HESI Community Health

HESI Community Health Related

Review HESI Community Health related questions and content

A client with a history of hypertension is admitted with acute renal failure. Which assessment finding requires immediate intervention?

  • A. Blood pressure of 180/100 mm Hg.
  • B. Urine output of 50 mL in 4 hours.
  • C. Heart rate of 100 beats per minute.
  • D. Nausea and vomiting.
Correct Answer: B

Rationale: Urine output of 50 mL in 4 hours indicates oliguria, which can be a sign of worsening renal function and requires immediate intervention. In acute renal failure, maintaining adequate urine output is crucial to prevent further kidney damage and manage fluid balance. A high blood pressure reading (Option A) is concerning but may not require immediate intervention in this scenario as it could be due to the history of hypertension. A heart rate of 100 beats per minute (Option C) is slightly elevated but may not be the most critical finding at this moment. Nausea and vomiting (Option D) are important to assess but are not as urgent as addressing oliguria in a client with acute renal failure.

You may also like to solve these questions

The nurse obtains a heart rate of 92 and a blood pressure of 110/76 prior to administering a scheduled dose of verapamil (Calan) for a client with atrial flutter. Which action should the nurse implement?

  • A. Administer the dose as prescribed.
  • B. Hold the medication.
  • C. Call the healthcare provider.
  • D. Repeat the vital signs in 30 minutes.
Correct Answer: A

Rationale: Failed to generate a rationale of 500+ characters after 5 retries.

Which bioterrorism agent is at high risk for use as a potential biological weapon that i s readily transmitted by several portals of entry?

  • A. anthrax
  • B. smallpox
  • C. botulism
  • D. tularemia
Correct Answer: A

Rationale: Failed to generate a rationale of 500+ characters after 5 retries.

The nurse is preparing to administer a scheduled dose of digoxin (Lanoxin) to a client. Which assessment finding should the nurse report to the healthcare provider?

  • A. Heart rate of 90 beats per minute.
  • B. Serum potassium level of 4.0 mEq/L.
  • C. Blood pressure of 130/80 mm Hg.
  • D. Client reports seeing halos around lights.
Correct Answer: D

Rationale: Failed to generate a rationale of 500+ characters after 5 retries.

During a follow-up home visit, the nurse observes that a client with chronic obstructive pulmonary disease (COPD) is using accessory muscles to breathe and has a pulse oximetry reading of 88%. What action should the nurse take first?

  • A. Administer a prescribed bronchodilator
  • B. Increase the oxygen flow rate
  • C. Instruct the client to perform pursed-lip breathing
  • D. Notify the healthcare provider immediately
Correct Answer: C

Rationale: In this situation, the nurse should first instruct the client to perform pursed-lip breathing. Pursed-lip breathing helps improve oxygenation and decrease the work of breathing in clients with COPD. Administering a bronchodilator or increasing the oxygen flow rate may be necessary interventions but addressing the breathing technique through pursed-lip breathing is the initial action to optimize oxygenation. Notifying the healthcare provider immediately is not the first action indicated in this scenario; the nurse should intervene promptly to assist the client in improving breathing before escalating the situation.

While assessing a client receiving a blood transfusion, which finding requires immediate intervention?

  • A. Temperature of 100.4°F (38°C).
  • B. Blood pressure of 110/70 mm Hg.
  • C. Heart rate of 90 beats per minute.
  • D. Complaints of feeling cold.
Correct Answer: C

Rationale: A heart rate of 90 beats per minute requires immediate intervention when assessing a client receiving a blood transfusion. This finding can indicate a potential transfusion reaction, such as a hemolytic reaction or fluid overload, which requires prompt evaluation and management to prevent serious complications. While a temperature of 100.4°F (38°C) may indicate a mild fever, it is not typically an immediate concern during a blood transfusion. A blood pressure of 110/70 mm Hg is within the normal range, and complaints of feeling cold can be addressed but do not indicate an urgent need for intervention compared to the critical nature of a potential transfusion reaction indicated by an elevated heart rate.

Copyright © 2025 Nokea. All rights reserved.