HESI RN
RN HESI Exit Exam Capstone
1. A client with hypothyroidism is prescribed levothyroxine. What should the nurse include in the teaching plan about this medication?
- A. Take the medication with a full meal
- B. Take the medication on an empty stomach
- C. Take the medication at bedtime
- D. Take the medication as needed for symptoms
Correct answer: B
Rationale: The correct answer is B: 'Take the medication on an empty stomach.' Levothyroxine should be taken on an empty stomach to enhance absorption and effectiveness. The medication is typically taken in the morning before breakfast. Choice A is incorrect because taking levothyroxine with a full meal can decrease its absorption. Choice C is incorrect because bedtime dosing may lead to insomnia. Choice D is incorrect because levothyroxine is a daily medication for hypothyroidism, not to be taken as needed for symptoms.
2. Which dietary instruction is most important for a client with renal disease?
- A. Avoid all protein-rich foods.
- B. Limit fluid intake to 1500 ml/day.
- C. Increase potassium intake to prevent weakness.
- D. Eat small, frequent meals high in carbohydrates.
Correct answer: B
Rationale: The most important dietary instruction for a client with renal disease is to limit fluid intake to 1500 ml/day. This is essential to prevent fluid overload, manage electrolyte balance, and reduce strain on the kidneys. Choice A is incorrect because while protein restriction may be necessary in some cases, avoiding all protein-rich foods is not recommended as some protein intake is essential for overall health. Choice C is incorrect because increasing potassium intake is generally not advised for clients with renal disease, as they often need to limit potassium intake. Choice D is also incorrect because while consuming small, frequent meals may be helpful, emphasizing a diet high in carbohydrates is not typically the primary focus for clients with renal disease.
3. A client with schizophrenia is experiencing paranoia. What is the nurse's priority intervention?
- A. Reassure the client that their fears are unfounded.
- B. Place the client in a private room to reduce stimuli.
- C. Provide the client with a distraction to redirect their attention.
- D. Encourage the client to express their concerns and validate their feelings.
Correct answer: D
Rationale: Encouraging clients with paranoia to express their concerns and validating their feelings is crucial as it helps establish trust and reduce anxiety. This approach also aids in building a therapeutic relationship. Reassuring the client that their fears are unfounded (Choice A) may invalidate their feelings and worsen trust. Placing the client in a private room to reduce stimuli (Choice B) may be helpful in some situations but does not address the underlying issue of paranoia. Providing a distraction (Choice C) may temporarily shift the client's focus but does not address the root cause of the paranoia. Therefore, the priority intervention is to encourage the client to express their concerns and validate their feelings.
4. A client with chronic obstructive pulmonary disease (COPD) presents with a respiratory rate of 32 breaths per minute and an oxygen saturation of 86%. What is the nurse's first action?
- A. Administer oxygen at 2 L/min via nasal cannula.
- B. Notify the healthcare provider immediately.
- C. Position the client in high Fowler's position.
- D. Suction the client's airway.
Correct answer: A
Rationale: Administering oxygen at 2 L/min via nasal cannula is the nurse's first action when a client with COPD presents with a respiratory rate of 32 breaths per minute and an oxygen saturation of 86%. Oxygen therapy helps improve oxygen saturation in patients with COPD and respiratory distress. While notifying the healthcare provider is important, immediate intervention to improve oxygenation takes priority. Positioning the client in high Fowler's position can also assist with breathing but is not the initial action in this scenario. Suctioning the airway is not indicated unless there are secretions obstructing the airway, which is not mentioned in the scenario.
5. The nurse is administering a new medication to a client. What is the priority action before administering the drug?
- A. Verify the client's allergies
- B. Check the client's blood pressure
- C. Assess the client's pain level
- D. Provide client education on the medication
Correct answer: A
Rationale: Verifying the client's allergies is the priority action before administering any medication. It is crucial to identify any known allergies to prevent potential allergic reactions, which can be severe and life-threatening. Checking the client's blood pressure, assessing pain levels, and providing education on the medication are important aspects of client care but verifying allergies is essential for ensuring the safety of the client.
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