Hesi Management Exam 2023
In application of the principles of pain treatment, what is the first consideration? Ans- The client's
perception of pain must be accepted.
The client must be believed, and his or her experience of pain must be acknowledged as valid. The data
gathered via client reports can then be applied to the other options in developing the treatment plan.
When an analgesic is titrated to manage pain, what is the priority goal? Ans- Titrate to the smallest dose
that provides relief with the fewest side effects.
The goal is to control pain while minimizing side effects. For severe pain, the medication can be titrated
upward until the pain is controlled. Downward titration occurs when the pain begins to subside.
Adequate dosing is important; however, the concept of controlled dosing applies more to potent
vasoactive drugs.
Which client is at greatest risk for respiratory depression while receiving opioids for analgesia? Ans-
Child with an arm fracture and cystic fibrosis
At greatest risk are elderly clients, opiate-naive clients, and those with underlying pulmonary disease.
The child has two of the three risk factors.
A client is crying and grimacing but denies pain and refuses pain medication, because "my sibling is a
drug addict and has ruined our lives." What is the priority intervention for this client? Ans- Encourage
expression of fears and past experiences.
This client has strong beliefs and emotions related to the issue of the sibling's addiction. First, encourage
expression. This indicates to the client that the feelings are real and valid. It is also an opportunity to
assess beliefs and fears. Giving facts and information is appropriate at the right time. Family
involvement is important, but it should be kept in mind that their beliefs about drug addiction may be
similar to those of the client.
,The physician has ordered a placebo for a client with chronic pain. You are a newly hired nurse and you
feel very uncomfortable administering the medication. What is the first action that you should take?
Ans- Contact the charge nurse for advice.
Administering placebos is generally considered unethical. Consult the charge nurse as a resource person
who can help you clarify the situation and locate and review the hospital policy. If the physician is
insistent, suggest that he or she could give the placebo. (Note: Use "could," not "should" when talking to
the physician. This provides a small opportunity to rethink the decision. "Should" is more commanding
and elicits a more defensive response.) While following your own ethical code is correct, you must
ensure that the client is not abandoned and that care continues.
For a cognitively impaired client who cannot accurately report pain, what is the first action that you
should take? Ans- Obtain baseline behavioral indicators from family members.
Complete information should be obtained from the family during the initial comprehensive history
taking and assessment. If this information is not obtained, the nursing staff will have to rely on
observation of nonverbal behavior and careful documentation to determine pain and relief patterns.
Which patient is at greatest risk for pancreatic cancer? Ans- An elderly African-American man who
smokes
Pancreatic cancer is more common in African-Americans, males, and smokers. Other associated factors
include alcohol use, diabetes, obesity, history of pancreatitis, exposure to organic chemicals,
consumption of a high-fat diet, and previous abdominal irradiation.
Patients receiving chemotherapy are at risk for thrombocytopenia related to chemotherapy or disease
processes. Which actions are needed for patients who must be placed on bleeding precautions? (Select
all that apply.) Ans- Mouthwash should not include alcohol, because it has a drying action that leaves
mucous membranes more vulnerable. Insertion of suppositories, probes, or tampons into the rectal or
vaginal cavity is not recommended. All other options are appropriate.
For care of a patient who has oral cancer, which task would be appropriate to delegate to an LPN/LVN?
Ans- Giving antacids and sucralfate suspension as ordered
, Giving medications is within the scope of practice of the LPN/LVN. Assisting the patient in brushing and
flossing should be delegated to the UAP. Explaining contraindications is the responsibility of the RN.
Recommendations for saliva substitutes should come from the physician or pharmacist.
When staff assignments are made for the care of patients who are receiving chemotherapy, what is the
major consideration regarding chemotherapeutic drugs? Ans- During preparation, drugs may be
absorbed through the skin or inhaled.
Chemotherapy drugs should be given by nurses who have received additional training in how to safely
prepare and deliver the drugs and protect themselves and others from exposure. The other options
express concerns, but the general principles of drug administration apply.
You are monitoring your patient who is at risk for spinal cord compression related to tumor growth.
Which patient statement is most likely to suggest an early manifestation? Ans- "Last night my back really
hurt, and I had trouble sleeping."
Back pain is an early sign of spinal cord compression occurring in 95% of patients. The other symptoms
are later signs.
You are caring for an older woman with hepatic cancer. The UAP informs you that the patient's level of
consciousness is diminished compared to earlier in the shift. Prioritize the steps of assessment and
intervention related to this patient's change of mental status. Ans- Determine level of consciousness and
responsiveness, and changes from baseline. Oxygen should be administered immediately in the
presence of respiratory distress or risk for decreased oxygenation and perfusion. Pulse oximetry can be
used for continuous monitoring. Adequate pulse, blood pressure, and respirations are required for
cerebral perfusion. Increased temperature may signal infection or sepsis. Blood glucose levels should be
checked even if the patient is not diabetic. Severe hypoglycemia should be immediately treated per
protocol. A patent IV line may be needed for delivery of emergency drugs. Electrolyte and ammonia
levels are relevant data for this patient, and abnormalities in these parameters may be contributing to
change in mental status. (Note: Laboratory results [i.e., electrolytes and ammonia levels] may be
concurrently available; however, you should train yourself to systematically look at data. Look at
electrolytes first because these are more commonly ordered. In some cases, you may actually have to
remind the physician to order the ammonia level if the patient with a hepatic disorder is having a
change in mental status.)
Which two cancer patients could potentially be placed together as roommates? Ans- A patient who
underwent debulking of a tumor to relieve pressure
In application of the principles of pain treatment, what is the first consideration? Ans- The client's
perception of pain must be accepted.
The client must be believed, and his or her experience of pain must be acknowledged as valid. The data
gathered via client reports can then be applied to the other options in developing the treatment plan.
When an analgesic is titrated to manage pain, what is the priority goal? Ans- Titrate to the smallest dose
that provides relief with the fewest side effects.
The goal is to control pain while minimizing side effects. For severe pain, the medication can be titrated
upward until the pain is controlled. Downward titration occurs when the pain begins to subside.
Adequate dosing is important; however, the concept of controlled dosing applies more to potent
vasoactive drugs.
Which client is at greatest risk for respiratory depression while receiving opioids for analgesia? Ans-
Child with an arm fracture and cystic fibrosis
At greatest risk are elderly clients, opiate-naive clients, and those with underlying pulmonary disease.
The child has two of the three risk factors.
A client is crying and grimacing but denies pain and refuses pain medication, because "my sibling is a
drug addict and has ruined our lives." What is the priority intervention for this client? Ans- Encourage
expression of fears and past experiences.
This client has strong beliefs and emotions related to the issue of the sibling's addiction. First, encourage
expression. This indicates to the client that the feelings are real and valid. It is also an opportunity to
assess beliefs and fears. Giving facts and information is appropriate at the right time. Family
involvement is important, but it should be kept in mind that their beliefs about drug addiction may be
similar to those of the client.
,The physician has ordered a placebo for a client with chronic pain. You are a newly hired nurse and you
feel very uncomfortable administering the medication. What is the first action that you should take?
Ans- Contact the charge nurse for advice.
Administering placebos is generally considered unethical. Consult the charge nurse as a resource person
who can help you clarify the situation and locate and review the hospital policy. If the physician is
insistent, suggest that he or she could give the placebo. (Note: Use "could," not "should" when talking to
the physician. This provides a small opportunity to rethink the decision. "Should" is more commanding
and elicits a more defensive response.) While following your own ethical code is correct, you must
ensure that the client is not abandoned and that care continues.
For a cognitively impaired client who cannot accurately report pain, what is the first action that you
should take? Ans- Obtain baseline behavioral indicators from family members.
Complete information should be obtained from the family during the initial comprehensive history
taking and assessment. If this information is not obtained, the nursing staff will have to rely on
observation of nonverbal behavior and careful documentation to determine pain and relief patterns.
Which patient is at greatest risk for pancreatic cancer? Ans- An elderly African-American man who
smokes
Pancreatic cancer is more common in African-Americans, males, and smokers. Other associated factors
include alcohol use, diabetes, obesity, history of pancreatitis, exposure to organic chemicals,
consumption of a high-fat diet, and previous abdominal irradiation.
Patients receiving chemotherapy are at risk for thrombocytopenia related to chemotherapy or disease
processes. Which actions are needed for patients who must be placed on bleeding precautions? (Select
all that apply.) Ans- Mouthwash should not include alcohol, because it has a drying action that leaves
mucous membranes more vulnerable. Insertion of suppositories, probes, or tampons into the rectal or
vaginal cavity is not recommended. All other options are appropriate.
For care of a patient who has oral cancer, which task would be appropriate to delegate to an LPN/LVN?
Ans- Giving antacids and sucralfate suspension as ordered
, Giving medications is within the scope of practice of the LPN/LVN. Assisting the patient in brushing and
flossing should be delegated to the UAP. Explaining contraindications is the responsibility of the RN.
Recommendations for saliva substitutes should come from the physician or pharmacist.
When staff assignments are made for the care of patients who are receiving chemotherapy, what is the
major consideration regarding chemotherapeutic drugs? Ans- During preparation, drugs may be
absorbed through the skin or inhaled.
Chemotherapy drugs should be given by nurses who have received additional training in how to safely
prepare and deliver the drugs and protect themselves and others from exposure. The other options
express concerns, but the general principles of drug administration apply.
You are monitoring your patient who is at risk for spinal cord compression related to tumor growth.
Which patient statement is most likely to suggest an early manifestation? Ans- "Last night my back really
hurt, and I had trouble sleeping."
Back pain is an early sign of spinal cord compression occurring in 95% of patients. The other symptoms
are later signs.
You are caring for an older woman with hepatic cancer. The UAP informs you that the patient's level of
consciousness is diminished compared to earlier in the shift. Prioritize the steps of assessment and
intervention related to this patient's change of mental status. Ans- Determine level of consciousness and
responsiveness, and changes from baseline. Oxygen should be administered immediately in the
presence of respiratory distress or risk for decreased oxygenation and perfusion. Pulse oximetry can be
used for continuous monitoring. Adequate pulse, blood pressure, and respirations are required for
cerebral perfusion. Increased temperature may signal infection or sepsis. Blood glucose levels should be
checked even if the patient is not diabetic. Severe hypoglycemia should be immediately treated per
protocol. A patent IV line may be needed for delivery of emergency drugs. Electrolyte and ammonia
levels are relevant data for this patient, and abnormalities in these parameters may be contributing to
change in mental status. (Note: Laboratory results [i.e., electrolytes and ammonia levels] may be
concurrently available; however, you should train yourself to systematically look at data. Look at
electrolytes first because these are more commonly ordered. In some cases, you may actually have to
remind the physician to order the ammonia level if the patient with a hepatic disorder is having a
change in mental status.)
Which two cancer patients could potentially be placed together as roommates? Ans- A patient who
underwent debulking of a tumor to relieve pressure
