HESI RN
HESI RN Exit Exam 2023
1. A client with chronic obstructive pulmonary disease (COPD) is admitted with an exacerbation. Which assessment finding is most concerning?
- A. Oxygen saturation of 90%
- B. Respiratory rate of 24 breaths per minute
- C. Use of accessory muscles
- D. Inspiratory crackles
Correct answer: C
Rationale: The correct answer is C. Use of accessory muscles is the most concerning finding in a client with COPD experiencing an exacerbation. This indicates increased work of breathing and can be a sign of respiratory failure, requiring immediate intervention. Oxygen saturation of 90% is low but not as concerning as the increased work of breathing. A respiratory rate of 24 breaths per minute can be within normal limits. Inspiratory crackles may be present in COPD due to airway inflammation but are not as concerning as the use of accessory muscles.
2. A patient who has small cell carcinoma of the lung develops syndrome of inappropriate antidiuretic hormone (SIADH). The nurse should notify the healthcare provider about which assessment finding?
- A. Reported weight gain
- B. Serum hematocrit of 42%
- C. Serum sodium level of 120 mEq/L
- D. Total urinary output of 280 mL during the past 8 hours
Correct answer: C
Rationale: The correct answer is C, a serum sodium level of 120 mEq/L. Hyponatremia is the most important finding to report in SIADH. SIADH causes water retention and a decrease in serum sodium levels. Hyponatremia can lead to confusion and other central nervous system effects and requires treatment. Adequate kidney function is indicated by a urinary output of at least 30 mL/hr. A hematocrit level of 42% is normal. Weight gain is expected due to water retention in SIADH.
3. The nurse is planning for a 5-month-old with gastroesophageal reflux disease whose weight has decreased by 3 ounces since the last clinic visit one month ago. To increase caloric intake and decrease vomiting, what instructions should the nurse provide this mother?
- A. Give small amounts of baby food with each feeding.
- B. Thicken formula with cereal for each feeding.
- C. Dilute the child's formula with equal parts of water.
- D. Offer 10% dextrose in water between most feedings.
Correct answer: B
Rationale: Thickening formula with cereal is a recommended intervention for infants with gastroesophageal reflux disease (GERD) to help reduce vomiting and increase caloric intake. This modification can help the infant keep the food down better, reducing reflux symptoms while providing adequate nutrition. Giving small amounts of baby food with each feeding (Choice A) is not recommended for a 5-month-old with GERD as it may exacerbate symptoms. Diluting the child's formula with equal parts of water (Choice C) can lead to inadequate nutrition and is not advisable. Offering 10% dextrose in water between most feedings (Choice D) is not appropriate for managing GERD in infants and does not address the underlying issue of reflux.
4. What is the definition of incomplete abortion?
- A. Part of the products of conception, especially the fetus, is expelled while the placenta and membranes are retained.
- B. All products of conception are expelled, and there is minimal per vaginal bleeding.
- C. The cervix is closed, and the products of conception remain in the uterus.
- D. The cervix dilates, and the products of conception are expelled.
Correct answer: A
Rationale: Incomplete abortion is defined as part of the products of conception, especially the fetus, being expelled while the placenta and membranes are retained. This is the correct definition, making option A the right choice. Option B is incorrect as it describes a complete abortion. Option C is incorrect because in incomplete abortion, the products of conception are not retained in the uterus, and the cervix may be open. Option D is incorrect as it describes a situation more likely to be seen in an inevitable abortion.
5. The healthcare provider is monitoring a client with syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following interventions should the healthcare provider include in the care plan?
- A. Encourage oral fluids
- B. Restrict fluid intake
- C. Administer potassium supplements
- D. Increase sodium intake
Correct answer: B
Rationale: The correct intervention for a client with SIADH is to restrict fluid intake. SIADH leads to water retention and dilution of sodium levels in the body, resulting in hyponatremia. Restricting fluid intake helps prevent further dilutional hyponatremia. Encouraging oral fluids (Choice A) would exacerbate the condition by further increasing fluid retention. Administering potassium supplements (Choice C) is not directly related to managing SIADH. Increasing sodium intake (Choice D) is contraindicated because it can worsen hyponatremia in clients with SIADH.