م9:57 2024/3/30 PN EXIT HESI Rationales
PN EXIT HESI / RATIONALES
A fully oriented person is - correct answer Oriented to person, place, time, &
situation (oriented x4).
A person who is only oriented to one of these elements is at risk for injury. The
PN should provide instructions to the UAP about additional support to the client.
Orthostatic falls - correct answer The PN should obtain standing blood pressure
measurements to evaluate the orthostatic falls in the blood pressure that can
cause lightheaded or faint feeling when rising from a lying position.
Atopic dermatitis (Eczema) - correct answer Heat and humidity can cause
perspiration, which intensifies itching with atopic dermatitis (Eczema), so a client
should be encouraged to shower, using non perfume scented soaps.
Rotating injection sites - correct answer The PN should reteach the client to
rotate the noon site to a site other than the same one used for the AM dose..
Rotation is recommended for the dose used during the one specific time of the
day.
Pain scale - correct answer A rating scale should be used by the client to evaluate
current pain. The PN should also determine when the last pain medication was
administered and the effectiveness of that last dose.
Nystatin administration to an infant - correct answer Nystatin is the most
commonly used antifungal agent for oral candidiasis. When administering
nystatin to an infant, the medication needs to be applied topically by using a
gloved finger to rub the suspension over the infected area.
How do you prevent tissue loss in a client with hyperemia? - correct answer The
presence of reactive hyperemia occurs from pressure causing dilation of
superficial capillaries, and resolves without tissue loss if the pressure if relieved.
The UAP should be instructed in the need to turn the client every 2 hours.
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, م9:57 2024/3/30 PN EXIT HESI Rationales
PNs role during a fire alarm - correct answer The PN has the expertise to
determine how to safely transport and evacuate residents with varying medical
problems during a fire alarm.
Intention of droplet precaution - correct answer Droplet precautions are intended
to prevent transmission of pathogens spread through close respiratory or
mucous membrane contact with respiratory secretions and include keeping the
door to the client's room closed.
How should the PN respond to an RN who requested the PN to administer
unlabeled medication that the PN did not draw? - correct answer The PN can
respond in an assertive manner by refusing to administer the medication but
offering to assist the RN with another task. An aggressive response is refusing to
administer the drug while not offering to help in another way.
Slight bleeding during stoma care - correct answer While providing stoma care
with a client, it is a normal occurrence to see a little blood on a washcloth due to
the stoma being a very vascular site.
Upright positioning - correct answer Sitting upright facilities diaphragm
excursion and enhances thoracic and abdominal expansion.
What outdoor game provides socialization for older clients? - correct answer An
outdoor team game of ring-toss provides opportunities for socialization, as well
as exercise. The activity addresses the older clients' psychosocial, interpersonal
and physical needs.
Where is the center of gravity in an elderly client? - correct answer The center of
gravity changes as a person age from the hips to the UPPER TORSO.
Where can hospice care be provided? - correct answer Hospice care can be
provided anywhere the client lives, including in the home, and focuses on
comfort, dignity and emotional support.
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PN EXIT HESI / RATIONALES
A fully oriented person is - correct answer Oriented to person, place, time, &
situation (oriented x4).
A person who is only oriented to one of these elements is at risk for injury. The
PN should provide instructions to the UAP about additional support to the client.
Orthostatic falls - correct answer The PN should obtain standing blood pressure
measurements to evaluate the orthostatic falls in the blood pressure that can
cause lightheaded or faint feeling when rising from a lying position.
Atopic dermatitis (Eczema) - correct answer Heat and humidity can cause
perspiration, which intensifies itching with atopic dermatitis (Eczema), so a client
should be encouraged to shower, using non perfume scented soaps.
Rotating injection sites - correct answer The PN should reteach the client to
rotate the noon site to a site other than the same one used for the AM dose..
Rotation is recommended for the dose used during the one specific time of the
day.
Pain scale - correct answer A rating scale should be used by the client to evaluate
current pain. The PN should also determine when the last pain medication was
administered and the effectiveness of that last dose.
Nystatin administration to an infant - correct answer Nystatin is the most
commonly used antifungal agent for oral candidiasis. When administering
nystatin to an infant, the medication needs to be applied topically by using a
gloved finger to rub the suspension over the infected area.
How do you prevent tissue loss in a client with hyperemia? - correct answer The
presence of reactive hyperemia occurs from pressure causing dilation of
superficial capillaries, and resolves without tissue loss if the pressure if relieved.
The UAP should be instructed in the need to turn the client every 2 hours.
about:blank 1/13
, م9:57 2024/3/30 PN EXIT HESI Rationales
PNs role during a fire alarm - correct answer The PN has the expertise to
determine how to safely transport and evacuate residents with varying medical
problems during a fire alarm.
Intention of droplet precaution - correct answer Droplet precautions are intended
to prevent transmission of pathogens spread through close respiratory or
mucous membrane contact with respiratory secretions and include keeping the
door to the client's room closed.
How should the PN respond to an RN who requested the PN to administer
unlabeled medication that the PN did not draw? - correct answer The PN can
respond in an assertive manner by refusing to administer the medication but
offering to assist the RN with another task. An aggressive response is refusing to
administer the drug while not offering to help in another way.
Slight bleeding during stoma care - correct answer While providing stoma care
with a client, it is a normal occurrence to see a little blood on a washcloth due to
the stoma being a very vascular site.
Upright positioning - correct answer Sitting upright facilities diaphragm
excursion and enhances thoracic and abdominal expansion.
What outdoor game provides socialization for older clients? - correct answer An
outdoor team game of ring-toss provides opportunities for socialization, as well
as exercise. The activity addresses the older clients' psychosocial, interpersonal
and physical needs.
Where is the center of gravity in an elderly client? - correct answer The center of
gravity changes as a person age from the hips to the UPPER TORSO.
Where can hospice care be provided? - correct answer Hospice care can be
provided anywhere the client lives, including in the home, and focuses on
comfort, dignity and emotional support.
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