HESI RN
HESI RN Exit Exam Capstone
1. The mother of a 2-day-old infant girl expresses concern about a 'flea bite' type rash on her daughter's body. The nurse identifies a pink papular rash with vesicles superimposed over the thorax, back, buttocks, and abdomen. Which explanation should the nurse offer?
- A. We need to monitor the rash for signs of worsening or fever
- B. Your baby may have an allergic reaction to laundry detergent
- C. This is a common newborn rash that will resolve after several days
- D. This is likely a bacterial infection requiring antibiotics
Correct answer: C
Rationale: The rash described is typical of erythema toxicum neonatorum, a common and benign newborn rash that resolves on its own within a few days. No treatment is necessary, and the nurse should reassure the mother. Choice A is incorrect as the rash is self-limiting and does not require monitoring for worsening signs or fever. Choice B is incorrect as erythema toxicum neonatorum is not caused by an allergic reaction to laundry detergent. Choice D is incorrect as this rash is not indicative of a bacterial infection that requires antibiotics.
2. The nurse is caring for a client with a suspected myocardial infarction (MI). Which laboratory test result is most indicative of a recent MI?
- A. Elevated troponin levels
- B. Increased white blood cell count
- C. Increased lactate dehydrogenase (LDH)
- D. Elevated C-reactive protein (CRP)
Correct answer: A
Rationale: Elevated troponin levels are the most specific and sensitive indicator of myocardial infarction. Troponin levels increase within hours of an MI and remain elevated for several days. White blood cell count, lactate dehydrogenase (LDH), and C-reactive protein (CRP) are not specific markers for MI. An increased white blood cell count may indicate inflammation or infection, increased LDH levels can be seen in various conditions like liver disease or muscle injury, and elevated CRP is a general marker of inflammation rather than specific to MI.
3. When teaching a group of mothers of young children about emergency care for poisoning, which of the following statements should be included?
- A. Induce vomiting immediately after the poison ingestion
- B. Call the local Poison Control Center after inducing vomiting
- C. Call the Poison Control Center prior to any interventions
- D. Take the child to the emergency department before calling the Poison Control Center
Correct answer: C
Rationale: The correct statement to include when teaching about emergency care for poisoning is to call the Poison Control Center prior to any interventions. This is important because the Poison Control Center can provide guidance on the appropriate steps to take based on the type of poisoning, the amount ingested, and the age of the child. Inducing vomiting without professional advice can sometimes do more harm than good. Choice A is incorrect because inducing vomiting immediately is not recommended without consulting with professionals. Choice B is incorrect as it suggests calling the Poison Control Center after inducing vomiting, which is not the recommended sequence. Choice D is incorrect because it is advisable to contact the Poison Control Center first before taking the child to the emergency department.
4. An older client is admitted with fluid volume deficit and dehydration. Which assessment finding is the best indicator of hydration status?
- A. Urine specific gravity of 1.040.
- B. Systolic blood pressure decreases by 10 points when standing.
- C. The client denies feeling thirsty.
- D. Skin turgor exhibits tenting on the forearm.
Correct answer: A
Rationale: In the context of fluid volume deficit and dehydration, urine specific gravity of 1.040 is the best indicator of hydration status. High urine specific gravity indicates concentrated urine, suggesting dehydration. Choice B, systolic blood pressure decreasing when standing, is more indicative of orthostatic hypotension rather than hydration status. Choice C, denial of thirst, is a subjective finding and may not always reflect actual hydration status. Choice D, skin turgor exhibiting tenting on the forearm, is a sign of dehydration but may not be as accurate as urine specific gravity in assessing hydration status.
5. A client with a 42-week gestation refuses induction. What is the most important action the nurse should take?
- A. Discuss alternative ways to support the client's birth plan.
- B. Explain the risks of induction after 42 weeks.
- C. Ask the healthcare provider to discuss the situation with the client.
- D. Discuss the characteristics of labor with oxytocin vs. natural labor.
Correct answer: A
Rationale: The most important action for the nurse in this situation is to discuss alternative ways to support the client's birth plan. By doing so, the nurse can ensure that the client feels heard, respected, and supported in their decision-making process. While explaining the risks of induction after 42 weeks (Choice B) may be important, it is secondary to supporting the client's autonomy and preferences. Asking the healthcare provider to discuss the situation with the client (Choice C) may delay crucial communication and support that the nurse can provide. Discussing the characteristics of labor with oxytocin vs. natural labor (Choice D) is not the priority when the client has refused induction, as the focus should be on respecting their decision and exploring other options for support.
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