HESI RN
HESI RN Exit Exam 2023 Capstone Questions
Question 1 of 5
A client is admitted with a severe burn injury. What is the nurse's priority intervention?
Correct Answer: B
Rationale: The correct answer is B: Administer intravenous fluids. In a client with severe burn injury, the priority intervention is to administer intravenous fluids to prevent shock. Monitoring urine output (
Choice
A) is important but not the priority. Applying cool, moist compresses (
Choice
C) can be beneficial but is not the priority over fluid resuscitation. Covering the burn area with a sterile dressing (
Choice
D) is important for wound care but is not the immediate priority in managing severe burns.
Question 2 of 5
An older adult client with chronic emphysema is admitted with acute onset of weakness, palpitation, and vomiting. Which information is most important for the nurse to obtain during the initial interview?
Correct Answer: A
Rationale: The correct answer is A: Medication compliance over the past few weeks. In a client with chronic emphysema experiencing acute symptoms, it is crucial to assess medication compliance as it directly impacts symptom control and disease management. Ensuring the client has been adherent to their prescribed medications can provide insights into potential exacerbating factors or the need for adjustments in the treatment plan.
Choices B, C, and D are less critical during the initial assessment compared to medication compliance. Recent sleep patterns and rest (choice
B) may be relevant but are secondary to ensuring proper medication management. While smoking history (choice
C) is important in chronic lung conditions, the immediate focus should be on the current status of medication use. Activity level prior to symptom onset (choice
D) is also pertinent but not as crucial as confirming medication compliance to address the acute symptoms.
Question 3 of 5
An unlicensed assistive personnel (UAP), who usually works on a surgical unit, is assigned to float to a pediatric unit. Which question by the charge nurse would be most appropriate when making delegation decisions?
Correct Answer: D
Rationale: The most appropriate question by the charge nurse would be to ask the UAP if they have reviewed the list of expected skills needed on the pediatric unit. This ensures that the UAP is aware of the specific skills required for safe and appropriate care in that particular unit.
Choices A, B, and C do not directly address the need for the UAP to review the expected skills, which is crucial for delegation decisions during floating assignments.
Question 4 of 5
During a thyroid storm, what is the nurse's priority intervention for a client experiencing increased heart rate and tremors?
Correct Answer: A
Rationale: The correct answer is to administer antithyroid medications as prescribed during a thyroid storm. Antithyroid medications help control the overproduction of thyroid hormones, which is crucial in managing symptoms such as increased heart rate and tremors. These symptoms can be life-threatening if not promptly addressed. Administering a beta-blocker (
Choice
B) may help control the heart rate, but addressing the underlying cause with antithyroid medications is the priority. Monitoring the client's temperature (
Choice
C) is important but not the priority intervention during a thyroid storm. Lastly, preparing the client for an emergency thyroidectomy (
Choice
D) is not the initial intervention for managing symptoms of a thyroid storm.
Question 5 of 5
A client with hyperkalemia is receiving insulin and glucose. Which laboratory value should the nurse monitor closely?
Correct Answer: D
Rationale: The correct answer is to monitor the client's potassium level. When administering insulin and glucose in hyperkalemia, the aim is to shift potassium from the bloodstream into the cells, lowering elevated levels.
Therefore, monitoring potassium levels closely is essential to prevent hypokalemia or further complications. Monitoring blood glucose levels (
Choice
A) is important but not the priority in this scenario. Monitoring sodium (
Choice
B) and calcium levels (
Choice
C) is not directly related to the treatment of hyperkalemia with insulin and glucose.