HESI RN
HESI Exit Exam RN Capstone
1. A client is newly diagnosed with a duodenal ulcer. What information should the nurse provide during medication teaching?
- A. Take antacids regularly to manage symptoms.
- B. Avoid spicy foods and alcohol.
- C. Ensure proper administration of antibiotics.
- D. Stop all food intake until symptoms subside.
Correct answer: B
Rationale: The correct answer is B. Clients with duodenal ulcers should avoid spicy foods and alcohol as they can exacerbate symptoms and delay healing. Choice A is incorrect because while antacids may help with symptoms, they are not the primary focus of medication teaching for duodenal ulcers. Choice C is not directly related to medication teaching for duodenal ulcers unless antibiotics are specifically prescribed. Choice D is incorrect as stopping all food intake is not recommended and can lead to other complications.
2. When teaching a group of mothers of young children about emergency care for poisoning, which of the following statements should be included?
- A. Induce vomiting immediately after the poison ingestion
- B. Call the local Poison Control Center after inducing vomiting
- C. Call the Poison Control Center prior to any interventions
- D. Take the child to the emergency department before calling the Poison Control Center
Correct answer: C
Rationale: The correct statement to include when teaching about emergency care for poisoning is to call the Poison Control Center prior to any interventions. This is important because the Poison Control Center can provide guidance on the appropriate steps to take based on the type of poisoning, the amount ingested, and the age of the child. Inducing vomiting without professional advice can sometimes do more harm than good. Choice A is incorrect because inducing vomiting immediately is not recommended without consulting with professionals. Choice B is incorrect as it suggests calling the Poison Control Center after inducing vomiting, which is not the recommended sequence. Choice D is incorrect because it is advisable to contact the Poison Control Center first before taking the child to the emergency department.
3. A client with a colostomy is being discharged. What teaching is most important for the nurse to provide?
- A. Change the ostomy bag daily to prevent skin irritation.
- B. Avoid foods that can cause gas, such as broccoli.
- C. Empty the ostomy pouch when it is one-third full.
- D. Use a skin barrier to protect the surrounding skin.
Correct answer: C
Rationale: The most important teaching for a client with a colostomy is to empty the ostomy pouch when it is one-third full. This practice helps prevent leakage and skin irritation by maintaining the proper seal of the pouching system. Changing the ostomy bag daily (Choice A) is not necessary unless it leaks or becomes loose. Avoiding gas-producing foods (Choice B) is essential for some clients but is not the most important teaching. Using a skin barrier (Choice D) is important but not as crucial as emptying the ostomy pouch at the right time to prevent complications.
4. The nurse is caring for a client with an indwelling urinary catheter. Which of the following actions should the nurse prioritize to prevent infection?
- A. Maintain a closed drainage system
- B. Cleanse the catheter insertion site daily
- C. Increase the client's fluid intake
- D. Empty the collection bag every 4 hours
Correct answer: A
Rationale: The correct answer is to maintain a closed drainage system. This action is crucial in preventing infection as it helps prevent bacteria from entering the urinary tract. While cleansing the catheter insertion site and ensuring adequate hydration are important aspects of catheter care, the top priority is maintaining the integrity of the closed system to prevent infection. Emptying the collection bag regularly is also important but not as critical as ensuring a closed drainage system to minimize infection risk.
5. A nurse receives a report on a client who is four hours post-total abdominal hysterectomy. The previous nurse reported that it was necessary to change the client's perineal pad hourly and that it is again saturated. The previous nurse also reports that the client's urinary output has decreased. Which action should the nurse implement first?
- A. Measure urinary output
- B. Assess for weakness or dizziness
- C. Increase IV fluids
- D. Check for vaginal bleeding
Correct answer: D
Rationale: Saturation of the perineal pad after a hysterectomy suggests excessive vaginal bleeding, which must be addressed immediately. Assessing for vaginal bleeding is the priority in this situation as it can lead to hypovolemic shock. Measuring urinary output, assessing for weakness or dizziness, and increasing IV fluids are important interventions but checking for vaginal bleeding takes precedence due to the risk of hemorrhage post-hysterectomy.
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