HESI RN
Community Health HESI 2023 Quizlet
1. The nurse is caring for a client with hyperthyroidism. Which assessment finding requires immediate intervention?
- A. Heart rate of 100 beats per minute.
- B. Blood pressure of 150/90 mm Hg.
- C. Respiratory rate of 24 breaths per minute.
- D. Weight loss of 5 pounds in one week.
Correct answer: D
Rationale: Weight loss of 5 pounds in one week in a client with hyperthyroidism is concerning as it may indicate severe hypermetabolism, leading to potential complications such as cardiac arrhythmias, muscle weakness, and other metabolic disturbances. Rapid weight loss in hyperthyroidism indicates an accelerated metabolic rate and increased energy expenditure, which can be detrimental to the client's health. The other assessment findings (heart rate of 100 beats per minute, blood pressure of 150/90 mm Hg, respiratory rate of 24 breaths per minute) are commonly seen in clients with hyperthyroidism and may not necessarily require immediate intervention unless they are significantly outside the normal range or causing distress to the client.
2. How can menopause affect health?
- A. Causing conjunctivitis
- B. Leading to colitis or bowel upsets
- C. Increasing the risk of cancer
- D. Triggering urinary infections
Correct answer: D
Rationale: Menopause can lead to changes in the urinary tract, such as decreased estrogen levels, which can increase the likelihood of urinary tract infections. While menopause can impact various aspects of health, including bone density and heart health, it is not directly linked to conjunctivitis, colitis, or an increased risk of cancer. Therefore, the correct answer is D.
3. During a home visit, the nurse finds that an elderly client has multiple expired medications. What should the nurse do first?
- A. instruct the client to dispose of the expired medications
- B. review the client's current medication regimen
- C. contact the client's healthcare provider
- D. educate the client on the dangers of taking expired medications
Correct answer: B
Rationale: The correct first action for the nurse to take when finding multiple expired medications in an elderly client's home is to review the client's current medication regimen. This step is crucial to identify any potential issues, ensure the client is taking the correct medications, and understand why the expired medications were not used. Instructing the client to dispose of the expired medications (Choice A) can come after understanding the current medication situation. Contacting the client's healthcare provider (Choice C) may be necessary but reviewing the medication regimen should be the initial step. Educating the client on the dangers of taking expired medications (Choice D) is important but should be done after addressing the immediate concern of reviewing the current medications.
4. A client with a history of myocardial infarction (MI) is admitted with chest pain. Which laboratory test should the nurse expect to be ordered to determine if the client is experiencing another MI?
- A. Troponin
- B. Myoglobin
- C. CK-MB
- D. C-reactive protein
Correct answer: A
Rationale: Troponin is the most specific and sensitive laboratory test for detecting myocardial infarction (MI). It is released when there is damage to the heart muscle, making it a valuable marker for diagnosing another MI. Myoglobin and CK-MB can also be elevated in MI, but troponin is preferred due to its higher specificity. C-reactive protein is a marker of inflammation and not specific to MI.
5. In a client with cirrhosis admitted with ascites and jaundice, which clinical finding requires immediate intervention?
- A. Peripheral edema
- B. Confusion and altered mental status
- C. Increased abdominal girth
- D. Yellowing of the skin
Correct answer: B
Rationale: Confusion and altered mental status in a client with cirrhosis and associated ascites and jaundice are indicative of hepatic encephalopathy, a serious complication that requires immediate intervention. This condition can progress rapidly and lead to coma if not addressed promptly. Peripheral edema (choice A) and increased abdominal girth (choice C) are common manifestations of fluid retention in cirrhosis but may not require immediate intervention unless severe. Yellowing of the skin (choice D) is a classic sign of jaundice, which is already known in this client and may not necessitate immediate intervention unless associated with other concerning symptoms.