HESI BSN 246 PART II EXAM QUESTIONS AND ANSWERS 100% CORRECT!!, Exams of Nursing

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HESI BSN 246 PART II EXAM QUESTIONS

AND ANSWERS 100% CORRECT!!

The nurse reviews the health record of a client with melasma. The nurse would anticipate that this client will exhibit: -ANSWER Blotchy brown macules across the cheeks and forehead

The client with cellulitis of the lower leg has had cultures done on the affected area. The nurse reviewing the results of the culture report interprets that which of the following organisms is not part of the normal flora of the skin? -ANSWER Escherichia coli

The client complains of chronic pruritus. Which of the following diagnoses would the nurse expect to support this client's complaint? -ANSWER Renal Failure

A client being seen in an ambulatory clinic for an unrelated complaint has a butterfly rash noted across the nose. The nurse interprets that this finding is consistent with early manifestations of which of the following disorders? -ANSWER Systemic lupus erythematosus (SLE)

The nurse notes that the older adult client has a number of bright, ruby-colored, round lesions scattered on the trunk and thighs. The nurse correctly interprets the finding as alterations in blood vessels of the skin and defines them as: -ANSWER Cherry angioma

The client has been diagnosed with paronychia. The nurse understands that this is a disorder of the: -ANSWER Nails

The client is diagnosed with a full-thickness burn. The nurse understands that which of the following structural areas of the skin is involved? -ANSWER Epidermis, entire dermis, and epithelial portion of subcutaneous fat

A client who suffered carbon monoxide poisoning from working on an automobile in a closed garage has a carbon monoxide level of 15%. The nurse would anticipate observing which sign or symptom? -ANSWER Flushing

A client is admitted to the hospital with cellulitis of the lower leg. The nurse would anticipate which of the following therapies to be prescribed? -ANSWER Warm compresses to the affected area

The nurse is caring for a client with a dysfunctional thyroid gland and is concerned that the client will exhibit signs of thyroid storm. Which of the following is an early indicator of this complication? -ANSWER Hyperreflexia

The client is undergoing an oral glucose tolerance test. The nurse interprets that the client's results are not compatible with diabetes mellitus if the glucose level is lower than which of the following cutoff values after 120 minutes (2 hours)? -ANSWER 140 mg/dL

A client who visits the physician's office for a routine physical reports new onset of intolerance to cold. Knowing that this is a frequent complaint associated with hypothyroidism, the nurse continues to assess for which of the following? -ANSWER Complaints of weakness and lethargy

The nurse is caring for a client diagnosed with suspected acute pancreatitis. When reviewing the client's laboratory results, the nurse determines that which of these findings will support the diagnosis? -ANSWER Elevated serum levels

A nurse is caring for a client postoperatively following creation of a colostomy. Which of the following nursing diagnoses should the nurse include in the plan of care? -ANSWER Disturbed body image

The client is experiencing blockage of the common bile duct. Which of the following food selections made by the client indicates the need to plan for further diet teaching? -ANSWER Whole milk

The nurse is reviewing laboratory test results for the client with liver disease and notes that the client's albumin level is low. Which of the following nursing actions is focused on the consequence of low albumin levels? -ANSWER Palpating for peripheral edema

Discharge teaching for a client recovering from an attack of chronic pancreatitis should include which of the following instructions? -ANSWER Avoid caffeine, because it may aggravate symptoms.

A client returns to the nursing unit after undergoing an esophagogastroduodenoscopy (EGD). Which of the following reflects appropriate intervention by the nurse? -ANSWER Withhold oral fluids until the client's gag reflex has returned.

The nurse is assisting the physician during a colonoscopy procedure. The nurse helps the client to assume which of the following positions for the procedure? -ANSWER Left Sims

The nurse would identify that which of the following foods should be increased in the diet to help decrease the risk of cancer development? -ANSWER Broccoli

The nurse would include which of the following in a list of the most helpful foods for the vegan client wishing to increase foods high in vitamin A? -ANSWER carrots

According to the American Cancer Society, fecal occult blood testing should be done annually after the age of _____ years. -ANSWER 50

A 27-year-old female client is undergoing evaluation of lumps in her breasts. In determining whether the client could have fibrocystic breast disorder, the nurse should ask the client whether the breast lumps seem to become more prominent or troublesome at which of the following times? -ANSWER before menses

client presents to the urgent care center with complaints of abdominal pain and vomits bright red blood. Which of the following is the priority action taken by the nurse? -ANSWER Take the vitals

The client with frequent upper respiratory infections (URIs) asks the nurse why food doesn't seem to have any taste during illness. The nurse understands that this is because of which of the following? -ANSWER Blocked nasal passages impair the senses of smell and taste.

The nurse providing instructions to the client using an incentive spirometer tells the client to sustain the inhaled breath for 3 seconds. When the client asks the nurse about the rationale for this action, the nurse explains that the primary benefit is to: -ANSWER Maintain inflation of the alveoli.

The nurse understands that increasing the flow of oxygen to more than 2 L/min in the client with chronic obstructive pulmonary disease (COPD) could be harmful because it: -ANSWER Decreases the client's oxygen-based respiratory drive

The nurse participating in a client care conference with other health team members is discussing the condition of a client with adult respiratory distress syndrome (ARDS). The physician states that because of fluid in the alveoli, surfactant production is falling. The nurse understands that the consequence of insufficient surfactant is: -ANSWER Collapse of alveoli and decreased compliance

he ambulatory care nurse measures the blood pressure of a client and finds it to be 156/94 mm Hg. Which of the following areas is unnecessary to emphasize when providing client education for blood pressure control? -ANSWER Instruct the client to limit protein intake.

The nurse identifies that a client is having occasional premature ventricular contractions (PVCs) on the cardiac monitor. The nurse reviews the client's laboratory results and determines that which of the following results would be consistent with the observation? -ANSWER Serum potassium level of 2.8 mEq/L

The client who has had intracranial surgery is experiencing diabetes insipidus. The nurse understands that the client is experiencing which of the following problems? -ANSWER Insufficient production of antidiuretic hormone (ADH)

The client is admitted to the hospital with a tentative diagnosis of bladder cancer. The nurse expects the client history to reveal which of the following earliest manifestations of the disease? -ANSWER Hematuria with no pain

The client with glomerulonephritis has developed acute renal failure (ARF) as a complication. The nurse would expect to note which of the following abnormal findings documented on the client's medical record? -ANSWER Hypertension

The client has been diagnosed with pyelonephritis. The nurse interprets that which of the following health problems has placed the client at risk for this disorder? -ANSWER Diabetes mellitus

The nurse has a prescription to collect a 24-hour urine specimen from a client. The nurse should avoid which of the following errors in technique when implementing this procedure? -ANSWER Ask the client to void, save the specimen, and note the start time.

The nurse who is collecting data from the client notes that the client's left-sided eyelid is drooping. The nurse documents that the client is exhibiting which of the following conditions? -ANSWER Ptosis

The nurse is attempting to inspect the lacrimal apparatus of the client's eye. Because of its anatomical location, the nurse should do which of the following? -ANSWER Retract the upper eyelid, and ask the client to look down.

The nurse conducting an eye examination notes that the client exhibits rapid, involuntary, oscillating movements of the eyeball when looking at the nurse. The nurse documents this finding as: -ANSWER Nystagmus

The nurse who is assessing the client's eyes notes that the pupil gets larger when looking at an object in the distance and gets smaller when looking at a near object. The nurse documents this finding as: -ANSWER Accommodation

The nurse suspects the client may be experiencing dysfunction in the area of the semicircular canals of the ear if the client experiences: -ANSWER Disturbance in balance

A client is experiencing blockage of the eustachian tubes. Which of the following activities by the client may forcibly open the eustachian tube? -ANSWER Performing the Valsalva maneuver

A nurse is caring for a client diagnosed with Ménière's disease. The nurse plans care, understanding that this disorder is characterized by: -ANSWER Dizziness

The client has a cerebellar lesion. The nurse would plan to obtain which of the following for use by this client? -ANSWER Walker

The client has sustained damage to Wernicke's area in the temporal lobe from a brain attack (stroke). Which of the following should the nurse anticipate when caring for this client? -ANSWER The client will have difficulty understanding language.

The nurse is preparing to administer a prescribed antibiotic to a client with bacterial meningitis. The nurse understands that the selection of an antibiotic to treat meningitis is based on which of the following? -ANSWER It is able to cross the blood-brain barrier.

The client who is experiencing an inferior wall myocardial infarction has had a drop in heart rate into the 50 to 56 beats/min range. The client is also complaining of nausea. The nurse interprets that these symptoms are because of stimulation of which cranial nerve (CN)? -ANSWER Vagus CN: X

The client is being scheduled for a positron emission tomography (PET) scan. The nurse provides which of the following explanations to the client? -ANSWER "The test detects abnormal glucose metabolism in the brain."

notes that the pain occurs in the absence of precipitating factors. How would the nurse best describe this type of anginal pain? -ANSWER Variant Angina

A client's total cholesterol level is 344 mg/dL, low-density lipoprotein cholesterol (LDL-C) level is 164 mg/dL, and high-density lipoprotein cholesterol (HDL-C) level is 30 mg/dL. Based on analysis of the data, how should the nurse direct client teaching? -ANSWER The client is at high risk for cardiovascular disease, and measures to modify all identified risk factors should be taught.

The nurse caring for a client who has undergone kidney transplantation is monitoring the client for organ rejection. The nurse understands that in cases in which the recipient rejects transplanted organs, the cells of the transplanted organs are seen by the body as a(n): -ANSWER Foreign antigen

A client is admitted to the hospital with a diagnosis of parasitic worms. The nurse understands that the primary cell type that will attack these foreign particles is: -ANSWER Eosinophils

Tetanus toxoid is prescribed for a client who has sustained a foot laceration from a piece of metal while walking barefoot on the beach. The nurse understands that the toxoid is a(n): -ANSWER Toxin produced by bacteria that has been altered so that it is no longer toxic

The nursing instructor is questioning a nursing student about the organs of the immune system and asks the student where Kupffer's cells are located. The student responds correctly by stating that these types of cells are located in the: -ANSWER Liver

The nursing student understands that the primary purpose of neutrophils in the inflammatory response is to: -ANSWER Phagocytize any potentially harmful agents.

The nursing student correctly describes the process of phagocytosis as: -ANSWER A process whereby a particle is ingested and digested by a cell

The nurse is receiving a client from the postanesthesia care unit following left above-knee amputation. The priority nursing action at this time is which of the following? -ANSWER Elevate the foot of the bed.

The nurse is providing instructions to a client and family regarding home care following cataract removal from the left eye. The nurse would plan to teach the client which of the

following pieces of information about positioning in the postoperative period? -ANSWER Avoid sleeping on the left side.

The nurse caring for a client following craniotomy who has a supratentorial incision understands that the client should most likely be maintained in which of the following positions? -ANSWER Semi-Fowler's position

The nurse is teaching a client with chronic airflow limitation (CAL) about positions that help breathing during dyspneic episodes. Which position, assumed by the client, would indicate that the client needs additional teaching regarding positioning? -ANSWER laying on his or her back

The nurse is assisting the physician with insertion of a chest tube. The nurse notes fluctuation of the fluid level in the water seal chamber after the tube is inserted. Based on this observation, the nurse takes which of the following actions? -ANSWER Document the accurate functioning of the tube

. The physician is about to remove a chest tube from a client. After the dressing is removed and the sutures have been cut, the nurse assisting the physician asks the client to: -ANSWER Perform the Valsalva maneuver.

The nurse is assisting in caring for the client immediately after removal of the endotracheal tube. Which of the following findings should be reported to the health care physician immediately? -ANSWER Stridor

The nurse understands that the most significant rationale for the application of heat to an area of contusion 72 hours after the injury is to: -ANSWER Reabsorb blood from the injured tissue

The nurse is assisting in performing a physical assessment of a right-handed client's musculoskeletal system. Which of the following would be an abnormal finding? -ANSWER Presence of fasciculations

The nurse explaining the procedure of indium imaging to a client with a bone infection would include which of the following? -ANSWER Some of the client's white blood cells are tagged with indium, which will later accumulate in infected bone.

The client was admitted to the hospital 2 hours ago following multiple fractures to the pelvis and soft tissue injury to the abdomen. Diagnostic studies have ruled out perforation of abdominal organs. The nurse places highest priority on monitoring this

The client with liver dysfunction has low serum levels of fibrinogen and a prolonged prothrombin time (PT). Based on these findings, which of the following actions are planned to promote client safety? Select all that apply. -ANSWER -Provide the client with a soft toothbrush. -Instruct the client to use an electric razor. -Monitor all secretions for frank or occult blood.

The nurse is doing volunteer work in a homeless shelter. The nurse monitors the individuals in the shelter for which of the following initial symptoms of tuberculosis (TB)? Select all that apply. -ANSWER Fatigue Lethargy Low-grade fever Morning cough

The nurse notes that the client's serum calcium level is 6.0 mg/dL. Which of the following assessment findings would be anticipated in this client? Select all that apply. -ANSWER Tetany Hypotension Prolonged QT interval Positive Chvostek's sign

The nurse notes during assessment and history taking that the older client exhibits visual changes. Which of the following are normal age-related changes of the eye? Select all that apply. -ANSWER -Decreased visual acuity -Decreased tolerance of glare -Decreased peripheral vision

The nurse caring for a client admitted to the hospital with acute back pain understands that this problem can be most likely caused by which of the following? Select all that apply. -ANSWER -Twisting of the spine -Hyperflexion of the spine -Herniation of an intervertebral disk

The client who sustained a severe sprain of the ankle is told by the physician that the pain experienced is caused by muscle spasm and swelling in the area of the injury. Which of the following interventions should the nurse anticipate will be included in the client's plan of care? Select all that apply -ANSWER -Ice bags -Elevation -Compression by an elastic bandage

The nurse collecting data related to the client's risk factors associated with osteoporosis would include which of the following? Select all that apply. -ANSWER -Thin body build -Smoking history -Postmenopausal age -Chronic corticosteroid use -Family history of osteoporosis

The student nurse is assisting with an assessment of a client's level of consciousness using the Glasgow Coma Scale. The student understands that which of the following categories of client functioning are included in this assessment? Select all that apply. -ANSWER -Eye opening -Best verbal response -Best motor response

An adult client trapped in a burning house has suffered burns to the back of the head, upper half of the posterior trunk, and the back of both arms. Using the rule of nines, what does the nurse determine the extent of the burn injury to be? (Enter the answer in the space provided.) Answer: __________% -ANSWER 22.

The client has been diagnosed with gout. In developing a teaching plan for this client, the nurse should include a list that identifies which of the following foods to be avoided? -ANSWER Chicken Liver

The client with a history of gastrointestinal upset has been diagnosed with acute diverticulitis. The nurse gives the client suggestions for foods to aid in symptom management that are in which of the following diet types? -ANSWER a low fiber diet

The nurse is caring for the client with cirrhosis. As part of dietary teaching to minimize the effects of the disorder, the nurse teaches the client about foods that are high in thiamine. The nurse determines that the client has the best understanding of the material if the client states to increase intake of which of the following? -ANSWER Pork

102. The client is resuming a diet after hemigastrectomy. To minimize complications, the nurse would tell the client to avoid doing which of the following? -ANSWER Drinking liquid with meals