HESI RN
HESI RN CAT Exit Exam
1. The nurse is planning care for a client receiving chemotherapy. Which intervention should the nurse include to manage the client's nausea?
- A. Administer an antiemetic before meals
- B. Provide frequent mouth care
- C. Encourage small, frequent meals
- D. Offer clear liquids
Correct answer: A
Rationale: Administering an antiemetic before meals is a crucial intervention to manage chemotherapy-induced nausea. Antiemetics help prevent or reduce nausea and vomiting associated with chemotherapy. Providing frequent mouth care (choice B) is important for managing oral mucositis but not specifically for nausea. Encouraging small, frequent meals (choice C) and offering clear liquids (choice D) are beneficial strategies for managing gastrointestinal side effects but may not be as effective in controlling nausea as administering antiemetics.
2. A client who is taking ciprofloxacin (Cipro) reports to the nurse of having a loss of appetite and a metallic taste in the mouth. What action should the nurse implement?
- A. Reassure the client that these are common side effects of ciprofloxacin.
- B. Instruct the client to take ciprofloxacin with food.
- C. Notify the healthcare provider of the client's symptoms.
- D. Encourage the client to increase fluid intake.
Correct answer: C
Rationale: The correct action for the nurse to take when a client on ciprofloxacin reports loss of appetite and a metallic taste in the mouth is to notify the healthcare provider of the client's symptoms. These symptoms could indicate a need for a change in medication or additional treatment, which the healthcare provider would need to assess. Instructing the client to take ciprofloxacin with food (choice B) may help with gastrointestinal upset but will not address the reported symptoms. Reassuring the client (choice A) is important for providing emotional support but does not address the need for further evaluation. Encouraging increased fluid intake (choice D) is generally beneficial but may not directly address the specific side effects reported.
3. When obtaining an admission history for a client who is at 9 weeks gestation, the client states, 'I had a miscarriage 2 years ago.' Which information is most important for the nurse to obtain?
- A. How long was your previous pregnancy?
- B. How long did it take for you to become pregnant after your miscarriage?
- C. Was your miscarriage during the first trimester?
- D. Do you have any children now?
Correct answer: A
Rationale: The correct answer is A. Understanding the duration of the previous pregnancy helps assess the client's obstetric history. Choice B focuses on the time it took to conceive after the miscarriage, which is less relevant at this point. Choice C asks about the timing of the miscarriage rather than the duration of the previous pregnancy. Choice D inquires about the current status of having children, which is not directly related to the client's obstetric history.
4. A client receiving amlodipine (Norvasc), a calcium channel blocker, develops 1+ pitting edema around the ankles. It is most important for the nurse to obtain what additional client data?
- A. Bladder distention
- B. Serum albumin level
- C. Abdominal girth
- D. Breath sounds
Correct answer: D
Rationale: The correct answer is 'D. Breath sounds.' When a client receiving amlodipine develops edema, it is crucial to assess for potential heart failure, a side effect of the medication. Checking breath sounds helps in identifying any signs of pulmonary edema, a severe complication of heart failure. Choices A, B, and C are less relevant in this context. Bladder distention could be associated with urinary issues, serum albumin level with malnutrition or liver disease, and abdominal girth with gastrointestinal problems, none of which directly relate to the potential heart failure induced by amlodipine.
5. A nurse is assessing the learning needs of a client who is diagnosed with Addison's disease. Which statement indicates that the client needs further teaching?
- A. I should take my medications daily to replace necessary hormones
- B. I need to eat a diet high in protein and carbohydrates
- C. I should avoid drinking fluids with caffeine
- D. I should notify my healthcare provider if I start feeling dizzy
Correct answer: B
Rationale: The correct answer is B. A diet high in protein and carbohydrates is not specifically required for Addison's disease. The focus should be on maintaining a balanced diet that is rich in fruits, vegetables, whole grains, and adequate protein sources. Choice A is correct as adherence to medication therapy is crucial in managing Addison's disease. Choice C is correct as caffeine can exacerbate symptoms of Addison's disease. Choice D is correct as dizziness can be a sign of adrenal crisis in Addison's disease, and prompt notification of healthcare providers is essential.
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