PN HESI V4 EXIT EXAM Latest Solutions 2022

PN HESI V4 EXIT EXAM Latest

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2022 HESI PN V4 EXIT EXAM 110

QUESTION AND ANSWER(S)

1.

Assessment by the home health nurse of an older client who lives alone indicates that client

has chronic constipations. Daily medications include furosemide for hypertension and heart

failure and laxatives. To manage the client’s constipation, which suggestions should the nurse

provide? (Select all that apply)

• Decrease laxative use to every other day, and use oil retention enemas as needed.

• Include oatmeal with stewed pruned for breakfast as often as possible.

• Increase fluid intake by keeping water glass next to recliner.

• Recommend seeking help with regular shopping and meal preparation.

• Report constipation to healthcare provider related to cardiac medication side

effects.

• Rational: older adult are at higher risk for chronic constipation due to decreased

gastrointestinal muscle tone leading to reduce motility. Oatmeal with prunes

increases dietary fiber and bowel stimulation, thereby decreasing need for

laxatives. Increased fluid intake also decreases constipations. Assistance with

food preparation might help the client eat more fresh fruits and vegetables and

result on less reliance on microwaved and fast foods, which are usually high in

sodium and fat with little fiber. Laxatives can be reduced gradually by improving

the diet, without resorting to using enemas.

2. A young boy who is in a chronic vegetative state and living at home is readmitted to the

hospital with pneumonia and pressure ulcers. The mother insists that she is capable of caring

for her son and which action should the nurse implement next?

• Report the incident to the local child protective services.

• Find a home health agency that specializes in brain injuries.

• Determine the mother’s basic skill level in providing care.

• Consult the ethics committee to determine how to proceed.

• Rational: Although the mother states she is a capable caregiver, the client is

manifesting disuse syndrome complications, and the mother’s skill in providing

basic care should be determined. Further assessment is needed before

implementing other nursing actions.

3. After the risk and benefits of having a cardiac catheterization are reviewed by the healthcare

provider, an older adult with unstable angina is scheduled for the procedure. When the nurse

presents the consent form for signature, the client asks how the wires will keep a heart

heating during the procedure. What action should the nurse take?

• Explain the procedure again in detail and clarify any misconceptions.

• Notify the healthcare provider of the client’s lack of understanding.

• Call the client’s next of kin and have them provide verbal consent.

• Postpone the procedure until the client understands the risk and benefits.

• Rational: the nurse is only witnessing the signature, and is not responsible for the

client’s understanding of the procedure. The healthcare provider needs to clarify

any questions and misconceptions. Explaining the procedure again is the

healthcare provider’s legal responsibility. The other options are not indicated.

4. In assessing a client at 34-weeks’ gestation, the nurse notes that she has a slightly elevated

total T4 with a slightly enlarged thyroid, a hematocrit of 28%, a heart rate of 92 beats per

minute, and a systolic murmur. Which finding requires follow-up?

• Elevated thyroid hormone level.

• Hematocrit of 28%.

• Heart rate of 92 beats per minute.

• Systolic murmur.

• Rational: although physiologic anemia is expected in pregnancy, a hematocrit of

28% is below pregnant norms and could signify iron-deficiency anemia. Other

options are normal finding pregnancy

5. A client with osteoporosis related to long-term corticosteroid therapy receives a prescription

for calcium carbonate. Which client’s serum laboratory values requires intervention by the

nurse?

• Total calcium 9 mg/dl (2.25 mmol/L SI)

• Creatinine 4 mg/dl (354 micromol/L SI)

• Phosphate 4 mg/dl (1.293 mmol/L SI)

• Fasting glucose 95 mg/dl (5.3 mmol/L SI)

6. A clinical trial is recommended for a client with metastatic breast cancer, but she refuses to

participate and tells her family that she does not wish to have further treatments. The client’s

son and daughter ask the nurse to try and convince their mother to reconsider this decision.

How should the nurse respond?

• Ask the client with her children present if she fully understands the decision she

has made.

• Discuss success of clinical trials and ask the client to consider participating for

one month.

• Explain to the family that they must accept their mother’s decision.

• Explore the client’s decision to refuse treatment and offer support

• Rationale: as long as the client is alert, oriented and aware of the disease

prognosis, the healthcare team must abide by her decisions. Exploring the

decision with the client and offering support provides a therapeutic interaction and

allows the client to express her fears and concerns about her quality of life. Other

options are essentially arguing with the client’s decisions regarding her end of life

treatment or diminish the opportunity for the client to discuss her feelings