HESI RN
HESI Community Health
1. A nurse is planning a community health fair to promote cancer awareness. Which activity should be included to best engage participants?
- A. free cancer screenings
- B. lectures on cancer prevention
- C. distribution of educational materials
- D. testimonials from cancer survivors
Correct answer: A
Rationale: Offering free cancer screenings should be included in the community health fair to best engage participants. This activity provides immediate, valuable information about participants' cancer risk, making it highly engaging and actionable. While lectures on cancer prevention and distribution of educational materials are informative, they may not offer the same level of immediate engagement and impact as free screenings. Testimonials from cancer survivors, although inspiring, do not provide participants with direct information about their own cancer risk, making them less effective in engaging participants actively.
2. After coronary artery bypass graft surgery, a male client is admitted to the coronary care unit. Which nursing diagnosis is of the highest priority?
- A. Ineffective breathing pattern.
- B. Impaired gas exchange.
- C. Acute pain.
- D. Risk for infection.
Correct answer: B
Rationale: Impaired gas exchange is the highest priority nursing diagnosis because it directly impacts the client's oxygenation. Following coronary artery bypass graft surgery, ensuring adequate oxygen exchange is crucial for the client's recovery. Ineffective breathing pattern, although important, may not be as critical as impaired gas exchange in the immediate postoperative period. Acute pain, while significant, can be managed effectively with appropriate interventions and is not as emergent as addressing impaired gas exchange. Risk for infection is also a valid concern post-surgery, but ensuring optimal gas exchange takes precedence to prevent complications associated with inadequate oxygenation.
3. The nurse is assessing a client with pneumonia who is receiving oxygen therapy. Which finding indicates that the therapy is effective?
- A. The client's respiratory rate is 20 breaths per minute.
- B. The client's arterial blood gases show a pH of 7.35.
- C. The client's oxygen saturation is 92%.
- D. The client's breath sounds are clear.
Correct answer: A
Rationale: A respiratory rate of 20 breaths per minute indicates effective oxygen therapy. In pneumonia, the respiratory rate typically increases due to the body's effort to improve oxygenation. Option B (pH of 7.35) is related to acid-base balance, not specifically indicating oxygen therapy effectiveness. Option C (oxygen saturation of 92%) is below the normal range (95-100%), suggesting the need for oxygen therapy. Option D (clear breath sounds) is a positive finding but not a direct indicator of oxygen therapy effectiveness.
4. The nurse is assessing a client with a suspected deep vein thrombosis (DVT). Which finding supports this diagnosis?
- A. Positive Homan's sign.
- B. Unilateral leg swelling.
- C. Bilateral calf pain.
- D. Redness and warmth in the affected leg.
Correct answer: D
Rationale: The correct answer is D: Redness and warmth in the affected leg. These are classic signs of deep vein thrombosis (DVT) and support the diagnosis. Choice A, Positive Homan's sign, is an outdated and unreliable test for DVT, so it is not the best choice. Choice B, Unilateral leg swelling, can be seen in DVT but is less specific compared to redness and warmth. Choice C, Bilateral calf pain, is not a typical finding in DVT, as the pain in DVT is usually unilateral.
5. The healthcare provider is assessing the laboratory results for a client who is admitted with renal failure and osteodystrophy. Which findings are consistent with this client's clinical picture?
- A. Serum potassium of 4.0 mEq/L and total calcium of 9 mg/dL.
- B. White blood cell count of 15,000/mm3.
- C. Serum potassium of 5.5 mEq/L and total calcium of 6 mg/dL.
- D. Hemoglobin of 12 g/dL and phosphorus of 2 mg/dL.
Correct answer: C
Rationale: In renal failure and osteodystrophy, there is an alteration in serum electrolyte balance. The correct answer is serum potassium of 5.5 mEq/L and total calcium of 6 mg/dL. Renal failure is associated with hyperkalemia (elevated serum potassium) and hypocalcemia (low total calcium levels). Hyperphosphatemia is also commonly seen in renal failure. Choice A is incorrect as it describes normal levels of serum potassium and total calcium. Choice B is unrelated to the client's condition. Choice D is incorrect as it does not reflect the typical electrolyte imbalances seen in renal failure and osteodystrophy.
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