HESI RN
HESI 799 RN Exit Exam Capstone
1. A client with lupus erythematosus is prescribed prednisone. What teaching should the nurse include?
- A. Take the medication with food to prevent stomach upset.
- B. Avoid crowded places to reduce the risk of infection.
- C. Take the medication in the morning to prevent insomnia.
- D. Take extra calcium supplements to prevent osteoporosis.
Correct answer: B
Rationale: The correct teaching for a client with lupus erythematosus prescribed prednisone is to avoid crowded places to reduce the risk of infection. Prednisone suppresses the immune system, making individuals more susceptible to infections. Taking the medication with food may help reduce stomach upset but is not the priority teaching. Taking prednisone in the morning may help reduce insomnia, but infection prevention is more critical. While prednisone can lead to osteoporosis, advising extra calcium supplements is not the most immediate concern when starting the medication.
2. The nurse has given discharge instructions to parents of a child on phenytoin (Dilantin). Which of the following statements suggests that the teaching was effective?
- A. We will call the health care provider if the child develops acne.
- B. Our child should brush and floss carefully after every meal.
- C. We will skip the next dose if vomiting or fever occur.
- D. When our child is seizure-free for 6 months, we can stop the medication.
Correct answer: B
Rationale: Phenytoin can cause gingival hyperplasia, so good oral hygiene is important to prevent complications.
3. An unresponsive male victim of a diving accident is brought to the emergency department where immediate surgery is required to save his life. No family members are available. What action should the nurse take first?
- A. Ask the friend to sign an informed consent.
- B. Notify the unit manager that a court order is needed.
- C. Continue providing life support until a guardian is found.
- D. Proceed with surgery preparation without consent.
Correct answer: D
Rationale: In emergency situations where immediate surgery is required to save a patient's life and no family members are available, consent can be waived to proceed with necessary interventions. The priority in this scenario is to proceed with surgery preparation without waiting for consent, as any delay could jeopardize the patient's life. Asking the friend to sign informed consent or notifying the unit manager for a court order would cause unnecessary delays, which are not advisable in this critical situation. Continuing life support until a guardian is found is not the most appropriate action when immediate surgical intervention is necessary.
4. An antibiotic IM injection for a 2-year-old child is ordered. The total volume of the injection equals 2.0 ml. The correct action is to
- A. Administer the medication in 2 separate injections
- B. Give the medication in the dorsal gluteal site
- C. Call to get a smaller volume ordered
- D. Check with the pharmacy for a liquid form of the medication
Correct answer: A
Rationale: Injections over 1 mL should be split into two separate injections for young children. This helps in preventing discomfort, ensuring proper absorption, and reducing the risk of tissue damage. Giving the medication in one injection of 2.0 ml might be too much for a 2-year-old child. Choices B and D are incorrect because the dorsal gluteal site is not recommended for children due to potential injury, and changing the form of medication might not be necessary if the volume can be adjusted. Choice C is unnecessary as splitting the dose into two injections is the appropriate action.
5. An adolescent with major depressive disorder has been taking duloxetine (Cymbalta) for the past 12 days. Which assessment finding requires immediate follow-up?
- A. Increased appetite
- B. Describes life without purpose
- C. Exhibits mood swings
- D. Complains of insomnia
Correct answer: B
Rationale: An adolescent expressing 'life without purpose' after taking duloxetine (Cymbalta) may be indicating suicidal ideation, which requires immediate attention. The initial period of antidepressant treatment can increase the risk of suicidal thoughts, especially in younger populations. Increased appetite (Choice A) is a common side effect of duloxetine and may not require immediate follow-up. Mood swings (Choice C) and insomnia (Choice D) are also possible side effects of the medication but are not as urgent as addressing suicidal ideation.
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