HESI Remediation RN
Pharmacology Cassandra
Thompson
• While supervising the LPN’s technique with medication administration, the nurse
manager sees the LPN beginning to dispense an incorrect dose. How should the nurse
manager respond initially?
Because the nurse is supervising, not evaluating, the LPN, questioning the dosage rather than
pointing out the error is a positive approach that will allow the LPN to grow and help foster a
supportive working relationship.
• What instructions should the nurse give to the parents of a toddler?
The nurse should instruct the parents to serve finger foods to the child. This allows the
toddler to feed herself and satisfy her need for independence and control. The nurse should
instruct the parents to provide graded independence to their child, allowing the toddler to
do things that do not result in harm to herself or others.
• The parents of a 2-year-old child who is being admitted to the hospital tell the nurse that
their child is accustomed to sleeping with a favorite blanket. What should the nurse do,
knowing that the blanket is worn and dirty?
The blanket represents a security object to the child, who needs security in the unfamiliar
setting of a hospital. Refusing to allow the parents to leave the blanket is insensitive because it
ignores the emotional needs of the child.
• The nurse is assessing a term newborn. Which sign should the nurse report to the
pediatric primary healthcare provider?
A breathing pattern with recurrent sternal retractions is indicative of respiratory distress; the
expected pattern is abdominal with synchronous chest movement.
• A client diagnosed with adrenal gland hypofunction is receiving fludrocortisone
therapy. Which nursing intervention would help the client reduce the risk of
complications?
Fludrocortisone, prednisone, and cortisone are the drugs prescribed for the treatment of
adrenal gland hypofunction. During fludrocortisone therapy, the blood pressure of the client
should be regularly monitored because fludrocortisone has a potential to cause hypertension.
Client Needs
Reduction of Risk Potential
• Immediately after receiving spinal anesthesia a client develops hypotension. To what
physiologic change does the nurse attribute the decreased blood pressure?
,Paralysis of the sympathetic vasomotor nerves after administration of a spinal anesthetic
results in dilation of blood vessels, which causes a subsequent decrease in blood pressure.
• A client at 37 weeks’ gestation is admitted to the birthing unit from the emergency
department. She arrived in an ambulance after a motor vehicle accident. Her blood pressure
is 90/60 mm Hg, pulse is 108 beats/min, and respiratory rate is 24 breaths/min. She is
reporting sharp abdominal pain. What is the priority nursing intervention at this time?
The client’s clinical manifestations suggest abruptio placentae, and her vital signs
indicate that shock may be occurring; determining fetal viability so that appropriate
treatment may be instituted immediately is the priority.
• A 10-year-old child undergoes open heart surgery to repair a cardiac defect. The
healthcare provider informs the parents that antibiotics are required before any dental
work is performed. Later the parents ask the nurse why this is necessary. When
responding, the nurse explains that this is done to prevent what type of infection?
The administration of antibiotics before an invasive procedure can prevent subacute
bacterial endocarditis, which may occur in children and adults with heart abnormalities. The
endocardium is the lining membrane of the cavities of the heart and the connective tissue bed
on which it lies.
• A school-aged child is admitted to the hospital with severe burns on the arms.
Therapeutic escharotomy is planned. What is the priority nursing action at this time?
Eschar is rigid and may restrict circulation and lead to loss of limb perfusion.
• A nurse obtains daily stool specimens for a client with chronic bowel inflammation.
What does the nurse determine is the reason these stool examinations were prescribed?
Occult blood in the stool may indicate active bleeding.
Nursing Process
Planning
• What is a priority nursing intervention in the care of a drug-dependent mother and
infant?
A nurse should attempt to support the mother-child relationship; the mother is experiencing a
developmental crisis while coping with drug addiction and possibly guilt. It is the client's
right to decide who will share in the care of her child. The client needs contact with her new
infant to facilitate bonding. Helping the mother understand that the infant's problems are a
result of her drug intake will make the client feel guilty and will not facilitate positive action
at this point.
• A monoamine oxidase inhibitor (MAOI) is prescribed, and the nurse is formulating a
teaching plan. What will the nurse instruct the client to avoid while taking this drug? An
MAOI can cause hypertensive crisis if food or beverages that are high in tyramine, such as
fermented foods, are ingested. Prolonged exposure to the sun is hazardous for clients taking
, one of the phenothiazines. Strenuous physical exercise is not contraindicated.
Antihistamines are not prohibited with MAOI medications.
• What is the priority nursing objective of the therapeutic psychiatric environment for a
confused client?
The therapeutic milieu is directed toward helping the client develop effective ways of
functioning safely and independently. Helping the client relate to others is one small part of
the overall objectives. The therapeutic milieu allows some items from home to make the
client less anxious; however, the objective is not to duplicate a home situation.
Helping the client become accepted in a controlled setting is a worthwhile objective but not
as important as working toward the maximal degree of safe, independent function.
• The nurse is caring for a client with cancer of the rectum that is scheduled for an
abdominoperineal resection with the creation of a colostomy. For which type of surgery does
the nurse prepare the client?
When intestinal continuity cannot be restored after removal of the anus, rectum, and adjacent
colon (abdominoperineal resection), a permanent colostomy is formed. The ascending
segment of the colon lies on the right side of the abdomen and has no anatomical proximity to
the rectum. Temporary double-barrel colostomy is performed to allow a segment of colon to
heal; intestinal continuity is restored eventually. Temporary transverse loop colostomy
commonly is performed for inflammation of the colon when intestinal continuity eventually
can be restored.
• A client who is in preterm labor at 34 weeks’ gestation is receiving intravenous tocolytic
therapy. The frequency of her contractions increases to every 10 minutes, and her cervix
dilates to 4 cm. The infusion is discontinued. Toward what outcome should the priority
nursing care be directed at this time?
Labor is continuing, and promotion of the well-being of both client and fetus is the priority
nursing care during this period. Reduction of anxiety associated with preterm labor,
supportive communication with the client and her partner, and helping the family cope with
the impending preterm birth each address just one aspect of this client’s needs and must be
dealt with in the context of the priority need.
Clinical Concepts- Med Surg
Neurologic and Sensory Systems
• What are the reasons for performing a lumbar puncture on a client?
A lumbar puncture is the insertion of a spinal needle into the subarachnoid space between the
third and fourth lumbar vertebrae; it can be used to obtain cerebrospinal fluid readings with a
manometer. Using a lumbar puncture, contrast medium or air is injected for diagnostic study.
Evoked potentials measure the electrical signals to the brain generated
by sound, light, or touch, and are used to confirm neurologic conditions like spinal cord
injuries and multiple sclerosis. Evoked potentials are also used to assess sensory nerve
Pharmacology Cassandra
Thompson
• While supervising the LPN’s technique with medication administration, the nurse
manager sees the LPN beginning to dispense an incorrect dose. How should the nurse
manager respond initially?
Because the nurse is supervising, not evaluating, the LPN, questioning the dosage rather than
pointing out the error is a positive approach that will allow the LPN to grow and help foster a
supportive working relationship.
• What instructions should the nurse give to the parents of a toddler?
The nurse should instruct the parents to serve finger foods to the child. This allows the
toddler to feed herself and satisfy her need for independence and control. The nurse should
instruct the parents to provide graded independence to their child, allowing the toddler to
do things that do not result in harm to herself or others.
• The parents of a 2-year-old child who is being admitted to the hospital tell the nurse that
their child is accustomed to sleeping with a favorite blanket. What should the nurse do,
knowing that the blanket is worn and dirty?
The blanket represents a security object to the child, who needs security in the unfamiliar
setting of a hospital. Refusing to allow the parents to leave the blanket is insensitive because it
ignores the emotional needs of the child.
• The nurse is assessing a term newborn. Which sign should the nurse report to the
pediatric primary healthcare provider?
A breathing pattern with recurrent sternal retractions is indicative of respiratory distress; the
expected pattern is abdominal with synchronous chest movement.
• A client diagnosed with adrenal gland hypofunction is receiving fludrocortisone
therapy. Which nursing intervention would help the client reduce the risk of
complications?
Fludrocortisone, prednisone, and cortisone are the drugs prescribed for the treatment of
adrenal gland hypofunction. During fludrocortisone therapy, the blood pressure of the client
should be regularly monitored because fludrocortisone has a potential to cause hypertension.
Client Needs
Reduction of Risk Potential
• Immediately after receiving spinal anesthesia a client develops hypotension. To what
physiologic change does the nurse attribute the decreased blood pressure?
,Paralysis of the sympathetic vasomotor nerves after administration of a spinal anesthetic
results in dilation of blood vessels, which causes a subsequent decrease in blood pressure.
• A client at 37 weeks’ gestation is admitted to the birthing unit from the emergency
department. She arrived in an ambulance after a motor vehicle accident. Her blood pressure
is 90/60 mm Hg, pulse is 108 beats/min, and respiratory rate is 24 breaths/min. She is
reporting sharp abdominal pain. What is the priority nursing intervention at this time?
The client’s clinical manifestations suggest abruptio placentae, and her vital signs
indicate that shock may be occurring; determining fetal viability so that appropriate
treatment may be instituted immediately is the priority.
• A 10-year-old child undergoes open heart surgery to repair a cardiac defect. The
healthcare provider informs the parents that antibiotics are required before any dental
work is performed. Later the parents ask the nurse why this is necessary. When
responding, the nurse explains that this is done to prevent what type of infection?
The administration of antibiotics before an invasive procedure can prevent subacute
bacterial endocarditis, which may occur in children and adults with heart abnormalities. The
endocardium is the lining membrane of the cavities of the heart and the connective tissue bed
on which it lies.
• A school-aged child is admitted to the hospital with severe burns on the arms.
Therapeutic escharotomy is planned. What is the priority nursing action at this time?
Eschar is rigid and may restrict circulation and lead to loss of limb perfusion.
• A nurse obtains daily stool specimens for a client with chronic bowel inflammation.
What does the nurse determine is the reason these stool examinations were prescribed?
Occult blood in the stool may indicate active bleeding.
Nursing Process
Planning
• What is a priority nursing intervention in the care of a drug-dependent mother and
infant?
A nurse should attempt to support the mother-child relationship; the mother is experiencing a
developmental crisis while coping with drug addiction and possibly guilt. It is the client's
right to decide who will share in the care of her child. The client needs contact with her new
infant to facilitate bonding. Helping the mother understand that the infant's problems are a
result of her drug intake will make the client feel guilty and will not facilitate positive action
at this point.
• A monoamine oxidase inhibitor (MAOI) is prescribed, and the nurse is formulating a
teaching plan. What will the nurse instruct the client to avoid while taking this drug? An
MAOI can cause hypertensive crisis if food or beverages that are high in tyramine, such as
fermented foods, are ingested. Prolonged exposure to the sun is hazardous for clients taking
, one of the phenothiazines. Strenuous physical exercise is not contraindicated.
Antihistamines are not prohibited with MAOI medications.
• What is the priority nursing objective of the therapeutic psychiatric environment for a
confused client?
The therapeutic milieu is directed toward helping the client develop effective ways of
functioning safely and independently. Helping the client relate to others is one small part of
the overall objectives. The therapeutic milieu allows some items from home to make the
client less anxious; however, the objective is not to duplicate a home situation.
Helping the client become accepted in a controlled setting is a worthwhile objective but not
as important as working toward the maximal degree of safe, independent function.
• The nurse is caring for a client with cancer of the rectum that is scheduled for an
abdominoperineal resection with the creation of a colostomy. For which type of surgery does
the nurse prepare the client?
When intestinal continuity cannot be restored after removal of the anus, rectum, and adjacent
colon (abdominoperineal resection), a permanent colostomy is formed. The ascending
segment of the colon lies on the right side of the abdomen and has no anatomical proximity to
the rectum. Temporary double-barrel colostomy is performed to allow a segment of colon to
heal; intestinal continuity is restored eventually. Temporary transverse loop colostomy
commonly is performed for inflammation of the colon when intestinal continuity eventually
can be restored.
• A client who is in preterm labor at 34 weeks’ gestation is receiving intravenous tocolytic
therapy. The frequency of her contractions increases to every 10 minutes, and her cervix
dilates to 4 cm. The infusion is discontinued. Toward what outcome should the priority
nursing care be directed at this time?
Labor is continuing, and promotion of the well-being of both client and fetus is the priority
nursing care during this period. Reduction of anxiety associated with preterm labor,
supportive communication with the client and her partner, and helping the family cope with
the impending preterm birth each address just one aspect of this client’s needs and must be
dealt with in the context of the priority need.
Clinical Concepts- Med Surg
Neurologic and Sensory Systems
• What are the reasons for performing a lumbar puncture on a client?
A lumbar puncture is the insertion of a spinal needle into the subarachnoid space between the
third and fourth lumbar vertebrae; it can be used to obtain cerebrospinal fluid readings with a
manometer. Using a lumbar puncture, contrast medium or air is injected for diagnostic study.
Evoked potentials measure the electrical signals to the brain generated
by sound, light, or touch, and are used to confirm neurologic conditions like spinal cord
injuries and multiple sclerosis. Evoked potentials are also used to assess sensory nerve
