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HESI MILESTONE EXIT EXAM V2-WITH 100% ACCURATE SOLUTIONS-2024-2025 HESI MILESTONE EXIT EXAM V2-WITH 100% ACCURATE SOLUTIONS-2024-2025 HESI MILESTONE EXIT EXAM V2-WITH 100% ACCURATE SOLUTIONS-2024-2025
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HESI Exit V
the air
A) "I strap the infant car seat on the front seat to face backwards."
B) "I place my infant in the middle of the living room floor on ablanket to play with my 4 year old while I make supper in the kitchen."
C) "My sleeping baby lies so cute in the crib with the little buttocksstuck up in
while the four year old naps on the sofa."
D) "I have the 4 year-old hold and help feed the four month-old abottle in
the kitchen
while I make supper."
The correct answer is D: "I have the four year-old hold andhelp feed the four month-old a bottle in the kitchen
B) Give information about advance directives
C) Assume that this client wishes a full code
D) Refer this issue to the unit secretary
does not have an advance directive. What action should the nurse take?
The correct answer is B: Give information about advance directives
after
the immunization was given, the client complains of itchy and wateryeyes, increased anxiety, and difficulty breathing. The nurse expects that the first action inthe sequence of
care for this client will be to
A) Maintain the airway
B) Administer epinephrine 1:1000 as ordered
C) Monitor for hypotension with shock
D) Administer diphenhydramine as ordered
The correct answer is B: Administer epinephrine 1:1000 asordered.
B) A toddler with severe deep abrasions over 98% of the body
C) A preschooler with 1 lower leg fracture and the other leg with anupper leg fracture
D) A school-age child with singed eyebrows and hair on the arms The correct answer is B: A toddler with severe deep abrasions over 98% of the body.
triage nurse put in the "treat last" category?
B) Use the bracelet and admission form until a replacement issupplied
C) Notify the admissions office and wait to apply the bracelet
D) Make a corrected identification bracelet for the client
with the admission form. In the event these do not match, the nurse’sbest action is to
B) 20 year-old in skeletal traction for 2 weeks since a motor cycleaccident
C) 72 year-old recovering from surgery after a hip replacement 2hours ago
D) 75 year-old who is in skin traction prior to planned hip pinningsurgery. The correct answer is C: 72 year-old recovering from surgery after ahip replacement 2 hours ago
see first?
B) That was done correctly. Did you have any problems with theinsertion?
C) Let’s check to see if the suppository is in far enough.
was told by the family member to turn to the right side and the client didthis. What is the
appropriate comment for the nurse to make?
D) Did you feel any stool in the intestinal tract?
The correct answer is B: That was done correctly. Did youhave any problems with the insertion?
B) droplet precautions
C) contact precautions
D) compromised host precautions
died. Which type of precautions is the appropriate type to use whenperforming postmortem care?
The correct answer is C: contact precautions
B) clean the meatus, begin voiding, then catch urine stream
C) Clean the meatus, then urinate into container
D) Void continuously and catch some of the urine
The correct answer is B: clean the meatus, begin voiding,then catch urine stream
B) watermelon
C) chicken
D) tomatoes
The correct answer is B: watermelon
nurse take?
A) Look up the policy on needle sticks
B) Contact employee health services
C) Immediately wash the hands with vigor
D) Notify the supervisor and risk management
The correct answer is C: Immediately wash the hands withvigor
B) Stop. Tell me why aspiration is needed.
A) An admission at the change of shifts with atrial fibrillation andheart failure - PN
B) Client who had a major stroke 6 days ago - PN nursing student
C) A child with burns who has packed cells and albumin IV running -charge
D) An elderly client who had a myocardial infarction a week ago -
the nurse manager?
nurse
UAP
The correct answer is A: An admission at the change ofshifts with atrial fibrillation and heart failure - PN
B) Restlessness and increased mucus production
C) Increased sleeping and listlessness
D) Diarrhea and poor skin turgor
be spitting up all the time and has a lot of gas. The nurse expects to findwhich of the following on the initial history and physical assessment?
The correct answer is B: Restlessness and increased mucus production
B) "The urine is dark yellow and small in amounts."
C) "Clothes are becoming tighter across her abdomen."
D) "We notice muscle weakness and some unsteadiness."
the parents require follow-up and are consistent with the diagnosis?
The correct answer is C: "Clothes are becoming tighteracross her abdomen."
A) Ask the teenager to wait until a parent or legal guardian can becontacted
B) Withhold treatment until telephone consent can be obtained fromthe partner
C) Refer the teenager to a community pediatric hospital emergencydepartment
that this
teenager is legally married and signs the consent form for treatment.
What would be the
appropriate action by the nurse?
D) Proceed with the triage process in the same manner as any adult
client
The correct answer is D: Proceed with the triage process inthe same manner as any adult client
B) Report hourly outputs of less than 30 ml/hr
C) Monitor client's ability for movement in the bed
D) Check skin turgor every 4 hours
The correct answer is B: Report output of less than 30 ml/hr
B) Strep throat went through all the children at the day care lastmonth.
C) Both ears were infected over 3 months age.
D) Last week both feet had a fungal skin infection.
Which nursing diagnosis should have priority?
The correct answer is A: Pain related to ischemia
B) Provide reasonable accommodations for disabled individuals
C) Make all necessary accommodations for disabled individuals
D) Consider both mental and physical disabilities The correct answer is B: Provide reasonable accommodations for disabled individuals
managers to
A) "I have problems with diarrhea."
B) "I have difficulty falling asleep."
C) "I have diminished sexual function."
D) "I often feel jittery."
noncompliance?
The correct answer is C: "I have diminished sexual function."
A) ”I will keep the cast for the next day uncovered to preventburning of the skin."
B) ”I can apply an ice pack over the area to relieve itching inside the
C) ”The cast should be propped on at least 2 pillows when my child
D) ”I think I remember that standing cannot be done until after 72hours." The correct answer is D: "I think I remember that standingcannot be done until after 72 hours."
ago. Which statement from the mother indicates that teaching has beeninadequate?
cast."
is lying down."
B) Assume a fair share of direct client care as a role model
C) Set daily goals with a prioritization of the work
D) Delegate tasks to reduce work load associated with direct careand meetings
nurse manager?
The correct answer is C: Set daily goals with a prioritizationof the
work
B) Hearing loss and ataxia
C) Headaches and vomiting
D) Abdominal mass and weakness
neuroblastoma. Findings observed by the nurse that is associated withthis problem include which of these?
The correct answer is D: Abdominal mass and weakness
A) "I will only have to wear this for 6 months."
B) "I should inspect my skin daily."
within the hearing of others. The employee does not respond to thehealth care provider's
complaints. The nurse manager's next action should be to
behavior."
D) Request an immediate private meeting with the health careprovider and staff nurse
The correct answer is D: Request an immediate privatemeeting with the health care provider and staff nurse
The client has been on the unit for 2 days and now states “I demand to bereleased now!” The appropriate action is for the nurse to
A) You cannot be released because you are still suicidal.
B) You can be released only if you sign a no suicide contract.
C) Let’s discuss your decision to leave and then we can prepare youfor discharge.
D) You have a right to sign out as soon as we get an order from thehealth care provider's discharge order.
The correct answer is C: Let’s discuss your decision to leaveand then we can prepare you for discharge.
B) Heart murmur
C) Macular rash
D) Hemorrhage
nurse to a complication of this condition?
The correct answer is B: Heart murmur Large, soft, rapidly developing vegetations attach to the heart valves.
B) Maintain alveolar surface tension
C) Begin normal pulmonary blood flow
D) Regulate intra cardiac pressure
In planning
care, nursing actions are based on the fact that the most likely cause ofthis problem stems from the infant's inabilityto
The correct answer is B: Maintain alveolar surface tension
following a diving accident. The injury is suspected to be at the level ofthe 2nd cervical
A) Response to stimuli
B) Bladder control
C) Respiratory function
D) Muscle weakness
vertebrae. The nurse's priority assessment should be
The correct answer is C: Respiratory function
B) White blood count
C) Blood glucose every 4 hours
D) Temperature every 2 hours
The correct answer is C: Check the blood pressure of a 2hours post operative client
first action the school nurse should take is
A) Call for emergency transport to the hospital
B) Immobilize the limb and joints above and below the injury
C) Assess the child and the extent of the injury
D) Apply cold compresses to the injured area
The correct answer is C: Assess the child and the extent ofthe injury
B) New furniture
C) Lead based paint
D) Plants such as cactus
what information about the child's environment?
The correct answer is A: Household pets
B) Incontinence
C) Muscle weakness
D) Rapid pulse
has had a blood pressure from 180/110 to 160/100 over the past 2 hours.
The nurse has
also noted increased lethargy. Which assessment finding should the nursereport immediately to the health care provider?
The correct answer is A: Slurred speech
B) Scabies
C) Regression
D) Pinworms
The correct answer is D: Pinworms
antibiotics. In planning for home care, what is the most important actionby the nurse?
A) Investigating the client's insurance coverage for home IV antibiotic therapy
B) Determining if there are adequate hand washing facilities in the
C) Assessing the client's ability to participate in self care and/or the
D) Selecting the appropriate venous access device
home
reliability of a
caregiver
The correct answer is C: Assessing the client''s ability to participate in self care and/or the reliability of a caregiver
B) Place client on a clear liquid diet
C) Tilt head back to facilitate swallowing reflex
D) Offer finger foods such as crackers or pretzels
The correct answer is A: Position client in upright positionwhile eating
B) a pig."
C) my thigh."
D) synthetic skin."
The
nurse knows the client understands the procedure when the client says, "Iwill receive tissue from…
The correct answer is C: my thigh."
B) Ineffective airway clearance
C) Altered nutrition
D) Risk for injury
Which nursing diagnosis is a priority?
The correct answer is B: Ineffective airway clearance
B) Reduce the drying time
C) Decrease irritation to the skin
D) Improve venous return
The correct answer is D: Improve venous return
A) Leave a book about relaxation techniques
B) Write out a daily exercise routine for them to assist the client to
C) List actions to improve the client's daily nutritional intake
D) Suggest communication strategies
with Alzheimer's disease with family members. Which of theseinterventions would be
most helpful at this time?
do
The correct answer is D: Suggest communication strategies
B) Keep a candy bar available at all times
C) Reduce carbohydrates intake to 25% of total calories
D) Keep a regular schedule of meals and snacks
prescribed diet. The nurse should teach the client to
The correct answer is D: Keep a regular schedule of mealsand snacks
B) Hepatitis B
C) Polio