HESI RN COMPREHENSIVE EXIT EXAM 1.. The nurse completes an admission assessment on a patient with asthma. Which information given by patient is indicates a need for a change in therapy?
a.The patient uses albuterol (Ventolin HFA) before aerobic exercise.
b.The patient says that the asthma symptoms are worse every spring.
c.The patient’s heart rate increases after using the albuterol (Ventolin HFA) inhaler.
d.The patient’s only medications are albuterol (Ventolin HFAl) and salmeterol (Serevent).
ANS: D
Long-acting b2-agonists should be used only in patients who also are using an inhaled corticosteroid for long- term control. Salmeterol should not be used as the first-line therapy for long-term control. Using a bronchodilator before exercise is appropriate. The other information given by the patient requires further assessment by the nurse but is not unusual for a patient with asthma.
2.The nurse takes an admission history on a patient with possible asthma who has new-onset wheezing and shortness of breath. Which information may indicate a need for a change in therapy?
a.The patient has chronic inflammatory bowel disease.
b.The patient has a history of pneumonia 6 months ago.
c.The patient takes propranolol (Inderal) for hypertension.
d.The patient uses acetaminophen (Tylenol) for headaches. ANS: C
b-Blockers such as propranolol can cause bronchospasm in some patients with asthma. The other information will be documented in the health history but does not indicate a need for a change in therapy.
3.A patient newly diagnosed with asthma is being discharged. The nurse anticipates including which topic in the discharge teaching?
Use of long-acting b-adrenergic medications c. Self-administration of inhaled corticosteroids a.
b. Side effects of sustained-release theophylline
d. Complications associated with O2 therapy ANS: C
Inhaled corticosteroids are more effective in improving asthma than any other drug and are indicated for all patients with persistent asthma. The other therapies would not typically be first-line treatments for newly diagnosed asthma.
4.A patient with cystic fibrosis (CF) has blood glucose levels that are consistently between 180 to 250 mg/ dL. Which nursing action will the nurse plan to implement?
a.Discuss the role of diet in blood glucose control.
b.Evaluate the patient’s use of pancreatic enzymes.
c.Teach the patient about administration of insulin.
d.Give oral hypoglycemic medications before meals. ANS: C1 The glucose levels indicate that the patient has developed CF-related diabetes, and insulin therapy is required. Because the etiology of diabetes in CF is inadequate insulin production, oral hypoglycemic agents are not effective. Patients with CF need a high-calorie diet. Inappropriate use of pancreatic enzymes would not be a cause of hyperglycemia in a patient with CF.
5.The nurse assesses a patient with a history of asthma. Which assessment finding indicates that the nurse should take immediate action?
a.Pulse oximetry reading of 91%
b.Respiratory rate of 26 breaths/min
c.Use of accessory muscles in breathing
d.Peak expiratory flow rate of 240
L/min ANS: C
Use of accessory muscle indicates that the patient is experiencing respiratory distress, and rapid intervention is needed. The other data indicate the need for ongoing monitoring and assessment but do not suggest that immediate treatment is required.
6.A patient who has been experiencing an asthma attack develops bradycardia and a decrease in wheezing. Which action should the nurse take first?
a.Notify the health care provider.
b.Document changes in respiratory status.
c.Encourage the patient to cough and deep breathe.
d.Administer IV methylprednisolone (Solu-
Medrol). ANS: A
The patient’s assessment indicates impending respiratory failure, and the nurse should prepare to assist with intubation and mechanical ventilation after notifying the health care provider. IV corticosteroids require several hours before having any effect on respiratory status. The patient will not be able to cough or deep breathe effectively. Documentation is not a priority at this time.
OBJ: Special Questions: Prioritization 36. A patient who is experiencing an acute asthma attack is admitted to the emergency department. Which assessment should the nurse complete first?
a.Listen to the patient’s breath sounds.
b.Ask about inhaled corticosteroid use.
c.Determine when the dyspnea started.
d.Obtain the forced expiratory volume (FEV) flow rate. ANS: A
Assessment of the patient’s breath sounds will help determine how effectively the patient is ventilating and whether rapid intubation may be necessary. The length of time the attack has persisted is not as important as determining the patient’s status at present. Most patients having an acute attack will be unable to cooperate with an FEV measurement. It is important to know about the medications the patient
is using but not as important as assessing the breath sounds. ALL HESI LINKS A V AILABLE
HESI PN MATERNAL NEWBERN OB EXAM (4
VERSIONS) / PN HESI MATERNAL NEWBERN OB2
a.The patient uses albuterol (Ventolin HFA) before aerobic exercise.
b.The patient says that the asthma symptoms are worse every spring.
c.The patient’s heart rate increases after using the albuterol (Ventolin HFA) inhaler.
d.The patient’s only medications are albuterol (Ventolin HFAl) and salmeterol (Serevent).
ANS: D
Long-acting b2-agonists should be used only in patients who also are using an inhaled corticosteroid for long- term control. Salmeterol should not be used as the first-line therapy for long-term control. Using a bronchodilator before exercise is appropriate. The other information given by the patient requires further assessment by the nurse but is not unusual for a patient with asthma.
2.The nurse takes an admission history on a patient with possible asthma who has new-onset wheezing and shortness of breath. Which information may indicate a need for a change in therapy?
a.The patient has chronic inflammatory bowel disease.
b.The patient has a history of pneumonia 6 months ago.
c.The patient takes propranolol (Inderal) for hypertension.
d.The patient uses acetaminophen (Tylenol) for headaches. ANS: C
b-Blockers such as propranolol can cause bronchospasm in some patients with asthma. The other information will be documented in the health history but does not indicate a need for a change in therapy.
3.A patient newly diagnosed with asthma is being discharged. The nurse anticipates including which topic in the discharge teaching?
Use of long-acting b-adrenergic medications c. Self-administration of inhaled corticosteroids a.
b. Side effects of sustained-release theophylline
d. Complications associated with O2 therapy ANS: C
Inhaled corticosteroids are more effective in improving asthma than any other drug and are indicated for all patients with persistent asthma. The other therapies would not typically be first-line treatments for newly diagnosed asthma.
4.A patient with cystic fibrosis (CF) has blood glucose levels that are consistently between 180 to 250 mg/ dL. Which nursing action will the nurse plan to implement?
a.Discuss the role of diet in blood glucose control.
b.Evaluate the patient’s use of pancreatic enzymes.
c.Teach the patient about administration of insulin.
d.Give oral hypoglycemic medications before meals. ANS: C1 The glucose levels indicate that the patient has developed CF-related diabetes, and insulin therapy is required. Because the etiology of diabetes in CF is inadequate insulin production, oral hypoglycemic agents are not effective. Patients with CF need a high-calorie diet. Inappropriate use of pancreatic enzymes would not be a cause of hyperglycemia in a patient with CF.
5.The nurse assesses a patient with a history of asthma. Which assessment finding indicates that the nurse should take immediate action?
a.Pulse oximetry reading of 91%
b.Respiratory rate of 26 breaths/min
c.Use of accessory muscles in breathing
d.Peak expiratory flow rate of 240
L/min ANS: C
Use of accessory muscle indicates that the patient is experiencing respiratory distress, and rapid intervention is needed. The other data indicate the need for ongoing monitoring and assessment but do not suggest that immediate treatment is required.
6.A patient who has been experiencing an asthma attack develops bradycardia and a decrease in wheezing. Which action should the nurse take first?
a.Notify the health care provider.
b.Document changes in respiratory status.
c.Encourage the patient to cough and deep breathe.
d.Administer IV methylprednisolone (Solu-
Medrol). ANS: A
The patient’s assessment indicates impending respiratory failure, and the nurse should prepare to assist with intubation and mechanical ventilation after notifying the health care provider. IV corticosteroids require several hours before having any effect on respiratory status. The patient will not be able to cough or deep breathe effectively. Documentation is not a priority at this time.
OBJ: Special Questions: Prioritization 36. A patient who is experiencing an acute asthma attack is admitted to the emergency department. Which assessment should the nurse complete first?
a.Listen to the patient’s breath sounds.
b.Ask about inhaled corticosteroid use.
c.Determine when the dyspnea started.
d.Obtain the forced expiratory volume (FEV) flow rate. ANS: A
Assessment of the patient’s breath sounds will help determine how effectively the patient is ventilating and whether rapid intubation may be necessary. The length of time the attack has persisted is not as important as determining the patient’s status at present. Most patients having an acute attack will be unable to cooperate with an FEV measurement. It is important to know about the medications the patient
is using but not as important as assessing the breath sounds. ALL HESI LINKS A V AILABLE
HESI PN MATERNAL NEWBERN OB EXAM (4
VERSIONS) / PN HESI MATERNAL NEWBERN OB2
