HESI RN
HESI Fundamentals
1. A client with a suspected kidney infection is admitted to the hospital for observation. Which action should the nurse implement to assess the client’s kidney function?
- A. Monitor the client’s urine output
- B. Check for abdominal tenderness
- C. Evaluate the client’s fluid intake
- D. Inspect the client’s skin for edema
Correct answer: A
Rationale: Monitoring urine output is the most direct way to assess kidney function as it provides crucial information about the kidneys’ ability to filter waste and produce urine. Changes in urine output can indicate potential issues with kidney function, such as decreased filtration or impaired excretion of waste products.
2. In order to provide services effectively and in the best interests of the whole family:
- A. The wife's relatives need to be contacted
- B. It's important to seek the services of a traditional healer
- C. Health providers need to be aware of the roles and decision-making process within the family
- D. Health providers need to conduct door-to-door sensitization on health matters
Correct answer: C
Rationale: The correct answer is C: 'Health providers need to be aware of the roles and decision-making process within the family.' To provide services effectively, health providers must understand the dynamics within a family, including who makes decisions and how roles are distributed. This knowledge helps them tailor their services to meet the needs and preferences of the whole family. Choices A and B are incorrect because contacting the wife's relatives or seeking the services of a traditional healer may not necessarily align with providing effective services based on family dynamics. Choice D is also incorrect as door-to-door sensitization may not directly address the internal dynamics of a family.
3. A client with Cushing's syndrome is being assessed by the nurse. Which of the following clinical manifestations is consistent with this condition?
- A. Moon face
- B. Weight loss
- C. Hyperpigmentation
- D. Hypotension
Correct answer: A
Rationale: The correct clinical manifestation consistent with Cushing's syndrome is a 'moon face.' Cushing's syndrome is characterized by fat redistribution, leading to the round and full appearance of the face known as a moon face. Choice B, weight loss, is not common in Cushing's syndrome as patients often experience weight gain. Choice C, hyperpigmentation, is more indicative of Addison's disease, not Cushing's syndrome. Choice D, hypotension, is not typically associated with Cushing's syndrome which often presents with hypertension due to excess cortisol.
4. A male client with schizophrenia tells the RN that he is being watched and that the television is speaking directly to him. Which response by the RN is appropriate?
- A. “The television cannot speak to you.”
- B. “That sounds very frightening for you.”
- C. “You should ignore the television.”
- D. “Why do you think the television is talking to you?”
Correct answer: B
Rationale: Option B is the correct response because it acknowledges the client's feelings and demonstrates empathy. By stating that the situation sounds frightening, the RN validates the client's experience without denying or reinforcing the delusion. This approach helps build rapport and trust with the client, which is essential in therapeutic communication. Options A and C are dismissive and may invalidate the client's experience, potentially worsening the trust relationship. Option D is confrontational and may make the client defensive, hindering effective communication and rapport-building.
5. A pregnant woman in her first trimester is experiencing watery vaginal discharge. What should the nurse tell her?
- A. Inform her that it is normal.
- B. Advise her to see a doctor immediately.
- C. Suggest using panty liners.
- D. Suggest a change in diet.
Correct answer: A
Rationale: Informing the pregnant woman that watery vaginal discharge is normal during the first trimester is crucial to providing reassurance and reducing anxiety. This discharge, known as leukorrhea, is common during pregnancy due to increased estrogen levels and increased blood flow to the pelvic area. It helps maintain a healthy balance of bacteria in the vagina and protects the birth canal from infection. Advising the woman to see a doctor immediately may cause unnecessary alarm, while suggesting the use of panty liners can help manage the discharge comfortably. Suggesting a change in diet is not relevant to addressing watery vaginal discharge in this scenario.