HESI RN
Leadership and Management HESI
1. Which of the following best describes the nurse's role in patient education?
- A. The nurse is responsible for providing patients with information they need to make informed decisions about their care.
- B. The nurse provides education to the patient and their family to help them understand the care plan and make informed decisions.
- C. The nurse is responsible for providing patients with written materials to help them understand their condition and treatment options.
- D. The nurse provides patients with verbal and written instructions on how to manage their care at home.
Correct answer: A
Rationale: The correct answer is A. The nurse's role in patient education involves providing patients with the necessary information to make informed decisions about their care. This includes explaining treatment options, potential risks and benefits, and answering any questions the patient may have. Choice B is incorrect because while nurses do educate patients and families, the primary focus is on empowering patients to make informed decisions. Choice C is incorrect as providing written materials is a part of patient education but not the sole responsibility of the nurse. Choice D is incorrect because while nurses do provide instructions on managing care at home, patient education goes beyond just the home care aspect to encompass a broader understanding of the patient's condition and treatment.
2. The parents of a 2-year-old child with a history of febrile seizures are being taught by the healthcare provider. Which statement by the parents indicates a need for further teaching?
- A. We should give our child acetaminophen when they have a fever.
- B. We should not place our child in a cool bath during a seizure.
- C. We should call 911 if the seizure lasts longer than 5 minutes.
- D. We should try to keep our child’s fever under control.
Correct answer: B
Rationale: Placing a child in a cool bath during a seizure is not recommended as it can be dangerous and may lead to accidental drowning or injuries. The priority during a febrile seizure is to ensure the safety of the child by placing them on a soft surface, removing any nearby objects that may cause harm, and gently turning their head to the side to prevent aspiration. Cooling measures like removing excess clothing can be employed, but immersing the child in a cool bath is not advised. Calling 911 if the seizure lasts longer than 5 minutes is important to seek immediate medical assistance. Administering acetaminophen to reduce fever and trying to keep the child's fever under control are appropriate interventions which should be continued.
3. A nurse from the maternity unit is floated to the critical care unit because of staff shortage on the evening shift. Which client would be appropriate to assign to this nurse?
- A. A client with a Dopamine drip IV with vital signs monitored every 5 minutes
- B. A client with a myocardial infarction that is free from pain and dysrhythmias
- C. A client with a tracheotomy of 24 hours in some respiratory distress
- D. A client with a pacemaker inserted this morning with intermittent capture
Correct answer: B
Rationale: In this scenario, it is more appropriate to assign a stable client, such as the one with a myocardial infarction who is free from pain and dysrhythmias, to a nurse who lacks specialized critical care experience. This client's condition is relatively stable and does not require immediate critical interventions. Choices A, C, and D involve clients with more complex and critical conditions that would be better managed by a nurse with specialized critical care training. Choice A involves a client on a Dopamine drip with frequent vital sign monitoring, Choice C has a client with a tracheotomy in respiratory distress, and Choice D describes a client with a pacemaker experiencing intermittent capture, all of which require a higher level of critical care expertise.
4. During a home visit, the nurse finds that an elderly client has multiple expired medications. What should the nurse do first?
- A. instruct the client to dispose of the expired medications
- B. review the client's current medication regimen
- C. contact the client's healthcare provider
- D. educate the client on the dangers of taking expired medications
Correct answer: B
Rationale: The correct first action for the nurse to take when finding multiple expired medications in an elderly client's home is to review the client's current medication regimen. This step is crucial to identify any potential issues, ensure the client is taking the correct medications, and understand why the expired medications were not used. Instructing the client to dispose of the expired medications (Choice A) can come after understanding the current medication situation. Contacting the client's healthcare provider (Choice C) may be necessary but reviewing the medication regimen should be the initial step. Educating the client on the dangers of taking expired medications (Choice D) is important but should be done after addressing the immediate concern of reviewing the current medications.
5. A client with a history of diabetes mellitus is admitted with diabetic ketoacidosis (DKA). Which finding requires immediate intervention?
- A. Blood glucose of 200 mg/dL.
- B. Serum bicarbonate of 20 mEq/L.
- C. Blood pressure of 140/90 mm Hg.
- D. Urine output of 50 mL in 4 hours.
Correct answer: D
Rationale: In a client with diabetic ketoacidosis (DKA), urine output of 50 mL in 4 hours indicates oliguria, which is a concerning sign of decreased renal perfusion and potential renal failure. This finding requires immediate intervention to prevent further deterioration of kidney function.\n\nChoice A (Blood glucose of 200 mg/dL) is elevated but not the most urgent concern in this scenario. Choice B (Serum bicarbonate of 20 mEq/L) reflects metabolic acidosis, which is expected in DKA but does not require immediate intervention. Choice C (Blood pressure of 140/90 mm Hg) is slightly elevated but not acutely concerning in the context of DKA.