HESI RN
HESI RN Exit Exam Capstone Questions
Question 1 of 5
An older client is admitted to the intensive care unit unconscious after several days of vomiting and diarrhea. The nurse inserts a urinary catheter and observes dark amber urine output. Which intervention should the nurse implement first?
Correct Answer: C
Rationale: A fluid bolus is the first step in stabilizing a client with hypovolemic symptoms.
Question 2 of 5
The nurse is caring for a client with a suspected myocardial infarction (MI). Which laboratory test result is most indicative of a recent MI?
Correct Answer: A
Rationale: Elevated troponin levels are the most specific and sensitive indicator of myocardial infarction. Troponin levels increase within hours of an MI and remain elevated for several days.
Question 3 of 5
A client is admitted with ascites, malnutrition, and recent complaints of spitting up blood. What assessment finding warrants immediate intervention by the nurse?
Correct Answer: C
Rationale: A round and tight abdomen suggests fluid accumulation from ascites, which could signal a more severe underlying condition requiring immediate intervention.
Question 4 of 5
A client with heart failure receiving furosemide develops muscle weakness. What is the nurse's priority action?
Correct Answer: B
Rationale: Muscle weakness in a client receiving furosemide (a diuretic) is often a sign of hypokalemia, as furosemide increases potassium loss. Monitoring potassium levels is essential to identify and address any imbalances and prevent complications such as arrhythmias.
Question 5 of 5
A client with adrenal insufficiency is admitted to the ICU with acute adrenal crisis. The client's vital signs include heart rate 138 bpm and BP 80/60. What is the nurse's first intervention?
Correct Answer: B
Rationale: An IV fluid bolus stabilizes blood pressure during adrenal crisis.
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