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HESI MILESTONE 2 REMEDIATION ACTUAL EXAM CONTAINS 150 QUESTIONS AND ANSWERS
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HESI MILESTONE 2 REMEDIATION ACTUAL EXAM CONTAINS 150 QUESTIONS AND ANSWERS
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HESI MILESTONE 2 REMEDIATION 2 023-2024 ACTUAL EXAM CONTAINS 15 0 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RAT IONALES (VERIFIED ANSWERS) |ALREADY GRADED A+ A male client with schizophrenia is admitted to the mental health unit after abruptly stopping his prescription for ziprasidone (Geodon) one month ago. Which question is most important for the RN to ask the client? - ANSWER>>>Do you hear sounds or voices that others do not hear? The schizophrenic client insists that he is returning to his apartment, alt hough the healthcare provider informed him that he will be moving to a boarding home. What is the most important nursing diagnosis for discharge planning? - ANSWER>>>Ineffective denial related to situational anxiety The nurse is interviewing a client with schizophrenia. Which client behavior requires immediate intervention? - ANSWER>>>Muscle twitches in the back and neck 32-year-old male client is admitted with paranoid schizophrenia - ANSWER>>>Reassure the client that he is safe and should rest . What is sc hizophrenia? - ANSWER>>>it is a chemical imbalance in the brain that causes disorganized thinking: . A resident of a long -term care facility, who has moderate dementia, is h aving difficulty eating in the dining room. The client becomes frustrated when dropping utensils on the floor and then refuses to eat. What action should the nurse implement? - ANSWER>>>Encourage finger foods, distraction, speak therapeutically 2 days afte r admission from alcohol withdrawal what should the nurse do? - ANSWER>>>Monitor HR and BP which action should the nurse implement first for a client experiencing alcohol withdrawal? - ANSWER>>>prepare the environment to prevent self injury: self A patient won't take oral meds that is going through alcohol withdrawal. The nurse starts giving saline lock per alcohol protocol and thiamine. What do you tell them that it will help with recovery? - ANSWER>>>Thiamine will replenish alcohol effects on the body (something to do with iron) A client comes in after being in a car accident and is experiencing alcohol withdrawal, magnesium level of 1.1, cardiac dysrhythmias. What would you give first? - ANSWER>>>Magnesium Patient having to get treated for benzodiazep ine and methadone overdose. What do you use? - ANSWER>>>Narcan When preparing to administer a domestic violence screening tool to a female client, which statement should the nurse provide? - ANSWER>>>all clients are screened for domestic abuse because it i s common in our society a mental health care worker caring for a client with escalating aggressive behavior. What action by the mental healthcare worker wards immediate interventions? - ANSWER>>> -attempting to physically restrain patient Violence handling - ANSWER>>> - Engage in dialogue to prevent escalation, intervene early in the cycle - Approach as non threatening, calm manner and convey empathy - Encourage the client to express their anger, build trust, anticipate need for meds, be consistent a 30 year old sales manager tells the nurse "i am thinking about a job change. i don't feel like i am living up to my potential." which of maslows developmental stages is the sales manager attempting to achieve - ANSWER>>>self actualization: A client is admitted to the mental health unit and reports taking extra anti anxiety medication because, "I'm so stressed out. I just want to go to sleep." The RN should plan one -on-one observation of the client based on which statement? - ANSWER>>>"I don't want to walk. Nothing matters anymore." What is the most important goal for a client diagnosed with major depression who has been receiving an antidepressant medication for two weeks? - ANSWER>>>not attempt to commit suicide The nurse is obtaining the me dical histories of new clients at a community -based primary care clinic. Which individual has the highest risk for experiencing elder abuse? - ANSWER>>>A 78 year old female on a fixed income who lives with her relatives Who is most prone to being abused (e lder abuse)? - ANSWER>>>Females over 75 living with their families. While caring for an older client, the RN observes multiple bruises in Over the client's legs, arms, back, and gluteal areas. When the RN suspects elder abuse. What action should the RN tak e? - ANSWER>>>Measure and document size, shape and color of the bruised areas. Grief priority - ANSWER >>>Priority should be based on SHOCK! When checking a third grader's height and weight the school nurse notes that these measurements have not changed in the last year. The child is currently taking daily vitamins, albuterol, and methylphenidate for attention deficit hyperactivity disorder (ADHD). Which intervention should the nurse implement? - ANSWER>>>Refer child to the family healthcare provider A middl e school male student was recently diagnosed with Attention -Deficit Hyperactivity Disorder (ADHD) and is having trouble with his grades. He is referred to the school nurse by the teacher because he continues to have learning problems. Which action should t he school nurse take? - ANSWER>>>• Refer the child to the school counselor for educational testing A female client with obsessive compulsive personality disorder is admitted to the hospital for a cardiac catheterization. The afternoon before the procedure, the client begins to keep detailed notes of the nursing care she is receiving, and reports herThe benefits of buying summaries with Stuvia:
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