HESI Cbc Version 2 Exam-Htc 145

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Sample questions from HESI Cbc Version 2 Exam-Htc 145

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.At change of shift on a medical unit, four clients are assigned to the RN. Which client should the RN assess first?

   • A.A client 2 hours after thyroidectomy who reports tightness in the throat and has inspiratory stridor
   • B.A client with diabetes whose premeal glucose is 246 mg/dL and who is due for insulin
   • C.A client with a leg fracture who reports pain of 7 on a 0-to-10 scale after physical therapy
   • D.A client with pneumonia whose temperature is 38.1 C (100.6 F) and who requests acetaminophen

   Rationale: Throat tightness and stridor after thyroid surgery suggest airway obstruction from edema or bleeding and require immediate assessment and intervention. Fever, hyperglycemia, and post-therapy pain need care but are not as immediately life-threatening. Prioritize airway threats over other concerns.

2. 2.Refer to the client's chart. Which actions should the nurse take now? Select all that apply.

   • A.Restart the antibiotic at a slower rate after the rash fades
   • B.Place the client supine with the legs elevated if tolerated
   • C.Document the reaction after stabilizing the client
   • D.Notify the provider and activate the emergency response process
   • E.Stop the current infusion and maintain IV access with normal saline using new tubing
   • F.Administer prescribed intramuscular epinephrine promptly

   Rationale: The new urticaria, wheezing, and falling blood pressure during an IV antibiotic indicate anaphylaxis, so the infusion must stop and emergency treatment, including prescribed IM epinephrine, is urgent. Notify the provider or emergency response team and document the event after immediate stabilization. Elevating the legs may be appropriate if tolerated, but it is not a substitute for airway support and epinephrine; the antibiotic must not be restarted after this reaction.

3. 3.A client with limited English proficiency arrives at a community clinic with a family member who offers to interpret. What should the nurse do?

   • A.Ask the family member to interpret because the client brought them
   • B.Use a different family member to confirm the first family member's interpretation
   • C.Arrange a qualified medical interpreter and speak directly to the client
   • D.Speak loudly and use simple English while the family member summarizes

   Rationale: A qualified medical interpreter supports accurate communication, confidentiality, and informed decision-making. The nurse should address the client directly and use the interpreter to convey the client's words without relying on family members. Speaking loudly or using multiple unqualified interpreters does not ensure accurate communication.

4. 4.At a rehabilitation center, a client with a spinal cord injury at T4 develops a pounding headache, facial flushing, and a blood pressure of 196/104 mm Hg. Which action should the nurse take first?

   • A.Administer the scheduled antihypertensive and reassess in an hour
   • B.Encourage the client to take slow deep breaths and rest
   • C.Place the client flat and elevate the legs
   • D.Sit the client upright and loosen restrictive clothing

   Answer and rationale are in the full material.

5. 5.On a surgical unit, an RN is planning assignments for a licensed practical nurse (LPN) and a UAP. Which tasks are appropriate to assign to the LPN? Select all that apply.

   • A.Reinforce previously taught instructions about incentive spirometry
   • B.Perform the initial assessment of a newly admitted client with chest pain
   • C.Change a dressing on a stable client with a routine, uncomplicated wound
   • D.Develop the nursing diagnosis and initial plan for a newly diagnosed client
   • E.Evaluate whether a newly administered IV opioid relieved the client's pain
   • F.Administer a scheduled oral medication to a stable client with an established plan of care

   Answer and rationale are in the full material.