HESI RN
HESI RN Exit Exam Capstone
1. A client asks the nurse for information about reducing risk factors for BPH. Which information should the nurse provide?
- A. Increase physical activity
- B. Decrease alcohol consumption
- C. Reduce intake of dairy products
- D. Avoid caffeine and spicy foods
Correct answer: A
Rationale: The correct answer is A: Increase physical activity. Physical activity can help reduce the risk of benign prostatic hyperplasia (BPH) by improving overall circulation and reducing inflammation. While decreasing alcohol consumption and avoiding caffeine and spicy foods may help with symptom management, increasing physical activity is more strongly linked to the prevention of BPH.
2. A client with a history of coronary artery disease is experiencing chest pain. What is the nurse's first action?
- A. Administer sublingual nitroglycerin
- B. Obtain a 12-lead electrocardiogram
- C. Call the healthcare provider
- D. Check the client's oxygen saturation
Correct answer: A
Rationale: The correct answer is A: Administer sublingual nitroglycerin. Sublingual nitroglycerin is the first-line treatment for chest pain related to coronary artery disease. It helps dilate the coronary arteries and improve blood flow to the heart, providing immediate relief from ischemia. Administering nitroglycerin promptly can help alleviate the chest pain and prevent further complications. Obtaining a 12-lead electrocardiogram (Choice B) is important but should not delay the administration of nitroglycerin. Calling the healthcare provider (Choice C) can be done after initiating immediate treatment. Checking the client's oxygen saturation (Choice D) is relevant but not the first action to take in this scenario.
3. A client with a head injury reports severe nausea. What is the nurse's priority action?
- A. Administer anti-nausea medication as prescribed.
- B. Prepare the client for a CT scan.
- C. Elevate the head of the bed and provide an emesis basin.
- D. Notify the healthcare provider immediately.
Correct answer: D
Rationale: Severe nausea in a client with a head injury may be a sign of increased intracranial pressure. The nurse should notify the healthcare provider immediately to ensure timely intervention, as increased pressure can lead to further complications such as brain herniation. Administering anti-nausea medication or preparing for a CT scan may delay necessary treatment for the underlying cause of the nausea, which could be related to the head injury. Elevating the head of the bed and providing an emesis basin may help manage symptoms but should not be the priority over addressing the potential increase in intracranial pressure.
4. A client with hypertension is being educated on lifestyle changes by a nurse. Which recommendation is the most important to reduce blood pressure?
- A. Increase water intake
- B. Avoid alcohol consumption
- C. Exercise regularly
- D. Reduce sodium intake
Correct answer: D
Rationale: Reducing sodium intake is crucial in managing hypertension as high sodium levels can lead to fluid retention and increased blood pressure. While increasing water intake is beneficial for overall health, reducing sodium has a more significant impact on blood pressure. Regular exercise is important for cardiovascular health but does not have as direct an impact on blood pressure as sodium reduction. Avoiding alcohol is also important, but in terms of managing blood pressure, reducing sodium intake takes precedence.
5. A client with tuberculosis is prescribed rifampin. What side effect should the nurse inform the client about?
- A. Report orange-colored urine as a sign of kidney dysfunction.
- B. Expect red-orange discoloration of urine as a harmless side effect.
- C. Monitor for signs of liver toxicity.
- D. Call the healthcare provider if vision changes occur.
Correct answer: B
Rationale: The correct answer is B. Rifampin can cause red-orange discoloration of bodily fluids, including urine, saliva, and tears. This is a harmless side effect, but clients should be informed beforehand to prevent alarm. Choice A is incorrect as orange-colored urine is not a sign of kidney dysfunction related to rifampin. Choice C is incorrect because rifampin is more commonly associated with liver toxicity rather than kidney dysfunction. Choice D is incorrect as vision changes are not a typical side effect of rifampin.
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