HESI RN
Adult Health 1 HESI
1. What is the first action the nurse should take when a patient complains of acute chest pain and dyspnea soon after insertion of a centrally inserted IV catheter?
- A. Notify the health care provider.
- B. Offer reassurance to the patient.
- C. Auscultate the patient’s breath sounds
- D. Give the prescribed PRN morphine sulfate IV
Correct answer: C
Rationale: The correct first action for the nurse to take when a patient complains of acute chest pain and dyspnea after the insertion of a centrally inserted IV catheter is to auscultate the patient's breath sounds. This is important to assess for any potential complications such as embolism or pneumothorax, which can present with such symptoms. Auscultation can provide immediate information on the patient's respiratory status and guide further interventions. Notifying the health care provider, offering reassurance, or administering morphine should only be considered after assessing the patient's condition through auscultation.
2. A public health nurse is evaluating a program designed to reduce childhood obesity. Which outcome indicates that the program is successful?
- A. increased participation in physical activities
- B. higher attendance at nutrition education sessions
- C. reduced rates of childhood obesity
- D. greater knowledge of healthy eating habits
Correct answer: C
Rationale: The correct answer is C: reduced rates of childhood obesity. A reduction in childhood obesity rates is a direct indicator that the program is successful in achieving its goal. Increased participation in physical activities (choice A) and higher attendance at nutrition education sessions (choice B) are positive outcomes, but they do not directly measure the program's effectiveness in reducing obesity. Greater knowledge of healthy eating habits (choice D) is important but does not guarantee a decrease in obesity rates. Therefore, the most significant outcome to determine the success of a childhood obesity reduction program is a reduction in obesity rates.
3. When should a new nurse graduate consider applying for a position as a nurse manager?
- A. When she is comfortable in her current position
- B. When she begins mentoring other new nurses
- C. As soon as a position opens
- D. When she has developed leadership and clinical expertise
Correct answer: D
Rationale: A new nurse graduate should consider applying for a position as a nurse manager when she has developed leadership and clinical expertise. Option A, 'When she is comfortable in her current position,' is incorrect as comfort in the current position may not necessarily align with the skills required for a managerial role. Option B, 'When she begins mentoring other new nurses,' is not a definitive indicator of readiness for a managerial position. Option C, 'As soon as a position opens,' does not take into account the necessary skills and experience required for a nurse manager role. Therefore, the best time to consider applying for a nurse manager position is after developing the required leadership and clinical expertise.
4. A 12-year-old child is admitted to the hospital with a diagnosis of osteomyelitis. Which finding should the nurse expect during the assessment?
- A. Localized pain and swelling
- B. Generalized joint stiffness
- C. Pain in the muscles
- D. Limited range of motion in the limbs
Correct answer: A
Rationale: In osteomyelitis, an infection of the bone, patients typically present with localized pain, swelling, and warmth over the affected bone. This is due to the inflammatory response in the bone tissue. Generalized joint stiffness, pain in the muscles, and limited range of motion in the limbs are not specific to osteomyelitis and are more commonly associated with other conditions.
5. A client with chronic obstructive pulmonary disease (COPD) is being discharged home. What should the nurse include in the discharge teaching?
- A. Limit fluid intake to prevent lung congestion
- B. Avoid all physical activity to conserve energy
- C. Perform pursed-lip breathing during activities
- D. Increase oxygen flow rate if shortness of breath occurs
Correct answer: C
Rationale: The correct answer is C. Pursed-lip breathing helps control breathing and improves oxygen exchange in clients with COPD. It can ease shortness of breath during activities and should be included in discharge teaching to manage symptoms. Option A is incorrect as adequate fluid intake is important for thinning mucus in COPD. Option B is wrong as physical activity, as tolerated, is beneficial for COPD patients. Option D is also incorrect because changing oxygen flow rate without healthcare provider guidance can be dangerous.