HESI RN
RN HESI Exit Exam
1. A client with chronic kidney disease (CKD) is scheduled for a renal biopsy. Which laboratory value should the nurse review before the procedure?
- A. Serum potassium
- B. Serum creatinine
- C. Hemoglobin
- D. White blood cell count
Correct answer: B
Rationale: Before a renal biopsy, the nurse should review the serum creatinine level. Serum creatinine is a key indicator of kidney function. In clients with chronic kidney disease (CKD), monitoring creatinine levels is crucial as elevated levels may indicate worsening kidney function, which could impact the safety and outcome of the biopsy. Hemoglobin (choice C) is important for assessing oxygen-carrying capacity but is not directly related to the kidney biopsy procedure. Serum potassium (choice A) is important to monitor in CKD but is not specifically crucial before a renal biopsy. White blood cell count (choice D) is more relevant for assessing infection or inflammation, which is not the primary concern before a renal biopsy.
2. The mother of a one-month-old boy born at home brings the infant to his first well-baby visit. She mentions that he was born two weeks after his due date and is a 'good, quiet baby' who almost never cries. To assess for hypothyroidism, what question is most important for the nurse to ask the mother?
- A. Has your son had any immunizations yet?
- B. Is your son sleepy and difficult to feed?
- C. Are you breastfeeding or bottle feeding your son?
- D. Were any relatives born with birth defects?
Correct answer: B
Rationale: The correct answer is B. Sleepiness and difficulty feeding are key signs of congenital hypothyroidism, which requires early diagnosis and treatment. Asking about immunizations (choice A) is important but not directly related to assessing hypothyroidism. The feeding method (choice C) is relevant for overall health but not specific to hypothyroidism. Inquiring about relatives with birth defects (choice D) is not the most crucial question to assess hypothyroidism in this scenario.
3. A client with a history of chronic alcoholism is admitted with confusion, ataxia, and diplopia. Which nursing intervention is a priority for this client?
- A. Monitor for signs of alcohol withdrawal.
- B. Administer thiamine as prescribed.
- C. Provide a quiet environment to reduce confusion.
- D. Initiate fall precautions.
Correct answer: B
Rationale: The correct answer is to administer thiamine as prescribed. This intervention is a priority for clients with chronic alcoholism to prevent Wernicke's encephalopathy, a serious complication of thiamine deficiency. Monitoring for signs of alcohol withdrawal (choice A) is important but not the priority in this scenario. Providing a quiet environment (choice C) may be beneficial but does not address the immediate need to prevent Wernicke's encephalopathy. Initiating fall precautions (choice D) is also important but not the priority compared to administering thiamine to prevent a life-threatening condition.
4. A client with a history of severe rheumatoid arthritis is receiving a corticosteroid. Which assessment finding should the nurse report to the healthcare provider immediately?
- A. Blood glucose level of 180 mg/dL
- B. Weight gain of 2 pounds in 24 hours
- C. Blood pressure of 140/90 mmHg
- D. Increased joint pain
Correct answer: C
Rationale: Elevated blood pressure (140/90 mmHg) is a significant finding that the nurse should report immediately. Hypertension can be a severe side effect of corticosteroid therapy, especially in clients with preexisting conditions like rheumatoid arthritis. It requires prompt intervention to prevent complications such as cardiovascular events. The other options, while important to monitor, are not as critical as elevated blood pressure in this context. A blood glucose level of 180 mg/dL may indicate hyperglycemia, weight gain could be due to fluid retention, and increased joint pain is expected in a client with severe rheumatoid arthritis.
5. A client with a history of atrial fibrillation is receiving warfarin (Coumadin). Which laboratory value should the nurse monitor closely?
- A. International Normalized Ratio (INR)
- B. Prothrombin time (PT)
- C. Serum sodium level
- D. Hemoglobin level of 12 g/dl
Correct answer: A
Rationale: The correct answer is A: International Normalized Ratio (INR). The INR should be closely monitored in a client receiving warfarin (Coumadin) to assess the effectiveness and safety of anticoagulation therapy. Monitoring the INR helps ensure that the client is within the therapeutic range to prevent both bleeding and clotting events. Choices B, C, and D are incorrect because while PT is used to monitor warfarin therapy, INR is a more precise indicator of therapeutic levels. Serum sodium level and hemoglobin level are not directly related to monitoring warfarin therapy.
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