hesi health assessment test bank 2023

Questions 84

ATI RN

ATI RN Test Bank

hesi health assessment test bank 2023 Questions

Question 1 of 5

Which value should a nurse monitor closely when a client is on TPN?

Correct Answer: C

Rationale: The correct answer is C: Glucose. Total Parenteral Nutrition (TPN) is a form of nutrition delivered directly into the bloodstream, providing all essential nutrients including glucose. Monitoring glucose levels is crucial to prevent hyperglycemia or hypoglycemia. Calcium (A), Magnesium (B), and Cholesterol (D) are not typically monitored closely when a client is on TPN, as they are not directly impacted by TPN administration. Calcium and Magnesium levels are usually monitored for other conditions, and Cholesterol levels are not typically affected by TPN administration.

Question 2 of 5

What nursing interventions are important for a client in Buck's traction?

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.

Question 3 of 5

During an interview, the nurse notices that the patient is avoiding eye contact. What would be the best action for the nurse to take?

Correct Answer: C

Rationale: The correct answer is C because asking open-ended questions helps the patient express their feelings without feeling pressured. This approach allows the patient to share at their own pace and comfort level. Choice A may make the patient feel uncomfortable or pressured. Choice B may not address the underlying issue of the patient's avoidance of eye contact. Choice D is more direct and may not be effective if the patient is not ready to discuss their emotions. Ultimately, using open-ended questions promotes a safe and supportive environment for the patient to open up willingly.

Question 4 of 5

Which of the following is an example of a symptom?

Correct Answer: A

Rationale: The correct answer is A: Chest pain. A symptom is a subjective indication of a condition experienced by the patient. Chest pain is a subjective sensation that a patient reports, making it a symptom. Clammy skin, serum potassium level, and temperature are all objective signs or measurements, not subjective experiences reported by the patient. Symptoms are what the patient feels or experiences, while signs are objective findings that can be measured or observed by healthcare providers.

Question 5 of 5

What is the priority action for a client with an open chest wound?

Correct Answer: A

Rationale: The correct answer is A: Apply a sterile dressing. Firstly, cover the wound with a sterile occlusive dressing to prevent air from entering the pleural space, reducing the risk of tension pneumothorax. This also helps to prevent infection and further complications. Administering morphine (B) or nitroglycerin (D) is not the priority in this situation as managing the chest wound is crucial. Applying an airtight dressing (C) may lead to tension pneumothorax if not done properly. Therefore, the immediate action should be to apply a sterile dressing to stabilize the wound and prevent further complications.

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