HESI NCLEX -PN Examination Review

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75 terms Kok A 43-year-old female client who has had a thyroidectomy due to Grave's disease is prescribed a thyroid replacement hormone. Which signs and symptoms are associated with thyroid hormone toxicity and should be reported promptly to the health care provider?

• Tinnitus and dizziness
• Tachycardia and chest pain
• Dry skin and intolerance to cold
• Weight gain and increased appetite

B The dosing of heparin intravenous infusion is guided by which laboratory value?

• Prothrombin time
• Fibrin split products
• Platelet count
• Partial thromboplastin time

D A client receiving the antibiotic vancomycin is prescribed to have a peak and trough level done with the next dose.What time should the practical nurse obtain the blood specimen for the trough level?

• 60 minutes after the antibiotic dose is administered.
• Immediately before the next antibiotic dose is given.
• When the next blood glucose level is to be checked.
• 30 minutes before the next antibiotic dose is given.

B The nurse is caring for a client who is taking prednisone to treat rheumatoid arthritis. The nurse expects which aspect of care to be emphasized with this client?

• Reducing the dose of insulin
• Monitoring for hyperkalemia
• Monitoring for substance abuse
• Treating infections as soon as they occur

D

A client prescribed glipizide asked why they had to take their insulin orally. How should the practical nurse respond?

• "Glipizide is an oral form of insulin and has the same actions and properties as

intermediate insulin."

• "Glipizide is an oral form of insulin and is distributed, metabolized, and excreted

in the same manner as insulin."

• "Glipizide is not an oral form of insulin and can be used only when some beta

cell function is present."

• "Glipizide is not an oral form of insulin, but it is effective for those who are

resistant to injectable insulins." C The practical nurse administered carbidopa-levodopa to a client diagnosed with Parkinson disease. Which outcome by the client would indicate a therapeutic response?

• Decreased blood pressure
• Decreased blood pressure
• Lessening of tremors
• Increased salivation
• Increased attention span

B The health care provider (HCP) has prescribed a 74-year- old client to be vaccinated with the influenza vaccine prior to discharge. Which client condition will make the practical nurse not to vaccinate the client and consult with the charge nurse?

• History of congested heart failure
• History of an allergy to eggs
• History of pneumococcal vaccination
• History of end-stage renal disease

B A client who is taking hydrochlorothiazide is admitted to the hospital and is experiencing muscle weakness and cramps. Which condition should the practical nurse suspect is causing these changes?

• Hypolipidemia
• Hypermagnesemia
• Hyperchloremia
• Hyponatremia

D A client who was diagnosed with oral thrush calls the clinic saying the medication bottle broke and all of the medication was spilled. The client is requesting a refill order. The nurse should contact the health care provider about a refill for which medication?

• Ampicillin
• Ciprofloxacin
• Neomycin sulfate
• Nystatin

D A client with angina pectoris has been prescribed nitroglycerin tablets prn for chest pain. Which statement by the client causes the practical nurse (PN) to clarify instructions for this client?

• I will take one tablet every 5 minutes, up to three tablets.
• I should take one tablet at the onset of angina and stop activity.
• I need to replace nitroglycerin tablets every 3 to 6 months to maintain

freshness.

• I should ensure that I chew the pill completely before swallowing it.

D A client with pulmonary tuberculosis has been taking rifampin for 3 weeks. The client reports orange urine.What should be the nurse's next action?

• Notify the health care provider.
• Inform the client this is not harmful.
• Assess the client for other signs of nephrotoxicity.
• Monitor the results of the most recent creatinine level.

B The practical nurse interprets the client's PPD as a positive skin test. Which drug is considered the primary prophylaxis for a client exposed to active tuberculosis?

• Isoniazid
• Rifampin
• Acyclovir
• Griseofulvin

A

At 1900, the nurse has received change of shift report regarding a 3-year-old child who is hospitalized for observation after swallowing his older sister's dose of phenytoin. During the "recommendation" section of the report, the off-going nurse states "You'll need to continue monitoring his gait. So far it has been normal." The nurse is monitoring for which adverse drug effect?

• Ataxia
• Nystagmus
• Gingival hyperplasia
• Paradoxical excitement

A The practical nurse administers lactulose to a client.Which client outcome would indicate a therapeutic response?

• An increase in urine output
• Two or three soft stools per day
• Absence of nausea
• Decreased serum potassium

B A client is experiencing an adverse effect of the gastrointestinal stimulant metoclopramide HCL. Which assessment finding would require immediate intervention by the nurse?

• Parkinson-like symptoms
• Inability to see well at night
• Dizziness when first getting up
• An unpleasant metallic taste in the mouth

A A practical nurse (PN) is reviewing the plan of care for client who is prescribed glucocorticoid methylprednisolone to treat an exacerbation of chronic obstructive pulmonary disease (COPD). The nurse expects to see which intervention is emphasized in the plan of care?

• Monitor the client's red blood cell (RBC) counts.
• Remind staff to wash hands before patient care.
• Encourage liquids to liquefy bronchial secretions.
• Administer nasal cannula oxygen at 4 L/m.

B The practical nurse (PN) administered 15 units of NPH insulin subcutaneously to a client before they consumed

their breakfast at 7:30 AM. At what time is the client at an

increased risk for a hypoglycemic reaction?

• 8:30 to 11:30 AM
• 3:30 to 7:30 PM

c. 9:30 PM to midnight

• 1:00 to 5:00 AM

B The health care provider orders 1000 mL of 0.45% lactated ringers to run over 8 hours. The drop factor is 15 gtt/mL. The nurse plans to adjust the flow rate to how many gtt/min? (Round to the nearest whole number.) 8x60 minutes =480 1000/480 x 15= 31 A client has been prescribed pregabalin. Which outcome(s) should the practical nurse (PN) anticipate a client to experience? (Select all that apply.)

• A decrease in joint pain resulting from osteoarthritis
• Elevated mood with improved responsiveness to family
• Decrease of inflammation in all major joints
• Improved range of motion during physical therapy exercises
• Decrease in the preprandial blood sugar level

AD

A client has vancomycin intravenous piggybacks (IVPB) prescribed. Which is the crucial aspect of care for this client?

• Monitoring the client's laboratory results for increased liver enzymes on a daily

basis

• Besides noting the urine output is less than the intake, report increased

creatinine levels

• The licensed practical/vocational nurse cannot care for a client receiving IVPB

medication

• It is expected that the client experiences tinnitus, headache, dizziness, and

hearing loss.B A client is receiving heparin to treat a deep vein thrombosis. The nurse should monitor which laboratory result to assist in evaluating the efficacy of the drug?

• Platelet count
• Prothrombin time
• Partial thromboplastin time
• Serum levels of protamine sulfate

C Escitalopram is prescribed for a 16-year-old adolescent client who is clinically depressed. Five days later, the parent tells the practical nurse (PN) that the drug is not working because their child is not feeling any better.Which explanation should the PN provide?

• "It takes 1 to 4 weeks for antidepressant medications to become effective."
• "The dosage may need to be increased; I will contact your health care

provider."

• "Depression is difficult to treat with drugs alone. Therapy sessions would

enhance their effectiveness."

• "Based on your child's response to this drug, the health care provider is

reviewing your medication regimen." A The practical nurse prepares to administer ophthalmic drops to a client before cataract surgery. List the steps in the order they should be implemented from first step to final step.(Arrange the sequence options in the correct order by assigning each option a number.) 2.Place the dominant hand on the client's forehead.

4.Ask the client to close the eye gently.

3.Drop prescribed number of drops into the conjunctival sac.

1.Wash hands and apply clean gloves.A client diagnosed with a urinary tract infection has been prescribed phenazopyridine. Which data would indicate to the practical nurse that the therapeutic outcome has been achieved?

• White blood cell count is 5000/mm3.
• Urine is a bright yellow and without sediment.
• Client denies pain when voiding.
• Urine culture is negative for bacterial growth.

C An 18-month-old toddler with a 3-day history of diarrhea was administered loperamide by their parent. What intervention is most important for the PN to implement initially?

• Tell the parent never to give this drug to her toddler.
• Ask if any other siblings have experienced diarrhea.
• Obtain the child's oral and tympanic temperatures.
• Question the parent how many wet diapers has the child had in 24 hours.

D A client who is prescribed sildenafil for pulmonary hypertension calls the clinic for advice. Which condition should the practical nurse notify the health care provider immediately and instruct the client to stop taking the medication?

• The client is experiencing vision and hearing loss.
• The client has an erection lasting longer than 2 hours.
• The client is complaining about nasal congestion.
• The client is complaining about feeling flushed.

A