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HESI RN EXIT CASE STUDY - STROKE, Exams of Study of Commodities

Case Western Reserve University (CWRU)Study of Commodities

HESI RN EXIT CASE STUDY - STROKE HESI RN EXIT CASE STUDY - STROKE HESI RN EXIT CASE STUDY - STROKE

Typology: Exams

2025/2026

Available from 04/05/2026

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HESI RN EXIT CASE STUDY - STROKE
1. Which additional clinical manifestations should the nurse expect to find if Mr. Jones'
symptoms have been caused by a stroke? (select all that apply)
ANS: -a carotid bruit
-elevated blood pressure
-hyporeflexic deep tendon reflexes
2. Which assessment findings warrant immediate intervention by the nurse? (select all that
apply)
ANS: -Mr. Jones' Glasgow Coma Scale (GCS) score changes from 12 to 9
-Mr. Jones has a positive Babinski's reflex bilaterally
-Mr. Jones is unable to verbalize responses to the nurse's questions
3. What clinical manifestations further support this assessment? (select all that apply)
ANS: -visual field deficit on the left side
-spatial-perceptual deficits
-paresthesia on the left side
-increased distractibility
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HESI RN EXIT CASE STUDY - STROKE

  1. Which additional clinical manifestations should the nurse expect to find if Mr. Jones' symptoms have been caused by a stroke? (select all that apply) ANS: -acarotid bruit -elevated blood pressure -hyporeflexic deep tendon reflexes
  2. Which assessment findings warrant immediate intervention by the nurse? (select all that apply) ANS: -Mr. Jones' Glasgow Coma Scale (GCS) score changes from12 to 9 -Mr. Jones has a positive Babinski's reflex bilaterally -Mr. Jones is unable to verbalize responses to the nurse's questions
  3. What clinical manifestations further support this assessment? (select allthat apply) ANS: -visual field deficit on the left side -spatial-perceptual deficits -paresthesia on the left side -increased distractibility
  1. Which intervention should the nurse implement when preparing Mr. Jones and his son for this procedure? ANS: Explain that the procedure requires the client tolie completely still.
  2. Which data warrants immediate intervention by the nurse concerting this diagnostic test?

ANS: Left hip replacement

  1. Which explanation by the nurse is the most therapeutic response? ANS: Your father has had a stroke, and the blood supply to the brain has been compromised.
  2. How should the nurse respond?

ANS: I know this is scary for you. Would you like tosit and talk?

  1. How many mg of enoxaparin will the nurse administer in each dose? ANS: 77
  2. With a diagnosis of stroke, which priority intervention should the nurseinclude in Mr. Jones' plan of care? (select all that apply)

-Monitor capillary refill every 2 to 4 hours -Monitor pulse oximetry

  1. How should the nurse respond to Barry? ANS: He is not a candidate because oftherapeutic time constraints related to this medication.
  2. Which nursing diagnosis has the highest priority? ANS: Impaired swallowing
  3. Which nursing intervention should the nurse implement to address Mr.Jones' self- care deficit? ANS: Use plate guards when Mr. Jones is eating.
  4. Which conditions are considered a modifiable risk factor for a stroke?(select all that apply) ANS: -high cholesterol levels -diet -lifestyle -history of atrial fibrillation
  5. Which statement is warranted in this situation? ANS: I should let you know thatsmoking is a strong risk factor for a stroke.
  1. Which nursing intervention would the nurse implement to address this condition? ANS: Place the objects Mr. Jones needs for activities of daily living on theright side of the table.
  2. Which intervention should the nurse implement when addressing this condition? ANS: Instruct Mr. Jones to clasp the left hand with the right hand and raiseboth hands above the head.
  3. How should the nurse respond? ANS: That procedure is only done with smallstrokes, not like the one your dad had.
  4. Which nursing care task should the nurse delegate to the UAP? (select allthat apply) ANS: -take Mr. Jones' vital signs -give Mr. Jones a bed bath and change the bed linens -measure Mr. Jones' intake and output each shift (I&O) 21. Which written documentation should the nurse put in the client's record?-

ANS: PT reported that client stated he felt dizzy and was lowered to the bed assisted bythe PT using a gait belt.

  1. Which interventions should the nurse implement to prevent joint deformi- ties? (select all that apply)
  1. Which intervention should the nurse perform prior to beginning a feed-ing? ANS: Elevate the head of the bed 30 to 40 degrees.
  2. At what rate would the nurse set the infusion pump? ANS: 75
  3. Which intervention should the nurse implement first? ANS: Continue to stay atMr. Jones' bedside and hold Barry's hand.
  4. How should the nurse respond? ANS: I am sorry, but I am unable to give you anyinformation.
  5. What actions should the nurse implement? (select all that apply) ANS: -obtainthe necessary permits and notify the regional organ donor center -Explain that Mr. Jones can only be a tissue donor, not an organ donor
  6. Which action would be most important for the nurse to take in this situa-tion? ANS: Have a clergy come to pray.
  7. How should the nurse respond? ANS: You seem really confused about what to do.Would you like to talk about it?