HESI RN
HESI RN Exit Exam 2024 Quizlet
1. A client with a history of chronic obstructive pulmonary disease (COPD) is admitted with an exacerbation. Which assessment finding is most concerning to the nurse?
- A. Barrel-shaped chest
- B. Use of accessory muscles
- C. Oxygen saturation of 85%
- D. Respiratory rate of 28 breaths per minute
Correct answer: C
Rationale: An oxygen saturation of 85% is significantly low for a client with COPD and indicates hypoxemia, requiring immediate intervention. In COPD, the body's ability to oxygenate adequately is already compromised, so a saturation of 85% is particularly concerning. A barrel-shaped chest and use of accessory muscles are common findings in COPD due to chronic air trapping and increased work of breathing. While a respiratory rate of 28 breaths per minute is elevated, a low oxygen saturation is a more critical finding that necessitates prompt attention.
2. A client with a history of chronic kidney disease is scheduled for a renal biopsy. Which laboratory value should the nurse report to the healthcare provider before the procedure?
- A. Serum creatinine of 1.8 mg/dl
- B. Prothrombin time of 18 seconds
- C. Hemoglobin of 9 g/dl
- D. Platelet count of 90,000/mm3
Correct answer: D
Rationale: A platelet count of 90,000/mm3 is low and concerning for a client scheduled for a renal biopsy, as it increases the risk of bleeding. Thrombocytopenia, indicated by a low platelet count, can lead to impaired blood clotting, posing a significant risk of bleeding during or after the biopsy procedure. Elevated serum creatinine levels may be expected in chronic kidney disease but are not directly related to bleeding risk during a renal biopsy. Prothrombin time and hemoglobin levels are not as directly relevant to the bleeding risk associated with a renal biopsy as platelet count.
3. A client with chronic kidney disease (CKD) is scheduled for a hemodialysis session. Which laboratory value should the nurse monitor closely?
- A. Serum potassium
- B. Serum creatinine
- C. Serum sodium
- D. Serum chloride
Correct answer: C
Rationale: The correct answer is C: Serum sodium. In a client with chronic kidney disease (CKD) scheduled for hemodialysis, monitoring serum sodium levels closely is essential. Hemodialysis can cause rapid shifts in sodium levels, leading to electrolyte imbalances. While serum potassium (choice A) is important to monitor in CKD, it is not the most crucial before hemodialysis. Serum creatinine (choice B) is an indicator of kidney function but is not the most immediate concern before hemodialysis. Serum chloride (choice D) is not typically the primary electrolyte of concern in CKD patients before hemodialysis.
4. A client who is at 36 weeks gestation is admitted with severe preeclampsia. After a 6-gram loading dose of magnesium sulfate is administered, an intravenous infusion of magnesium sulfate at a rate of 2 grams/hour is initiated. Which assessment finding warrants immediate intervention by the nurse?
- A. Urine output of 20 ml/hour
- B. Blood pressure of 138/88
- C. Respiratory rate of 18 breaths/min
- D. Temperature of 99.8°F
Correct answer: A
Rationale: A urine output of less than 30 ml/hour indicates that the kidneys are being affected by the high level of magnesium sulfate. This decreased urine output can lead to magnesium toxicity and impaired kidney function. Blood pressure of 138/88 is within normal limits for pregnancy and does not indicate an immediate concern related to magnesium sulfate. A respiratory rate of 18 breaths/min is normal, and a temperature of 99.8°F is slightly elevated but not a priority in the context of severe preeclampsia and magnesium sulfate administration.
5. A client with a history of chronic kidney disease (CKD) is admitted with hyperkalemia. Which clinical finding is most concerning?
- A. Peaked T waves on the ECG
- B. Bradycardia
- C. Muscle weakness
- D. Decreased deep tendon reflexes
Correct answer: A
Rationale: Peaked T waves on the ECG are the most concerning finding in a client with hyperkalemia. Hyperkalemia can lead to serious cardiac complications, including arrhythmias and cardiac arrest. Peaked T waves are a classic ECG finding associated with hyperkalemia and indicate the need for immediate intervention. Bradycardia, muscle weakness, and decreased deep tendon reflexes can also be seen in hyperkalemia, but the presence of peaked T waves signifies a higher risk of cardiac events, making it the most concerning finding in this scenario.
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