Questions 9

HESI RN

HESI RN Test Bank

RN HESI Exit Exam Capstone Questions

Question 1 of 5

A client with peripheral vascular disease reports leg pain while walking. What intervention is most effective for the nurse to recommend?

Correct Answer: B

Rationale: The correct answer is to encourage the client to increase walking distance gradually. This intervention is effective because gradual increases in walking distance promote circulation, improve oxygen delivery to tissues, and help reduce leg pain caused by peripheral vascular disease. Elevating the legs above the heart (Choice A) may be beneficial in other conditions like venous insufficiency but not specifically for peripheral vascular disease. Encouraging the client to avoid sitting or standing for long periods (Choice C) can help prevent blood pooling but does not directly address the walking-induced leg pain. Instructing the client to use warm compresses for pain relief (Choice D) may provide temporary relief but does not address the underlying circulation issues associated with peripheral vascular disease.

Question 2 of 5

Prior to administering warfarin to a client with a history of atrial fibrillation, what lab result should the nurse review?

Correct Answer: B

Rationale: The correct answer is B: Prothrombin time (PT) and International Normalized Ratio (INR). These lab values are crucial for monitoring the effectiveness of warfarin, an anticoagulant medication. PT measures the time it takes for blood to clot, while INR standardizes these results. Ensuring the client's PT/INR levels are within the therapeutic range is essential to prevent clotting or excessive bleeding. Choices A, C, and D are incorrect as they are not directly related to monitoring warfarin therapy in a client with atrial fibrillation.

Question 3 of 5

In monitoring tissue perfusion in a client following an above the knee amputation (AKA), which action should the nurse include in the plan of care?

Correct Answer: A

Rationale: After an amputation, monitoring the pulse closest to the stump is crucial in evaluating tissue perfusion and the overall health of the limb. Swelling and changes in perfusion can indicate complications such as blood clots or infection. Assessing the proximal pulse helps the nurse ensure adequate blood flow to the remaining limb, thereby preventing further complications. Choices B, C, and D are less directly related to monitoring tissue perfusion in this scenario and are more focused on wound healing and stump care.

Question 4 of 5

A client with hyperthyroidism is experiencing palpitations. What intervention should the nurse implement?

Correct Answer: B

Rationale: In clients with hyperthyroidism experiencing palpitations, administering a beta-blocker is the appropriate intervention. Beta-blockers help reduce heart rate and control symptoms in hyperthyroidism. Encouraging rest (Choice A) may be helpful but does not directly address the palpitations. Drinking cool fluids (Choice C) and providing a cool environment (Choice D) are more focused on temperature regulation and comfort, which are not the primary interventions for palpitations in hyperthyroidism.

Question 5 of 5

In assessing a client with type 1 diabetes mellitus, the nurse notes that the client's respirations have changed from 16 breaths/min with a normal depth to 32 breaths/min and deep, and the client becomes lethargic. Which assessment data should the nurse obtain next?

Correct Answer: B

Rationale: Deep, rapid respirations (Kussmaul respirations) and lethargy are signs of diabetic ketoacidosis (DKA), which occurs in uncontrolled type 1 diabetes. Checking the blood glucose is the priority to confirm hyperglycemia and guide immediate treatment. Pulse oximetry is not the priority in this situation as the issue is related to altered glucose levels, not oxygenation. Arterial blood gases and serum electrolytes may be important later in the management of DKA but are not the initial priority compared to confirming and addressing the hyperglycemia.

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