HESI UCA1 D444 Adult I OA 1.
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A client who was admitted yesterday with bilateral pneumonia has congested breath sounds, an oxygen saturation of 94%, and a temperature of 100°F (37.8°C). The client has a weak cough effort and is using their accessory muscles to breathe. Which intervention should the nurse implement first?
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Offer a prescribed PRN analgesic
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Administer a prescribed antipyretic
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Suction to clear secretions from airway
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Obtain arterial blood gas measurements
Explanation
Correct Answer: (C) Suction to clear secretions from airway
The client is demonstrating signs of airway compromise — congested breath sounds, oxygen saturation of 94%, weak cough effort, and use of accessory muscles to breathe. The inability to clear secretions effectively is the most immediate threat to airway patency and oxygenation. Suctioning to remove accumulated secretions is the priority intervention using the ABC framework, as maintaining a patent airway takes precedence over all other actions.
Why the other options are incorrect:
A. Offer a prescribed PRN analgesic — Pain management is not the priority in this situation. There is no indication that pain is contributing to the client's respiratory distress, and administering an analgesic does not address the immediate airway and oxygenation concerns.
B. Administer a prescribed antipyretic — While the client has a low-grade fever of 100°F, this is not the most urgent concern. The fever does not pose an immediate threat comparable to the compromised airway and declining oxygen saturation.
D. Obtain arterial blood gas measurements — ABG measurement provides important data about oxygenation and acid-base status, but it is an assessment action rather than a direct intervention. Clearing the airway takes priority before obtaining diagnostic data.
An older adult female client is hospitalized with a fractured femur. During a routine nursing assessment, she repeatedly asks the nurse to "speak up" so that she can hear the questions. Which action is best for the nurse to take?
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Over-enunciate word syllables
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Exaggerate nonverbal expressions
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Decrease speaking speed
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Raise voice volume to a shout
Explanation
Correct Answer: (C) Decrease speaking speed
When communicating with older adults who have hearing difficulties, speaking more slowly allows the listener more time to process each word and improves comprehension. Reducing speaking speed, combined with facing the client directly and speaking clearly, is the most effective and respectful communication strategy for a client with age-related hearing loss.
Why Other Options are Incorrect:
A. Over-enunciate word syllables — Exaggerated enunciation can distort sounds and actually make speech harder to understand for someone with hearing loss. Natural, clear pronunciation spoken at a slower pace is more effective.
B. Exaggerate nonverbal expressions — While nonverbal cues support communication, exaggerating facial expressions can appear condescending and does not directly address the client's difficulty hearing spoken words.
D. Raise voice volume to a shout — Shouting distorts speech sounds and can be perceived as aggressive or disrespectful. Many older adults with sensorineural hearing loss have difficulty with sound clarity rather than volume, so shouting does not improve understanding and may cause discomfort.
The healthcare provider (HCP) prescribes interferon beta-1b 0.125 mg every other day for a client with multiple sclerosis. The nurse reconstitutes the single-use vial of powder labeled "Interferon beta-1b 0.3 mg reconstitute with 1.2 mL of sterile water." How many mL should the nurse administer to the client? (Round to the nearest tenth.)
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0.5 mL
Explanation
Correct Answer: 0.5 mL
Using the standard dose calculation formula:
Dose ordered ÷ Dose available × Volume = Volume to administer
Dose available after reconstitution: 0.3 mg per 1.2 mL
First, calculate the concentration: 0.3 mg ÷ 1.2 mL = 0.25 mg/mL
Then calculate the volume for the ordered dose: 0.125 mg ÷ 0.25 mg/mL = 0.5 mL
The nurse should administer 0.5 mL to the client.
A client with chronic cirrhosis has esophageal varices. It is most important for the nurse to monitor the client for the onset of which problem?
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Anorexia
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Clay colored stool
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Brown, foamy urine
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Hematemesis
Explanation
Correct Answer: (D) Hematemesis
Esophageal varices are dilated, fragile veins in the esophagus that develop due to portal hypertension in cirrhosis. These vessels are prone to spontaneous rupture, causing sudden, massive upper gastrointestinal bleeding. Hematemesis — vomiting of blood — is the hallmark sign of variceal rupture and represents a life-threatening emergency requiring immediate intervention. It is the most critical complication to monitor for in this client.
Why Other Options are Incorrect:
A. Anorexia — Loss of appetite is a common chronic symptom of cirrhosis and liver disease in general, but it does not represent an acute life-threatening complication of esophageal varices specifically.
B. Clay colored stool — Pale or clay-colored stool indicates absence of bile in the stool, associated with biliary obstruction or liver disease. While relevant to cirrhosis overall, it is not the most urgent monitoring priority related to esophageal varices.
C. Brown, foamy urine — Dark or foamy urine can indicate bilirubin in the urine, a sign of liver dysfunction. It is a chronic finding in cirrhosis but not the acute life-threatening complication most associated with esophageal varices.
A client who has a prescription for benzonatate reports chewing and swallowing the capsules. Which intervention should the nurse take?
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Obtain a baseline electrocardiogram
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Apply continuous pulse oximetry
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Give naloxone intramuscular
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Notify the healthcare provider
Explanation
Correct Answer: (D) Notify the healthcare provider
Benzonatate capsules must be swallowed whole and must never be chewed, broken, or dissolved in the mouth. Chewing the capsules releases the medication directly into the oral mucosa, causing rapid local anesthesia of the mouth, pharynx, and airway. This can result in choking, severe hypersensitivity reactions, cardiovascular toxicity including dysrhythmias, central nervous system effects such as seizures, and potentially fatal respiratory arrest. The healthcare provider must be notified immediately so that the client can be assessed and monitored for toxicity.
Why the other options are incorrect:
A. Obtain a baseline electrocardiogram — While cardiac monitoring may be part of the management if toxicity is suspected, it is not the first action. Notifying the provider takes priority so that a comprehensive assessment and management plan can be initiated immediately.
B. Apply continuous pulse oximetry — Pulse oximetry monitoring may be warranted as part of monitoring for respiratory compromise, but it is a supportive action that follows provider notification rather than replacing it as the first intervention.
C. Give naloxone intramuscular — Naloxone reverses opioid toxicity and has no role in benzonatate toxicity. Benzonatate is not an opioid, and naloxone would not address the local anesthetic toxicity caused by chewing the capsules.
To assess the quality of an adult client's pain, which approach should the nurse use?
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Identify effective pain relief measures.
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Observe body language and movement.
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Ask the client to describe the pain.
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Provide a numeric pain scale.
Explanation
Correct Answer: (C) Ask the client to describe the pain.
Pain quality refers to the character or nature of the pain, such as burning, stabbing, aching, throbbing, or crushing. The most accurate and direct way to assess quality is to ask the client to describe it in their own words, as quality is a subjective experience that cannot be fully captured through observation or numeric ratings alone.
Why the other options are incorrect:
A. Identify effective pain relief measures — This assesses the response to treatment, not the quality of the pain itself. It is relevant to evaluating pain management but does not describe the character of the pain.
B. Observe body language and movement — Behavioral observation can provide supplementary information about pain intensity, particularly in non-verbal clients, but it does not reveal the quality or character of the pain experience.
D. Provide a numeric pain scale — A numeric scale measures pain intensity on a scale from zero to ten. It quantifies how severe the pain is, but it does not capture the qualitative nature or character of the pain being experienced.
A client with cholelithiasis has a gallstone lodged in the common bile duct and is unable to eat or drink without episodes of nausea and vomiting manifesting. Which finding should the nurse report to the healthcare provider (HCP)?
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Flatulence
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Belching
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Amber urine
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Yellow sclera
Explanation
Correct Answer: (D) Yellow sclera
Yellow sclera indicates jaundice, which occurs when bilirubin accumulates in the body because the common bile duct obstruction prevents bile from flowing into the small intestine. Bilirubin backs up into the bloodstream and deposits in body tissues including the sclera of the eyes. Jaundice is a significant clinical sign indicating worsening biliary obstruction that requires prompt medical attention and must be reported to the healthcare provider immediately.
Why the other options are incorrect:
A. Flatulence — Increased gas production is a common and expected symptom of cholelithiasis and gastrointestinal upset. While uncomfortable, it does not indicate a serious complication requiring urgent reporting to the HCP.
B. Belching — Belching is a common gastrointestinal symptom associated with dietary fat intolerance in clients with gallbladder disease. It is expected and does not represent a new or urgent complication requiring immediate provider notification.
C. Amber urine — While dark or amber urine can occur with dehydration from nausea and vomiting, it is a less specific and less alarming finding compared to jaundice. Yellow sclera is a more definitive and clinically significant sign of bilirubin accumulation from biliary obstruction that requires priority reporting.
The client with Clostridium difficile in the stool receives a prescription for vancomycin PO. Which action should the nurse take before administering the first dose?
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Check serum creatinine
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Auscultate bowel sounds
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Measure oxygen saturation
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Assess body temperature
Explanation
Oral vancomycin is prescribed specifically to treat Clostridium difficile infection in the gastrointestinal tract. Before administering the first dose, the nurse should auscultate bowel sounds to establish a baseline assessment of gastrointestinal motility. C. difficile causes severe colitis, which can progress to toxic megacolon — a life-threatening complication characterized by absent bowel sounds and extreme colonic dilation. Documenting baseline bowel activity is essential for monitoring treatment response and detecting complications.
Why Other Options are Incorrect:
A. Check serum creatinine — Monitoring renal function is critical when vancomycin is given intravenously due to its nephrotoxic potential. However, oral vancomycin for C. difficile is minimally absorbed from the GI tract and does not reach systemic levels sufficient to cause nephrotoxicity, making serum creatinine monitoring less relevant for the oral route.
C. Measure oxygen saturation — Oxygen saturation is not directly relevant to C. difficile infection or to the administration of oral vancomycin. It does not provide meaningful baseline data for this clinical situation.
D. Assess body temperature — While fever can be present with C. difficile infection, it is not the priority assessment before administering the first dose of oral vancomycin. Bowel sound assessment provides more direct clinical information about the GI status that oral vancomycin is targeting.
The nurse should include which information in the teaching plan for a client recently diagnosed with primary open-angle glaucoma? Select all that apply.
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Regular eye exams are necessary to monitor intraocular pressure (IOP) and visual fields
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Intermittent vision loss affecting central vision to peripheral vision
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Vigorous exercise such as jogging or running should be avoided
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Limit salt intake to reduce increased intraocular pressure (IOP)
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Daily eye medications are instilled to lower intraocular pressure (IOP)
Explanation
Regular eye exams are necessary to monitor intraocular pressure and visual fields — Ongoing monitoring is essential in glaucoma management because the condition is chronic and progressive. Regular examinations allow the provider to assess disease progression, evaluate treatment effectiveness, and adjust therapy as needed to prevent irreversible vision loss.
Daily eye medications are instilled to lower intraocular pressure — The primary treatment for primary open-angle glaucoma is the use of topical eye drops to reduce IOP. These medications must be used consistently every day as prescribed to maintain adequate pressure control and prevent optic nerve damage.
Why Other Options are Incorrect:
B. Intermittent vision loss affecting central vision to peripheral vision — This description is characteristic of macular degeneration, not glaucoma. Primary open-angle glaucoma causes gradual peripheral vision loss first, progressing toward central vision, and is often asymptomatic in early stages. It does not cause intermittent vision loss.
C. Vigorous exercise such as jogging or running should be avoided — Moderate aerobic exercise, including jogging, has actually been shown to lower IOP and is generally recommended for glaucoma patients. There is no standard clinical guideline advising avoidance of vigorous exercise in primary open-angle glaucoma.
D. Limit salt intake to reduce increased intraocular pressure — Dietary sodium restriction is not an established evidence-based intervention for managing IOP in primary open-angle glaucoma. Salt restriction is relevant to cardiovascular and renal conditions, not glaucoma management.
An adult client is admitted with AIDS and oral candidiasis manifested by several painful mouth ulcers. The nurse delegates oral care to the unlicensed assistive personnel (UAP) and discusses how to assist the client. Which instruction should the nurse provide the UAP?
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Assist with personal care, but leave oral care for the nurse to complete
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Wear sterile gloves when cleansing any areas of infected mucosa
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Provide a soft bristled toothbrush for the client to use during oral care
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Offer the client mouthwash for thorough cleansing after brushing teeth
Explanation
A soft bristled toothbrush minimizes trauma and irritation to the already painful and ulcerated oral mucosa associated with oral candidiasis. Gentle oral hygiene is essential in immunocompromised clients with mouth ulcers to maintain cleanliness without worsening tissue damage. This is a safe and appropriate task to delegate to the UAP with clear instruction.
Why the other options are incorrect:
A. Assist with personal care, but leave oral care for the nurse to complete — Oral care in a client with oral candidiasis is within the scope of a UAP when properly instructed by the nurse. There is no clinical reason that requires the nurse to exclusively perform this task.
B. Wear sterile gloves when cleansing any areas of infected mucosa — Standard precautions with clean gloves are appropriate for oral care. Sterile gloves are reserved for invasive procedures involving sterile body cavities. Using sterile gloves for oral care is unnecessary and not standard practice.
D. Offer the client mouthwash for thorough cleansing after brushing teeth — Commercial mouthwashes often contain alcohol, which can further irritate and dry out already painful oral ulcers. Alcohol-based mouthwash is contraindicated in clients with oral mucositis or candidiasis.
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