HESI RN
HESI RN Exit Exam 2024 Quizlet Capstone
1. A client with a history of asthma reports using an albuterol inhaler more frequently than prescribed. Which action should the nurse take first?
- A. Notify the healthcare provider immediately
- B. Schedule a pulmonary function test
- C. Assess the client's respiratory status
- D. Instruct the client to decrease inhaler use
Correct answer: C
Rationale: Increased use of a rescue inhaler like albuterol may indicate worsening asthma symptoms. The nurse should first assess the client's respiratory status to determine the severity of the issue and the next steps in care. Option A is not the first action because assessing the client's condition should precede notifying the healthcare provider. Option B, scheduling a pulmonary function test, is not the priority as immediate assessment of the client's respiratory status is crucial. Instructing the client to decrease inhaler use should come after assessing the client's condition to ensure the appropriate intervention.
2. A client with cirrhosis is experiencing ascites and peripheral edema. What is the nurse's priority intervention?
- A. Administer furosemide as prescribed.
- B. Administer albumin to increase oncotic pressure.
- C. Elevate the client's legs to reduce swelling.
- D. Administer a sodium-restricted diet.
Correct answer: A
Rationale: The correct answer is A: Administer furosemide as prescribed. Administering furosemide, a loop diuretic, is the priority intervention in a client with cirrhosis experiencing ascites and peripheral edema. Furosemide helps promote diuresis and reduce fluid buildup in the body. Choice B, administering albumin to increase oncotic pressure, may be beneficial in some cases but is not the priority intervention for immediate fluid removal. Elevating the client's legs (Choice C) and administering a sodium-restricted diet (Choice D) are important aspects of managing edema and ascites but are not the priority interventions in this situation.
3. The nurse is conducting diet teaching for a client diagnosed with hypertension. Which foods should the nurse encourage the client to eat?
- A. Pickled olives
- B. Canned soup
- C. Fresh or frozen vegetables without sauce
- D. Fruits without sauce
Correct answer: C
Rationale: The correct answer is C: Fresh or frozen vegetables without sauce. These foods are low in sodium, which is crucial for managing hypertension. Pickled olives (choice A) and canned soup (choice B) are high in sodium, which can exacerbate hypertension. While fruits without sauce (choice D) are generally healthy, emphasizing vegetables is more beneficial for hypertension due to their lower sodium content.
4. A client with hypothyroidism is prescribed levothyroxine. What instruction should the nurse provide?
- A. Take the medication in the morning before eating.
- B. Take the medication with a full glass of water.
- C. Take the medication with food to avoid nausea.
- D. Take the medication only when symptoms worsen.
Correct answer: A
Rationale: The correct answer is A: 'Take the medication in the morning before eating.' Levothyroxine should be taken on an empty stomach in the morning for optimal absorption. Choice B is incorrect because while taking medication with water is generally recommended, levothyroxine specifically needs to be taken on an empty stomach. Choice C is incorrect as taking levothyroxine with food can interfere with its absorption. Choice D is incorrect as levothyroxine should be taken regularly as prescribed, not only when symptoms worsen.
5. A client with heart failure is prescribed digoxin and reports nausea. What is the nurse's first action?
- A. Administer an anti-nausea medication as prescribed.
- B. Assess the client's digoxin level immediately.
- C. Assess the client’s apical pulse and hold the next dose if it's below 60 bpm.
- D. Instruct the client to reduce their fluid intake.
Correct answer: B
Rationale: When a client on digoxin reports nausea, it can be a sign of digoxin toxicity. The priority action for the nurse is to assess the client's digoxin level immediately. This assessment will help determine if the nausea is related to digoxin toxicity, requiring a dosage adjustment. Administering an anti-nausea medication (Choice A) does not address the underlying issue of potential digoxin toxicity. Assessing the client's apical pulse (Choice C) is important in general digoxin monitoring but not the first action when nausea is reported. Instructing the client to reduce fluid intake (Choice D) is not the initial response to nausea in a client taking digoxin.
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