Bowtie HESI BSN 315

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Sample questions from Bowtie HESI BSN 315

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

1. 1.At change of shift on a medical-surgical unit, a 68-year-old client with chronic kidney disease, heart failure, and atrial fibrillation is receiving digoxin. The client's apical pulse is 54/min, potassium is 3.0 mEq/L (reference range 3.5-5.0 mEq/L), and the client reports new nausea and yellow-tinted vision. Which action should the nurse take first?

   • A.Document the findings and reassess the client after the next scheduled dose.
   • B.Ask the unlicensed assistive personnel to obtain another pulse in 1 hour.
   • C.Hold the digoxin and notify the health care provider of the findings.
   • D.Administer the digoxin with food to reduce nausea.

   Rationale: The bradycardia, hypokalemia, nausea, and visual change suggest digoxin toxicity, so the nurse should hold the dose and promptly notify the provider. Giving the medication with food does not address toxicity, and waiting an hour or until the next dose risks worsening dysrhythmia. This is a narrow-therapeutic-index medication; assess and act on toxicity cues before administration.

2. 2.In a pediatric clinic, the parent of a 4-year-old with a newly diagnosed seizure disorder asks whether the child can attend preschool. The child is taking a prescribed antiseizure medication and has had no seizure for 2 weeks. Which response by the nurse best supports safe, coordinated care?

   • A.Tell the parent to ask the preschool to administer an extra medication dose before outdoor play.
   • B.Discuss an individualized seizure action plan with the parent and, with consent, coordinate training with preschool staff.
   • C.Advise the parent to share the child's full medical record with every family at the preschool.
   • D.Recommend keeping the child home until the child has been seizure-free for 6 months.

   Rationale: A seizure action plan, clear emergency instructions, and appropriate staff education support participation while protecting the child's safety and privacy. A fixed six-month exclusion is not justified by the information given, and an extra dose should not be given without a prescription. Sharing the full record with other families is unnecessary and violates confidentiality; information should be shared only with authorized caregivers who need it.

3. 3.A 46-year-old client is receiving unfractionated heparin for a pulmonary embolism. The nurse notes a substantial platelet decline and a new painful, cool right foot. Refer to the client's chart. Which actions should the nurse take? Select all that apply.

   • A.Anticipate orders for a non-heparin anticoagulant and further evaluation.
   • B.Administer the next scheduled heparin bolus because the aPTT is below the target.
   • C.Massage the painful calf to improve circulation.
   • D.Stop the heparin infusion and notify the health care provider promptly.
   • E.Assess and document distal pulses, skin temperature, color, and sensation.

   Rationale: The platelet count fell from 238,000 to 92,000/mm3 while the client developed a cool, painful extremity, concerning for heparin-induced thrombocytopenia with thrombosis; stop heparin and notify the provider. A focused neurovascular assessment establishes the severity of limb compromise, and a non-heparin anticoagulant may be prescribed. Giving more heparin can worsen the condition, and massaging a potentially thrombosed limb is unsafe.

4. 4.A primigravida at 32 weeks is admitted to the antepartum unit with severe preeclampsia and is receiving magnesium sulfate. The unlicensed assistive personnel reports that the client is difficult to arouse and has had no urine output for 2 hours. Respirations are 10/min and the patellar reflexes are absent. Which action should the nurse take first?

   • A.Ask the assistive personnel to recheck the urine output in 1 hour.
   • B.Place the client supine and encourage oral fluids.
   • C.Increase the infusion because absent reflexes can precede seizure activity.
   • D.Stop the magnesium sulfate infusion and immediately assess airway and breathing.

   Answer and rationale are in the full material.

5. 5.In the emergency department, a 15-year-old with type 1 diabetes arrives with vomiting, deep rapid respirations, and increasing drowsiness. Glucose is 512 mg/dL, potassium is 3.1 mEq/L (reference range 3.5-5.0 mEq/L), and the client has dry mucous membranes. Which prescription should the nurse question before implementation?

   • A.Begin intravenous regular insulin immediately at the ordered rate.
   • B.Obtain a repeat potassium level and report the result.
   • C.Place the client on continuous cardiac monitoring.
   • D.Initiate isotonic intravenous fluid replacement as prescribed.

   Answer and rationale are in the full material.