HESI RN
HESI Fundamentals Practice Test
1. The healthcare professional is monitoring a client receiving IV potassium chloride. Which assessment finding should prompt the healthcare professional to immediately stop the infusion?
- A. The client reports pain at the IV site
- B. The client’s heart rate is irregular
- C. The client has swelling at the IV site
- D. The client’s blood pressure is elevated
Correct answer: B
Rationale: An irregular heart rate is a critical sign of hyperkalemia, a serious condition that can lead to life-threatening cardiac arrhythmias. Stopping the infusion promptly is crucial to prevent further complications. The healthcare professional should inform the healthcare provider immediately for further evaluation and management. Choice A is incorrect because pain at the IV site is common and may not necessitate stopping the infusion. Choice C is incorrect as swelling at the IV site may indicate a local reaction but is not a reason to stop the infusion. Choice D is incorrect as an elevated blood pressure alone is not a direct indication to stop the infusion of IV potassium chloride.
2. A client is being educated about the use of sertraline (Zoloft) for depression. Which statement by the client indicates a need for further teaching?
- A. I should take the medication with a high-protein meal.
- B. I may experience dizziness when getting up quickly.
- C. I might notice a decrease in my sex drive.
- D. I should report any thoughts of self-harm to my healthcare provider.
Correct answer: A
Rationale: The statement 'I should take the medication with a high-protein meal' indicates a need for further teaching as sertraline (Zoloft) should not be taken with a high-protein meal due to potential interference with medication absorption. Choices B, C, and D are correct statements associated with the use of sertraline for depression. It is common to experience dizziness when quickly getting up, notice a decrease in sex drive, and important to report any thoughts of self-harm to the healthcare provider while on this medication.
3. A college student who is diagnosed with a vaginal infection and vulva irritation describes the vaginal discharge as having a 'cottage cheese' appearance. Which prescription should the nurse implement first?
- A. Cleanse the perineum with warm soapy water 3 times per day
- B. Instill the first dose of nystatin (Mycostatin) vaginally per applicator
- C. Perform a glucose measurement using a capillary blood sample
- D. Obtain a blood specimen for sexually transmitted diseases (STDs)
Correct answer: B
Rationale: The correct answer is to instill the first dose of nystatin vaginally per applicator. Nystatin is an antifungal medication used to treat yeast infections, which are characterized by 'cottage cheese' discharge. Cleansing the perineum with warm soapy water may help with hygiene but does not address the underlying infection. Performing a glucose measurement is not relevant to the diagnosis of a vaginal infection. Obtaining a blood specimen for STDs is not the priority in this scenario as the symptoms described are indicative of a yeast infection.
4. A client with a family history of polycystic kidney disease (PKD is being assessed by a nurse. For which clinical manifestations should the nurse assess? (Select all that apply.)
- A. Nocturia
- B. Flank pain
- C. Increased abdominal girth
- D. B & C
Correct answer: D
Rationale: Clients with PKD commonly present with flank pain and increased abdominal girth due to abdominal distention caused by cysts. Bloody urine is also a common symptom due to tissue damage from PKD. Nocturia and dysuria are not typical manifestations of PKD. Constipation is not directly associated with PKD. Therefore, the correct choices are flank pain and increased abdominal girth, making option D the correct answer.
5. A client is receiving intermittent bolus feedings via a nasogastric tube. In which position should the nurse place the client once the feeding is complete?
- A. Supine
- B. Head of bed flat
- C. Left lateral position
- D. Head of bed elevated 30 to 45 degrees
Correct answer: B
Rationale: After intermittent bolus feedings through a nasogastric tube, the correct position for the client is to keep the head of the bed flat. This position helps prevent vomiting and aspiration. Placing the client in a supine position (choice A) can increase the risk of aspiration. The left lateral position (choice C) is not typically used after nasogastric tube feedings. Elevating the head of the bed 30 to 45 degrees (choice D) is suitable for continuous tube feedings to reduce the risk of aspiration, but for intermittent bolus feedings, keeping the head of the bed flat is preferred to prevent regurgitation and aspiration.