HESI RN
HESI RN Exit Exam 2023 Capstone
1. A client with deep vein thrombosis (DVT) is prescribed warfarin. What teaching should the nurse provide to the client?
- A. Avoid leafy green vegetables while taking warfarin.
- B. Report any unusual bruising or bleeding.
- C. Take warfarin at the same time every day.
- D. Avoid alcohol consumption while on warfarin.
Correct answer: D
Rationale: The correct answer is D: 'Avoid alcohol consumption while on warfarin.' Alcohol can increase the risk of bleeding when taken with warfarin, so it should be avoided. Choice A is incorrect as leafy green vegetables contain vitamin K, which can interfere with the anticoagulant effects of warfarin. Choice B is important but not directly related to alcohol consumption. Choice C is a general instruction for medication adherence but not specifically related to the interaction with alcohol.
2. During fertilization, the portion of the decidua covering the blastocyst is called:
- A. Decidua basalis
- B. Decidua Vera
- C. Decidua parietalis
- D. Decidua capsularis
Correct answer: D
Rationale: During fertilization, the decidua capsularis is the specific portion of the decidua that covers the blastocyst, providing protection and support. Decidua basalis refers to the part of the decidua located at the site of implantation on the maternal side. Decidua vera is the remainder of the decidua lining the uterus. Decidua parietalis is the portion of the decidua that lines the rest of the uterine cavity, except for the site of implantation. Therefore, in the context of fertilization, the decidua capsularis is the correct answer.
3. A client is receiving continuous bladder irrigation via a triple-lumen suprapubic catheter that was placed during a prostatectomy. Which report by the unlicensed assistive personnel (UAP) requires intervention by the nurse?
- A. Leakage around the catheter insertion site.
- B. Pink-tinged urine in the drainage bag.
- C. Client reports discomfort at the catheter site.
- D. Decreased urine output in the last hour.
Correct answer: A
Rationale: The correct answer is A. Leakage around the catheter insertion site may indicate a problem with the catheter placement or function, requiring immediate intervention. Pink-tinged urine in the drainage bag is expected due to the continuous bladder irrigation. Discomfort at the catheter site is common after the procedure. Decreased urine output in the last hour may be due to the continuous bladder irrigation and doesn't require immediate intervention.
4. Which client is most likely to be at risk for spiritual distress?
- A. Roman Catholic woman considering an abortion
- B. Jewish man considering hospice care for his wife
- C. Seventh-day Adventist in need of a blood transfusion
- D. Muslim man in need of a total knee replacement
Correct answer: A
Rationale: The correct answer is A. In Roman Catholicism, abortion is strictly prohibited, so a Roman Catholic woman considering this procedure may experience spiritual distress due to conflicts with her religious beliefs. This conflict can lead to emotional and psychological turmoil, affecting her spiritual well-being. It is essential for healthcare providers to recognize and address such conflicts with sensitivity and understanding to provide holistic care.
5. A client with Graves' disease is prescribed propranolol. The nurse understands that the purpose of this medication is to:
- A. Treat the underlying cause of the disease
- B. Reduce thyroid hormone production
- C. Alleviate symptoms such as tachycardia and tremors
- D. Increase energy levels
Correct answer: C
Rationale: The correct answer is C: Alleviate symptoms such as tachycardia and tremors. Propranolol is a beta-blocker that helps manage symptoms like tachycardia (fast heart rate) and tremors in patients with Graves' disease. Choice A is incorrect because propranolol does not address the underlying cause of Graves' disease, which is autoimmune in nature. Choice B is incorrect because propranolol does not directly reduce thyroid hormone production; it mainly targets the symptoms. Choice D is incorrect because while propranolol may help with symptoms like tachycardia, it is not intended to increase energy levels.