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HESI EXIT RN 2022

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2 The nurse has completed the diet teaching of a client who is being discharged following treatment of a leg wound. A high protein diet is encouraged to promote wound healing. Which lunch choice by the client indicates that the teaching was effective? a. A peanut butter sandwich with soda and cookies. b. A tuna fish sandwich with chips and ice cream. c. Vegetable soup, crackers, and milk. d. A salad with three kinds of lettuce and fruit. 3 The nurse implements a primary prevention program for sexually transmitted diseases in a nurse managed health center. Which outcome indicates that the program was effective? A. Average client scores improved on specific risk factor knowledge test. B. More than half of at-risk client were diagnosed early in their process. C. New screening protocols were developed, validated, and implemented. D. Clients who incurred disease complications promptly received rehabilitation. 4 A young adult client is admitted to the emergency room following a motor vehicle collision. The client's head hit the dashboard. Admission assessments include blood pressure 85/45 mm Hg, oral temperature 98.6° F (37° C), pulse 124 beats/minute, and respirations 22 breaths/minute. Based on these data, the nurse formulates the first portion of a nursing problem as "Risk for injury". What term best expresses the "related to" portion of the nursing problem? a. head injury. b. infection. c. increased intracranial pressure. d. shock. 5 A nurse working on an endocrine unit should see which client first. a. An adolescent male with diabetes who is arguing about his insulin dose. b. An older client with Addison’s disease whose current blood sugar level is 62mg/dl (3.44 mmol/l). c. An adult with a blood sugar of 384mg/dl (21.31mmol/l) and urine output of 350 ml in the last hour. d. A client taking corticosteroids who has become disoriented in the last two hours. 6 Following a gunshot wound, an adult client has a hemoglobin level of 4 grams/dl (40 mmol/L SI). The nurse prepares to administer a unit of blood for an emergency transfusion. The client has AB negative blood type and the blood bank sends a unit of Type A Rh negative, reporting that there is no Type AB negative blood currently available. Which intervention should the nurse implement? a. Transfuse Type A negative blood until Type AB negative is available. b. Recheck the clienfs hemoglobin, blood type, and Rh factor. c. Obtain additional consent for administration of Type A negative blood. d. Administer normal saline solution until Type AB negative is available.

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