HESI RN
HESI 799 RN Exit Exam Capstone
1. 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.
2. A client with acute pancreatitis is prescribed nothing by mouth (NPO). What should the nurse prioritize in this client's care?
- A. Administer oral pain medication.
- B. Monitor the client's intake and output.
- C. Monitor the client for signs of infection.
- D. Insert a nasogastric tube for decompression.
Correct answer: B
Rationale: The correct answer is B: Monitor the client's intake and output. When a client with acute pancreatitis is prescribed nothing by mouth (NPO), the nurse should prioritize monitoring the client's intake and output. This is crucial for assessing the client's fluid balance and ensuring that they are not becoming dehydrated or developing complications related to fluid status. Option A is incorrect because oral pain medication should not be administered to a client who is NPO. Option C is not the priority at this time, although monitoring for infection is important in the overall care of the client. Option D is not the initial priority unless there are specific indications for decompression, which would be determined by the healthcare provider.
3. A client with pneumonia is prescribed antibiotics. What is the most important teaching point for the nurse to provide?
- A. Instruct the client to rest as much as possible.
- B. Encourage increased fluid intake to thin secretions.
- C. Explain the importance of completing the entire course of antibiotics.
- D. Instruct the client to stop taking antibiotics once symptoms subside.
Correct answer: C
Rationale: The correct answer is C. Antibiotics must be taken for the entire prescribed duration to ensure that the infection is completely eradicated. Stopping antibiotics early, even if symptoms improve, can lead to a recurrence of the infection or antibiotic resistance. Choice A is incorrect because though rest is important, completing the antibiotic course is crucial. Choice B is incorrect as while hydration is beneficial, completing the antibiotics is the priority. Choice D is incorrect as stopping antibiotics prematurely can have negative consequences.
4. A client with chronic kidney disease is prescribed a low-sodium diet. What is the nurse's priority teaching?
- A. Choose fresh fruits and vegetables.
- B. Restrict fluid intake to 1500 mL per day.
- C. Limit sodium intake to 2 grams per day.
- D. Increase potassium intake to prevent hypokalemia.
Correct answer: C
Rationale: The correct answer is C: 'Limit sodium intake to 2 grams per day.' For a client with chronic kidney disease, limiting sodium intake is crucial because it helps prevent fluid retention and reduces the workload on the kidneys. Choice A, 'Choose fresh fruits and vegetables,' is generally a healthy dietary recommendation but not the priority when focusing on a low-sodium diet. Choice B, 'Restrict fluid intake to 1500 mL per day,' is important but secondary to limiting sodium intake. Choice D, 'Increase potassium intake to prevent hypokalemia,' is not the priority teaching for a client with chronic kidney disease on a low-sodium diet.
5. The nurse is caring for a client with a nasogastric tube. Which of the following interventions is a priority to maintain client safety?
- A. Flush the tube with water every 4 hours
- B. Check the tube placement before each feeding
- C. Secure the tube to the client's nose with tape
- D. Keep the head of the bed elevated at 30 degrees
Correct answer: B
Rationale: Verifying the correct placement of a nasogastric tube before each feeding is essential to prevent aspiration and ensure that the tube is properly positioned in the stomach or intestine. This action is a priority to maintain client safety. Flushing the tube with water every 4 hours is important for tube patency but is not the priority over verifying placement. Securing the tube with tape and keeping the head of the bed elevated are crucial but are considered secondary measures compared to confirming the correct tube placement.
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