the nurse is assessing a client with chronic obstructive pulmonary disease copd who is receiving supplemental oxygen which laboratory value is most co
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Nursing Elites

HESI RN

RN HESI Exit Exam

1. The nurse is assessing a client with chronic obstructive pulmonary disease (COPD) who is receiving supplemental oxygen. Which laboratory value is most concerning?

Correct answer: C

Rationale: A serum bicarbonate level of 18 mEq/L is most concerning in a client with COPD as it indicates metabolic acidosis, requiring immediate intervention. In COPD, patients often retain carbon dioxide, leading to respiratory acidosis. A low serum bicarbonate level suggests that the body is compensating for this respiratory acidosis by increasing bicarbonate levels to maintain balance. Therefore, a low serum bicarbonate level in this scenario is alarming. Choices A, B, and D are within normal ranges and not directly related to the acid-base imbalance seen in COPD.

2. The nurse is assessing a client with left-sided heart failure. Which assessment finding requires immediate intervention?

Correct answer: C

Rationale: In a client with left-sided heart failure, crackles in the lungs are a critical assessment finding that necessitates immediate intervention. Crackles indicate pulmonary congestion, a sign of worsening heart failure that requires prompt attention to prevent respiratory distress. Jugular venous distention, shortness of breath, and peripheral edema are also common in heart failure, but crackles specifically point to pulmonary involvement and the urgent need for intervention.

3. A client with a history of atrial fibrillation is admitted with a new onset of confusion. Which laboratory value should the nurse monitor closely?

Correct answer: A

Rationale: The correct answer is A: International Normalized Ratio (INR). The INR should be closely monitored in a client with atrial fibrillation to assess the effectiveness and safety of anticoagulation therapy with warfarin. Monitoring the INR helps to ensure that the client is within the therapeutic range to prevent complications such as thrombosis or bleeding. Choices B, C, and D are less relevant in this scenario. While serum glucose levels are important in assessing metabolic status, and white blood cell count and prothrombin time are important indicators for other conditions, they are not the primary focus when a client with atrial fibrillation presents with confusion.

4. A client with newly diagnosed hypertension is being taught about lifestyle modifications by a nurse. Which client statement indicates a need for further teaching?

Correct answer: D

Rationale: The correct answer is D. Limiting caffeine intake is a positive lifestyle modification for managing hypertension. The statement indicates that the client understands the importance of reducing caffeine intake. Choices A, B, and C all reflect appropriate lifestyle modifications for managing hypertension, indicating good understanding by the client.

5. A client with rheumatoid arthritis is scheduled to receive a dose of methotrexate. Which laboratory result is most important for the nurse to review before administering the medication?

Correct answer: B

Rationale: The correct answer is B: Liver function tests. Before administering methotrexate, it is crucial to review liver function tests due to the medication's potential hepatotoxic effects. Methotrexate can cause liver damage, so monitoring liver function is essential to prevent any serious complications. While white blood cell count, kidney function tests, and complete blood count are important parameters to monitor in certain situations, they are not the most critical before administering methotrexate.

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