hesi health assessment test bank

Correct Answer: B

Rationale: The correct hand position for performing chest vibration is to spread the fingers. This allows for a larger surface area of contact with the chest, promoting effective transmission of vibrations to loosen chest secretions. Flattening the hands would reduce the effectiveness of the vibrations by limiting contact area. Cupping the hands creates a smaller contact area and may concentrate the pressure too much in one spot, potentially causing discomfort or injury. Therefore, spreading the fingers is the optimal hand position for chest vibration technique.

Correct Answer: C

Rationale: The correct answer is C: perimenopause. Perimenopause is the transitional phase leading to menopause, characterized by irregular menstrual cycles. Climacteric refers to the period of reproductive senescence, not just irregular menses. Menopause is the cessation of menstruation for 12 consecutive months. Postmenopause is the period after menopause, not characterized by irregular menses. Assessing for symptoms of perimenopause in a woman with irregular menses over the past six months is important to understand the hormonal changes and potential menopausal symptoms she may be experiencing.

Correct Answer: A

Rationale: The correct answer is A: Creatinine. Creatinine is a waste product produced by muscles and excreted by the kidneys. An elevated creatinine level indicates impaired kidney function, making it a key indicator for early detection of renal failure. Blood urea nitrogen (BUN) can also be elevated in renal failure, but creatinine is a more specific and sensitive marker. Sodium and potassium levels are not directly related to renal failure detection.

Correct Answer: A

Rationale: The correct answer is A: Administer IV fluids. In shock, the priority nursing action is to restore intravascular volume to improve tissue perfusion. IV fluids help increase blood pressure and cardiac output, addressing the underlying cause of shock. Monitoring vital signs (B) is important but administering fluids takes precedence. Administering fluids (C) is a general term and does not specify the urgency of IV fluids. Administering blood transfusion (D) may be indicated in certain types of shock but is not the initial priority.

Correct Answer: D

Rationale: The correct answer is D because breast implants can hinder mammography by obscuring the view of breast tissue, making it difficult to detect abnormalities like masses. This is due to the implants blocking the x-ray machine's view. Choice A is incorrect as discomfort is not the primary reason for interference. Choice B is incorrect as breast implants are not a contraindication to mammography but can complicate the process. Choice C is incorrect as implants are designed to be secure and are not likely to be dislodged during a mammogram.