “courses” in the same way as antibiotics, and completion of therapy is not appropriate when an infection has developed. The medication should be reassessed before further use.
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