hesi health assessment test bank 2023

Correct Answer: C

Rationale: The correct answer is C: Chocolate. Chocolate is known to trigger heartburn in individuals with GERD due to its high fat content and caffeine. Fat relaxes the lower esophageal sphincter, allowing stomach acid to flow back up the esophagus, leading to heartburn. Caffeine can also relax the sphincter and trigger acid reflux. Lettuce (A) and eggs (B) are generally well-tolerated and do not commonly trigger heartburn. Butterscotch (D) may be high in fat and sugar, but it is less likely to cause heartburn compared to chocolate.

Correct Answer: C

Rationale: Step 1: Nutrition is important for overall health and healing in a client in Buck's traction. Step 2: Elimination is necessary to prevent complications such as constipation. Step 3: Comfort measures help alleviate pain and promote well-being. Step 4: Safety measures ensure the client's well-being during traction. Step 5: ROM exercises are not recommended to prevent displacement of traction. Transportation and isotonic exercises are not directly related to Buck's traction care.

Correct Answer: B

Rationale: The correct answer is B: gout. Uric acid levels are typically checked for gout, a type of arthritis caused by the buildup of uric acid crystals in the joints. This condition directly relates to uric acid levels in the blood. Asthma (choice A), diverticulitis (choice C), and meningitis (choice D) do not typically require checking uric acid levels. Asthma is a respiratory condition, diverticulitis is a gastrointestinal condition, and meningitis is an inflammation of the protective membranes covering the brain and spinal cord.

Correct Answer: A

Rationale: The correct answer is A: Administer pain relief. The nurse's first priority is to address pain and ensure the client's comfort and well-being. Pain relief helps reduce distress, improve communication, and prevent complications. Monitoring blood pressure (B) and providing hydration (C) are important but not the immediate priority in severe trauma. Administering a blood transfusion (D) may be necessary but is not the first priority compared to addressing pain and stabilizing the client.

Correct Answer: B

Rationale: The correct answer is B. When a client is moving towards illness and premature death, signs and symptoms typically start to manifest. These can include physical changes, abnormal lab results, or new onset of health issues. This serves as a direct indication of the client's deteriorating health status. Choices A, C, and D are incorrect because stopping wellness-promoting activities (A) could simply be due to lack of motivation, starting to exercise (C) may not necessarily indicate illness progression, and verbalizing anxiety over medication costs (D) is not a direct indicator of impending illness and premature death.