ADULT HEALTH NURSING HESI ELABORATED QUESTIONS AND ANSWERS

ADULT HEALTH NURSING HESI ELABORATED QUESTIONS AND ANSWERS
A central venous catheter has been inserted via a jugular vein, and a radiograph has confirmed
placement of the catheter. A prescription has been received for a medication STAT, but IV fluids have
not yet been started. Which action should the nurse take prior to administering the prescribed
medication?
A. Assess for signs of jugular venous distention.
B. Obtain the needed intravenous solution.
C. Flush the line with heparinized solution.
D. Flush the line with normal saline. - CORRECT ANSWER -Answer, D
Rationale- Medication can be administered via a central line without additional IV fluids. The line should
first be flushed with a normal saline solution to ensure patency. Insufficient evidence exists on the
effectiveness of flushing catheters with heparin. Option A will not affect the decision to administer the
medication and is not a priority. Administration of the medication STAT is of greater priority than option
B.
A client is ready for discharge following the creation of an ileostomy. Which instruction should the nurse
include in discharge teaching?
A. Replace the stoma appliance every day.
B. Use warm tap water to irrigate the ileostomy.
C. Change the bag when the seal is broken.
D. Measure and record the ileostomy output. - CORRECT ANSWER -Answer- C