HESI RN
HESI RN Exit Exam Capstone
1. A client with pneumonia is prescribed antibiotics. What is the most important teaching point for the nurse to provide?
- A. Instruct the client to rest as much as possible.
- B. Encourage increased fluid intake to thin secretions.
- C. Explain the importance of completing the entire course of antibiotics.
- D. Instruct the client to stop taking antibiotics once symptoms subside.
Correct answer: C
Rationale: The correct answer is C. Antibiotics must be taken for the entire prescribed duration to ensure that the infection is completely eradicated. Stopping antibiotics early, even if symptoms improve, can lead to a recurrence of the infection or antibiotic resistance. Choice A is incorrect because though rest is important, completing the antibiotic course is crucial. Choice B is incorrect as while hydration is beneficial, completing the antibiotics is the priority. Choice D is incorrect as stopping antibiotics prematurely can have negative consequences.
2. A client with atrial fibrillation is prescribed warfarin. Which instruction should the nurse include in the teaching?
- A. Maintain a consistent intake of leafy green vegetables
- B. Use an electric razor when shaving
- C. Monitor blood pressure daily
- D. Avoid eating bananas and oranges
Correct answer: B
Rationale: Clients on warfarin are at increased risk of bleeding due to its anticoagulant effects. Using an electric razor reduces the risk of cuts and bleeding, which is an important safety precaution. While leafy greens should not be avoided, their intake should be consistent to maintain a stable level of vitamin K in the body. Monitoring blood pressure daily is important for other conditions but not directly related to warfarin therapy. Avoiding bananas and oranges is not a standard instruction for clients on warfarin.
3. The nurse is conducting diet teaching for a client diagnosed with hypertension. Which foods should the nurse encourage the client to eat?
- A. Pickled olives
- B. Canned soup
- C. Fresh or frozen vegetables without sauce
- D. Fruits without sauce
Correct answer: C
Rationale: The correct answer is C: Fresh or frozen vegetables without sauce. These foods are low in sodium, which is crucial for managing hypertension. Pickled olives (choice A) and canned soup (choice B) are high in sodium, which can exacerbate hypertension. While fruits without sauce (choice D) are generally healthy, emphasizing vegetables is more beneficial for hypertension due to their lower sodium content.
4. A client has burns covering 40% of their total body surface area (TBSA). What is the nurse’s priority action?
- A. Monitor the client's urinary output hourly.
- B. Apply cool, moist dressings to the burned areas.
- C. Administer pain medication to reduce discomfort.
- D. Administer IV fluids to prevent hypovolemia.
Correct answer: A
Rationale: The correct answer is A: Monitor the client's urinary output hourly. Clients with burns covering a large percentage of their total body surface area are at high risk for hypovolemia due to fluid loss. Monitoring urinary output is crucial because it helps assess kidney function and fluid balance, providing essential information about the client's hemodynamic status. Applying cool, moist dressings (choice B) is important but not the priority over assessing fluid balance. Administering pain medication (choice C) is essential for comfort but not the priority over monitoring for potential complications like hypovolemia. Administering IV fluids (choice D) is important to prevent hypovolemia, but monitoring urinary output should be the priority to guide fluid resuscitation.
5. A client with anemia is prescribed iron supplements. What teaching should the nurse provide?
- A. Take iron supplements with meals to prevent stomach upset.
- B. Take iron supplements with milk to improve absorption.
- C. Expect black, tarry stools as a side effect of iron supplements.
- D. Take iron supplements with vitamin C to improve absorption.
Correct answer: D
Rationale: The correct answer is D: Take iron supplements with vitamin C to improve absorption. Vitamin C enhances iron uptake, making it more bioavailable for the body. It is essential to avoid taking iron supplements with milk (choice B) as calcium-rich foods can hinder iron absorption. Taking iron supplements with meals (choice A) can help reduce stomach upset, but the optimal way to enhance absorption is with vitamin C. Black, tarry stools (choice C) are not a typical side effect of iron supplements and should be reported to the healthcare provider.
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