NUR 206 COMMUNITY HESI EXAM 2
2023-2024 ACTUAL EXAM ALL 270
QUESTIONS AND CORRECT DETAILED
ANSWERS
The nurse teaches a patient about pursed lip breathing. Which action by the
patient would indicate to the nurse that further teaching is needed?
The patient practices by blowing through a straw.
The patient's ratio of inhalation to exhalation is 1:3.
The patient inhales slowly through the nose.
The patient puffs up the cheeks while exhaling. - ANSWER>>4
A 55-year-old patient with increasing dyspnea is being evaluated for a possible
diagnosis of chronic obstructive pulmonary disease (COPD). When teaching a
patient about pulmonary function testing (PFT) for this condition, what is the
most important question the nurse should ask?
"Do you have any metal implants or prostheses?"
"Have you taken any bronchodilators in the past 6 hours?"
"Are you claustrophobic?"
"Are you allergic to shellfish?" - ANSWER>>2
,A patient has just been admitted with probable bacterial pneumonia and sepsis.
Which order should the nurse implement first?
Ciprofloxacin (Cipro) 400 mg IV
Acetaminophen (Tylenol) rectal suppository
Chest x-ray via stretcher
Blood cultures from two sites - ANSWER>>4
A patient hospitalized with chronic obstructive pulmonary disease (COPD) is
being discharged home on oxygen therapy. Which instruction should the nurse
include in the discharge teaching?
Oxygen flow should be increased if the patient has more dyspnea.
Oxygen use can improve the patient's prognosis and quality of life.
Storage of oxygen tanks will require adequate space in the home.
Travel opportunities will be limited because of the use of oxygen. - ANSWER>>2
A client in the emergency department is taking rifampin (Rifadin) for
tuberculosis. The client reports yellowing of the sclera and skin and bleeding
after minor trauma. What laboratory results correlate to this condition? (Select
all that apply.)
White blood cell (WBC) count: 72,000/mm
Prothrombin time: 35 seconds
Serum sodium: 130 mEq/L
,Blood urea nitrogen (BUN): 19 mg/dL
International normalized ratio (INR): 6.3 - ANSWER>>2,4,5
A patient who is experiencing an acute asthma attack is admitted to the
emergency department. Which assessment should the nurse complete first?
Determine when the dyspnea started.
Obtain the forced expiratory volume (FEV) flow rate.
Listen to the patient's breath sounds.
Ask about inhaled corticosteroid use. - ANSWER>>3
A patient with a tracheostomy has a new order for a fenestrated tracheostomy
tube. Which action should the nurse include in the plan of care in collaboration
with the speech therapist?
Assess the ability to swallow before using the fenestrated tube.
Inflate the tracheostomy cuff during use of the fenestrated tube.
Leave the tracheostomy inner cannula inserted at all times.
Place the decannulation cap in the tube before cuff deflation. - ANSWER>>1
An alcoholic and homeless patient is diagnosed with active tuberculosis (TB).
Which intervention by the nurse will be most effective in ensuring adherence
with the treatment regimen?
, Teach the patient about the high risk for infecting others unless treatment is
followed.
Arrange for a daily noon meal at a community center where the drug will be
administered.
Arrange for a friend to administer the medication on schedule.
Give the patient written instructions about how to take the medications. -
ANSWER>>2
A lobectomy is scheduled for a patient with stage I non-small cell lung cancer.
The patient tells the nurse, "I would rather have chemotherapy than surgery."
Which response by the nurse is most appropriate?
"Surgery is the treatment of choice for stage I lung cancer."
"Tell me what you know about the various treatments available."
"Are you afraid that the surgery will be very painful?"
"Did you have bad experiences with previous surgeries?" - ANSWER>>2
A nurse assesses a client who has a chest tube. For which manifestations should
the nurse immediately intervene? (Select all that apply.)
Drainage of 75 mL/hr
Tracheal deviation
Production of pink sputum
Pain at insertion site
2023-2024 ACTUAL EXAM ALL 270
QUESTIONS AND CORRECT DETAILED
ANSWERS
The nurse teaches a patient about pursed lip breathing. Which action by the
patient would indicate to the nurse that further teaching is needed?
The patient practices by blowing through a straw.
The patient's ratio of inhalation to exhalation is 1:3.
The patient inhales slowly through the nose.
The patient puffs up the cheeks while exhaling. - ANSWER>>4
A 55-year-old patient with increasing dyspnea is being evaluated for a possible
diagnosis of chronic obstructive pulmonary disease (COPD). When teaching a
patient about pulmonary function testing (PFT) for this condition, what is the
most important question the nurse should ask?
"Do you have any metal implants or prostheses?"
"Have you taken any bronchodilators in the past 6 hours?"
"Are you claustrophobic?"
"Are you allergic to shellfish?" - ANSWER>>2
,A patient has just been admitted with probable bacterial pneumonia and sepsis.
Which order should the nurse implement first?
Ciprofloxacin (Cipro) 400 mg IV
Acetaminophen (Tylenol) rectal suppository
Chest x-ray via stretcher
Blood cultures from two sites - ANSWER>>4
A patient hospitalized with chronic obstructive pulmonary disease (COPD) is
being discharged home on oxygen therapy. Which instruction should the nurse
include in the discharge teaching?
Oxygen flow should be increased if the patient has more dyspnea.
Oxygen use can improve the patient's prognosis and quality of life.
Storage of oxygen tanks will require adequate space in the home.
Travel opportunities will be limited because of the use of oxygen. - ANSWER>>2
A client in the emergency department is taking rifampin (Rifadin) for
tuberculosis. The client reports yellowing of the sclera and skin and bleeding
after minor trauma. What laboratory results correlate to this condition? (Select
all that apply.)
White blood cell (WBC) count: 72,000/mm
Prothrombin time: 35 seconds
Serum sodium: 130 mEq/L
,Blood urea nitrogen (BUN): 19 mg/dL
International normalized ratio (INR): 6.3 - ANSWER>>2,4,5
A patient who is experiencing an acute asthma attack is admitted to the
emergency department. Which assessment should the nurse complete first?
Determine when the dyspnea started.
Obtain the forced expiratory volume (FEV) flow rate.
Listen to the patient's breath sounds.
Ask about inhaled corticosteroid use. - ANSWER>>3
A patient with a tracheostomy has a new order for a fenestrated tracheostomy
tube. Which action should the nurse include in the plan of care in collaboration
with the speech therapist?
Assess the ability to swallow before using the fenestrated tube.
Inflate the tracheostomy cuff during use of the fenestrated tube.
Leave the tracheostomy inner cannula inserted at all times.
Place the decannulation cap in the tube before cuff deflation. - ANSWER>>1
An alcoholic and homeless patient is diagnosed with active tuberculosis (TB).
Which intervention by the nurse will be most effective in ensuring adherence
with the treatment regimen?
, Teach the patient about the high risk for infecting others unless treatment is
followed.
Arrange for a daily noon meal at a community center where the drug will be
administered.
Arrange for a friend to administer the medication on schedule.
Give the patient written instructions about how to take the medications. -
ANSWER>>2
A lobectomy is scheduled for a patient with stage I non-small cell lung cancer.
The patient tells the nurse, "I would rather have chemotherapy than surgery."
Which response by the nurse is most appropriate?
"Surgery is the treatment of choice for stage I lung cancer."
"Tell me what you know about the various treatments available."
"Are you afraid that the surgery will be very painful?"
"Did you have bad experiences with previous surgeries?" - ANSWER>>2
A nurse assesses a client who has a chest tube. For which manifestations should
the nurse immediately intervene? (Select all that apply.)
Drainage of 75 mL/hr
Tracheal deviation
Production of pink sputum
Pain at insertion site
