HESI RN
HESI RN Exit Exam 2023 Capstone
1. An adult male is brought to the ER after a motorcycle accident with periorbital bruising and bloody drainage from both ears. Which finding requires immediate attention?
- A. Rebound abdominal tenderness.
- B. Diminished breath sounds bilaterally.
- C. Rib pain with deep inspiration.
- D. Projectile vomiting.
Correct answer: D
Rationale: In this scenario, the patient's periorbital bruising and bloody drainage from both ears suggest a severe head injury. Projectile vomiting is a red flag symptom that may indicate increased intracranial pressure, which requires immediate attention to prevent further neurological deterioration. Rebound abdominal tenderness (choice A) typically indicates peritonitis and is not directly related to the primary head injury. Diminished breath sounds bilaterally (choice B) suggest a pneumothorax or hemothorax, which are important but not as immediately life-threatening in this context. Rib pain with deep inspiration (choice C) is concerning for rib fractures or pulmonary contusion, which are also important but do not take precedence over addressing the potential increased intracranial pressure.
2. A client with hypertension has been prescribed a calcium channel blocker. What should the nurse include in the client's teaching plan?
- A. Monitor heart rate regularly
- B. Avoid potassium-rich foods
- C. Increase fluid intake to avoid dehydration
- D. Take the medication with food
Correct answer: A
Rationale: Corrected Rationale: Calcium channel blockers can cause bradycardia, so it is important for the client to monitor their heart rate regularly. This helps detect any significant changes in heart rate that may require medical attention. Choice B is incorrect because there is no need to avoid potassium-rich foods with calcium channel blockers. Choice C is incorrect as increasing fluid intake is not specifically related to calcium channel blockers. Choice D is incorrect as calcium channel blockers are usually taken with or without food, depending on the specific medication, but not specifically on an empty stomach.
3. A client who is receiving chemotherapy asks the nurse, 'Why is so much of my hair falling out each day?' Which response by the nurse best explains the reason for alopecia?
- A. 'Chemotherapy affects the cells of the body that grow rapidly, both normal and malignant.'
- B. 'Alopecia is a common side effect you will experience during long-term steroid therapy.'
- C. 'Your hair will grow back completely after your course of chemotherapy is completed.'
- D. 'The chemotherapy causes permanent alterations in your hair follicles that lead to hair loss.'
Correct answer: A
Rationale: The correct answer is A: 'Chemotherapy affects the cells of the body that grow rapidly, both normal and malignant.' Chemotherapy targets rapidly dividing cells, which include not only cancer cells but also healthy cells like those in hair follicles. This leads to alopecia (hair loss) as a common side effect. Choice B is incorrect as alopecia is primarily associated with chemotherapy and not long-term steroid therapy. Choice C is incorrect because while hair may grow back after chemotherapy, it may not always be to the same extent or thickness. Choice D is incorrect as chemotherapy-induced hair loss is often temporary and reversible, not permanent alterations in hair follicles.
4. A male client with hypertension, who received new antihypertensive prescriptions at his last visit, returns to the clinic two weeks later to evaluate his blood pressure (BP). His BP is 158/106, and he admits that he has not been taking the prescribed medication because the drugs make him 'feel bad'. In explaining the need for hypertension control, the nurse should stress that an elevated BP places the client at risk for which pathophysiological condition?
- A. Blindness due to cataracts
- B. Acute kidney injury due to glomerular damage
- C. Stroke secondary to hemorrhage
- D. Heart block due to myocardial damage
Correct answer: C
Rationale: The correct answer is C, 'Stroke secondary to hemorrhage.' Uncontrolled hypertension can lead to the weakening of blood vessels in the brain, increasing the risk of a stroke due to hemorrhage. This can result in serious neurological deficits or even death. Choices A, B, and D are incorrect because while hypertension can have various complications including vision changes, kidney damage, and heart problems, the most immediate and severe risk associated with uncontrolled hypertension is a stroke from cerebral hemorrhage.
5. What information should be reinforced with the parents of a school-aged child about Reye's syndrome?
- A. Vaccinate your child before the age of 7 against Reye's syndrome.
- B. Keep the child at home for 2 days after the symptoms appear.
- C. Avoid giving any medication containing aspirin during a viral illness.
- D. Do not provide any citrus juices during a bacterial or viral illness.
Correct answer: C
Rationale: The correct answer is C: 'Avoid giving any medication containing aspirin during a viral illness.' It is crucial to advise parents to avoid giving any medication containing aspirin during a viral illness to prevent Reye's syndrome. Reye's syndrome is a rare but serious condition linked to the use of aspirin during viral illnesses in children and teenagers. Choices A, B, and D are incorrect because vaccinating against Reye's syndrome is not applicable as there is no specific vaccine for it, keeping the child at home for 2 days after symptoms appear is not a preventive measure for Reye's syndrome, and avoiding citrus juices is not directly related to the prevention of Reye's syndrome.