BSN 246 Practice HESI (1 & 2)
1. The registered nurse (RN) is caring 140 mg/dl. for a
young adult who is having an oral glucose tolerance
tests (OGTT). Rationale
Which laboratory result should the The two hour postprandial level should be less
140 RN assess as a normal value for the mg/dl for a young adult client. two hour
postprandial result?
140 mg/dl.
160 mg/dl.
180 mg/dl.
200 mg/dl.
2. The registered nurse (RN) is caring Polydipsia. for a
client who has a closed head
injury from a motor vehicle collision. Rationale
Which finding should the RN assess A characteristic finding of DI is excretion of large
quanthe client for the risk of diabetes in- tities of urine (5 to 20L/day), and most
clients com-
sipidus (DI)? pensate for fluid loss by drinking large amounts of
water (polydipsia). DI can occur when there has been
High fever. damage or injury to the pituitary gland or hypothalLow blood pressure.
amus as a result of head trauma, tumor or an illness
Muscle rigidity. such as meningitis. This damage interrupts the ADH
Polydipsia. production, storage and release causing the excessive
urination and thirst.
3. The registered nurse (RN) is caring Urine output of
40 mL/hour.
for a client who developed oliguria and was diagnosed with sepsis and Rationale
dehydration 48 hours ago. Which A decrease in urinary output is a sign of
, BSN 246 Practice HESI (1 & 2)
dehydration. assessment finding indicates to the When the urine output returns to
a normal range, 40
RN that the client is stabilizing? mL/hour, the client's kidneys are perfusing
adequately
and indicates the client's status is stablizing.
Urine output of 40 mL/hour.
Apical pulse 100 and blood pressure 76/42.
Urine specific gravity 1.001. Tented
skin on dorsal surface of hands.
4. A client who is uses ipratropium Withhold medication and report symptoms and
vital reports having nausea, blurred vi- signs to healthcare provider.
sion, headaches, and insomnia after using the
inhaler. Which action Rationale
should the registered nurse (RN) im- Headache, nausea, blurred vision and insomnia
are plement first? symptoms of excessive use of ipratropium, so with-
holding the medication until the
healthcare provider is Withhold medication and report notified should be initiated
to maintain client safety.
symptoms and vital signs to healthcare
provider.
Give PRN medication for nausea and
vomiting and evaluate client in 30
minutes.
Reassure client that the ipratropium given will
alleviate the symptoms.
, BSN 246 Practice HESI (1 & 2)
Delay administration of ipratropium until
next maintenance medication is
scheduled.
5. The registered nurse (RN) is assess- Sphygmomanometer.
ing a client who was discharged home after
management of chron- Rationale
ic hypertension. Which equipment Self-awareness is the best way for a client to
manage should the RN instruct the client to chronic hypertension, so the client
should obtain a
use at home? sphygmomanometer and learn how to monitor blood Exercise
bicycle. pressure daily and maintain a record.
Sphygmomanometer.
Blood glucose monitor.
Weekly medication box.
6. The registered nurse (RN) is teach- Promotes CO2 elimination.
ing a client who is newly diagnosed
with emphysema how to perform Rationale
pursed lip breathing. What is the pri- Pursed lip breathing helps eliminate CO2 by
increasmary reason for teaching the client ing positive pressure within the alveoli
increasing the this method of breathing? surface area of the alveoli making it
easier for the O2 Decreases respiratory rate. and CO2 gas exchange to occur .
Increases O2 saturation throughout the monoamine oxidase inhibitor
body. (MAOI), for a client on the
Conserves energy while ambulating. psychiatric unit with depression.
Promotes CO2 elimination. Which information is most
7. The registered nurse (RN) reviews the important for the RN to assess?
new prescription, phenelzine (Nardil), a
1. The registered nurse (RN) is caring 140 mg/dl. for a
young adult who is having an oral glucose tolerance
tests (OGTT). Rationale
Which laboratory result should the The two hour postprandial level should be less
140 RN assess as a normal value for the mg/dl for a young adult client. two hour
postprandial result?
140 mg/dl.
160 mg/dl.
180 mg/dl.
200 mg/dl.
2. The registered nurse (RN) is caring Polydipsia. for a
client who has a closed head
injury from a motor vehicle collision. Rationale
Which finding should the RN assess A characteristic finding of DI is excretion of large
quanthe client for the risk of diabetes in- tities of urine (5 to 20L/day), and most
clients com-
sipidus (DI)? pensate for fluid loss by drinking large amounts of
water (polydipsia). DI can occur when there has been
High fever. damage or injury to the pituitary gland or hypothalLow blood pressure.
amus as a result of head trauma, tumor or an illness
Muscle rigidity. such as meningitis. This damage interrupts the ADH
Polydipsia. production, storage and release causing the excessive
urination and thirst.
3. The registered nurse (RN) is caring Urine output of
40 mL/hour.
for a client who developed oliguria and was diagnosed with sepsis and Rationale
dehydration 48 hours ago. Which A decrease in urinary output is a sign of
, BSN 246 Practice HESI (1 & 2)
dehydration. assessment finding indicates to the When the urine output returns to
a normal range, 40
RN that the client is stabilizing? mL/hour, the client's kidneys are perfusing
adequately
and indicates the client's status is stablizing.
Urine output of 40 mL/hour.
Apical pulse 100 and blood pressure 76/42.
Urine specific gravity 1.001. Tented
skin on dorsal surface of hands.
4. A client who is uses ipratropium Withhold medication and report symptoms and
vital reports having nausea, blurred vi- signs to healthcare provider.
sion, headaches, and insomnia after using the
inhaler. Which action Rationale
should the registered nurse (RN) im- Headache, nausea, blurred vision and insomnia
are plement first? symptoms of excessive use of ipratropium, so with-
holding the medication until the
healthcare provider is Withhold medication and report notified should be initiated
to maintain client safety.
symptoms and vital signs to healthcare
provider.
Give PRN medication for nausea and
vomiting and evaluate client in 30
minutes.
Reassure client that the ipratropium given will
alleviate the symptoms.
, BSN 246 Practice HESI (1 & 2)
Delay administration of ipratropium until
next maintenance medication is
scheduled.
5. The registered nurse (RN) is assess- Sphygmomanometer.
ing a client who was discharged home after
management of chron- Rationale
ic hypertension. Which equipment Self-awareness is the best way for a client to
manage should the RN instruct the client to chronic hypertension, so the client
should obtain a
use at home? sphygmomanometer and learn how to monitor blood Exercise
bicycle. pressure daily and maintain a record.
Sphygmomanometer.
Blood glucose monitor.
Weekly medication box.
6. The registered nurse (RN) is teach- Promotes CO2 elimination.
ing a client who is newly diagnosed
with emphysema how to perform Rationale
pursed lip breathing. What is the pri- Pursed lip breathing helps eliminate CO2 by
increasmary reason for teaching the client ing positive pressure within the alveoli
increasing the this method of breathing? surface area of the alveoli making it
easier for the O2 Decreases respiratory rate. and CO2 gas exchange to occur .
Increases O2 saturation throughout the monoamine oxidase inhibitor
body. (MAOI), for a client on the
Conserves energy while ambulating. psychiatric unit with depression.
Promotes CO2 elimination. Which information is most
7. The registered nurse (RN) reviews the important for the RN to assess?
new prescription, phenelzine (Nardil), a
