HESI RN
HESI 799 RN Exit Exam Capstone Questions
Question 1 of 5
A male client admitted for schizophrenia is noted to be diaphoretic and pacing the hallway. What is the most important intervention?
Correct Answer: D
Rationale: In this scenario, the most important intervention for a male client with schizophrenia who is diaphoretic and pacing the hallway is to carefully observe the client throughout the shift. Diaphoresis and pacing can be indicators of agitation or distress in clients with schizophrenia. Careful observation is crucial to monitor the client's safety, assess for any potential escalation of symptoms, and provide timely intervention if needed. Taking the client's temperature and blood pressure (
Choice
A) may not address the immediate need for safety and observation. Encouraging the client to rest (
Choice
B) may not be effective if the client is agitated. Planning an activity involving physical exercise (
Choice
C) could potentially exacerbate the situation rather than addressing the immediate need for observation and safety.
Question 2 of 5
The nurse is planning care for a client with a venous leg ulcer. Which intervention should the nurse include in the plan of care to promote healing?
Correct Answer: A
Rationale: Compression therapy is essential for managing venous leg ulcers as it helps improve venous return, reduces edema, and promotes healing. By applying compression therapy to the affected leg, the nurse can assist in enhancing circulation, reducing swelling, and aiding in the healing process. Keeping the affected leg in a dependent position can worsen venous insufficiency. Massaging the area surrounding the ulcer is contraindicated as it can cause further damage and delay healing. While encouraging the client to elevate the leg is beneficial, it is not as effective as compression therapy for promoting healing in venous leg ulcers.
Question 3 of 5
A male client with schizophrenia is socially reclusive and pacing in the hallway. What is the most important intervention for the nurse to implement?
Correct Answer: D
Rationale: The correct answer is to carefully observe the client throughout the shift. In this situation, the client's behavior suggests agitation and restlessness, which could potentially escalate. Observation is crucial to monitor any changes in behavior, assess for signs of distress, and ensure the client's safety. Taking the client's temperature and blood pressure (
Choice
A) may not address the immediate need for managing the client's behavior. Encouraging the client to rest (
Choice
B) might not be effective if the client is highly agitated. Planning an activity that includes physical exercise (
Choice
C) could exacerbate the situation rather than address the current behavior.
Therefore, the priority is to observe the client closely to provide appropriate support and intervention as needed.
Question 4 of 5
The nurse prepares to teach clients about blood glucose monitoring. When should clients always check glucose, regardless of age or type of diabetes?
Correct Answer: C
Rationale: The correct answer is C: During acute illness. Checking blood glucose during acute illness is crucial as stress can elevate glucose levels. This monitoring is essential regardless of the client's age or the type of diabetes they have. Checking before going to bed (choice
A) may be important for some individuals, but it's not as universally necessary as during acute illness. Checking after meals (choice
B) and prior to exercising (choice
D) are important times for monitoring blood glucose, but they are not as universally applicable as during acute illness.
Question 5 of 5
A client with hypothyroidism is prescribed levothyroxine. What symptom indicates that the dosage may need adjustment?
Correct Answer: B
Rationale: Increased sensitivity to cold and dry skin may indicate that the dosage of levothyroxine is too low, requiring adjustment. This symptom is typical of hypothyroidism when the body's metabolism slows down, leading to feeling cold and having dry skin.
Choices A, C, and D present symptoms more commonly associated with hyperthyroidism, where the body is in a state of overactivity, leading to weight loss, increased heart rate, and sweating.
Therefore, these symptoms would not indicate the need for dosage adjustment in a client with hypothyroidism.