HESI RN
HESI RN Exit Exam 2023 Capstone
1. A client with atrial fibrillation is prescribed warfarin. What is the most important instruction the nurse should give?
- A. Take the medication with aspirin to improve effectiveness.
- B. Increase intake of green leafy vegetables to support the medication.
- C. Avoid foods high in potassium to reduce bleeding risk.
- D. Avoid alcohol and over-the-counter medications without consulting the provider.
Correct answer: D
Rationale: The correct answer is D. Clients taking warfarin should avoid alcohol and over-the-counter medications without consulting their healthcare provider, as these can interact with warfarin and increase the risk of bleeding. Aspirin, in particular, can exacerbate this risk. Choice A is incorrect because taking warfarin with aspirin can increase the risk of bleeding. Choice B is incorrect as while green leafy vegetables contain vitamin K which can interact with warfarin, it is more important to maintain a consistent intake rather than increase it. Choice C is incorrect because foods high in potassium do not directly impact the bleeding risk associated with warfarin.
2. A client with diabetes mellitus is experiencing diabetic ketoacidosis (DKA). What laboratory result should the nurse monitor closely?
- A. White blood cell count of 15,000.
- B. Blood glucose level of 320 mg/dL.
- C. Sodium level of 145 mEq/L.
- D. Serum creatinine level of 1.0 mg/dL.
Correct answer: B
Rationale: A blood glucose level of 320 mg/dL indicates the need for insulin to manage diabetic ketoacidosis.
3. A client has undergone renal angiography via the right femoral artery. The nurse determines that the client is experiencing a complication of the procedure upon noting:
- A. Urine output of 40 mL/hr
- B. Blood pressure of 118/76 mm Hg
- C. Respiratory rate of 18 breaths/min
- D. Pallor and coolness of the right leg
Correct answer: D
Rationale: Pallor and coolness of the right leg indicate a potential vascular complication following renal angiography, such as hemorrhage, thrombosis, or embolism. These signs suggest impaired circulation in the affected limb. Urine output, blood pressure, and respiratory rate are not typically associated with complications of renal angiography. Complications of this procedure mainly involve allergic reactions to the dye, dye-induced renal damage, and various vascular issues.
4. The nurse is preparing to administer an intramuscular injection to a client with muscle wasting in the gluteal region. What is the most appropriate site for the injection?
- A. Dorsogluteal site
- B. Ventrogluteal site
- C. Deltoid site
- D. Vastus lateralis site
Correct answer: D
Rationale: The vastus lateralis site is the most appropriate for an IM injection in a client with muscle wasting in the gluteal region. Administering the injection in the vastus lateralis ensures effective medication delivery due to muscle wasting in the gluteal region, preventing potential complications associated with the dorsogluteal or ventrogluteal sites, which may not be suitable in this specific client case. The deltoid site is mainly used for smaller volumes of medication and may not be ideal for this scenario.
5. Why is lactated Ringer’s solution given to a patient experiencing vomiting and diarrhea?
- A. To increase interstitial and intracellular hydration
- B. To maintain plasma volume over time
- C. To pull water from the interstitial space into the extracellular fluid
- D. To replace water and electrolytes
Correct answer: D
Rationale: Lactated Ringer’s solution is an isotonic solution commonly used to replace water and electrolytes lost due to conditions like vomiting and diarrhea. It helps to restore fluid balance by replacing the lost volume and electrolytes. Option A is incorrect because hypotonic fluids, not lactated Ringer’s solution, increase interstitial and intracellular hydration. Option B is incorrect as colloidal solutions, not lactated Ringer’s solution, are used to maintain plasma volume over time. Option C is incorrect as hypertonic solutions, not lactated Ringer’s solution, pull water from the interstitial space into the extracellular fluid.