HESI Community Health

HESI Community Health Related

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During a repeat home visit to see an 84-year-old widow, the nurse discovers that the client is unkempt, smells of stale urine, and does not recognize her neighbors or the nurse. What action should the nurse take?

  • A. Call the pharmacy to determine what medications she is taking
  • B. Seek the family's assistance in taking care of the client
  • C. Complete a physical and mental exam on the client
  • D. Call the adult protective services to obtain emergency nursing home placement
Correct Answer: C

Rationale: In this scenario, the nurse should prioritize completing a physical and mental exam on the client. This action is crucial to assess the client's health status comprehensively and identify any underlying issues contributing to her unkempt appearance, odor of stale urine, and confusion. Calling the pharmacy to determine medications (Choice A) may be important but is not the immediate priority. Seeking family assistance (Choice B) can be helpful, but the client's condition requires a thorough assessment first. While adult protective services (Choice D) may be necessary in the future, the immediate action should be to assess the client's physical and mental health status.

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What information should the nurse provide a client who has undergone cryosurgery for stage 1A cervical cancer?

  • A. Expect heavy, watery vaginal discharge for 3 to 6 weeks.
  • B. Use a tampon instead of a sanitary napkin.
  • C. Report any severe cramping immediately.
  • D. Avoid sexual intercourse for 3 to 6 weeks.
Correct Answer: D

Rationale: After cryosurgery for stage 1A cervical cancer, clients should avoid sexual intercourse for 3 to 6 weeks to reduce the risk of infection. Heavy, watery vaginal discharge is expected but not the focus of post-procedure instructions. Using tampons is contraindicated as they can introduce bacteria into the healing cervix. While reporting severe cramping is important, avoiding sexual intercourse is the priority to prevent complications.

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.

An adolescent tells the school nurse that she is pregnant. Her last menstrual period was 4 months ago. She has not received any medical care. She smokes but denies any other substance use. What is the priority nursing action?

  • A. notify her parents
  • B. refer her for prenatal care
  • C. teach breast feeding methods
  • D. offer nutritional instructions
Correct Answer: B

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

A client with a history of peptic ulcer disease is admitted with severe epigastric pain. Which finding requires immediate intervention?

  • A. Nausea and vomiting.
  • B. Hematemesis.
  • C. Melena.
  • D. Rebound tenderness.
Correct Answer: D

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

The healthcare professional is developing a teaching plan for an adolescent with a Milwaukee brace. Which instruction should the healthcare professional include?

  • A. Wear the brace over a T-shirt for 23 hours a day.
  • B. Remove the brace while sleeping.
  • C. Wear the brace directly against the skin.
  • D. Remove the brace while eating.
Correct Answer: A

Rationale: The correct answer is A. A Milwaukee brace should be worn over a T-shirt for 23 hours a day to reduce friction and chafing of the skin. This ensures that the brace is not directly against the skin, which can cause discomfort and skin irritation. Choice B is incorrect because the brace should typically be worn continuously, even while sleeping, unless otherwise instructed by a healthcare provider. Choice C is incorrect as wearing the brace directly against the skin can lead to skin issues. Choice D is incorrect since the brace should not be removed while eating to maintain the prescribed wear time.

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