HESI RN
HESI 799 RN Exit Exam Capstone Questions
Question 1 of 5
The nurse has given discharge instructions to parents of a child on phenytoin (Dilantin). Which of the following statements suggests that the teaching was effective?
Correct Answer: B
Rationale: In this scenario, option B, "Our child should brush and floss carefully after every meal," suggests that the teaching was effective. This statement indicates an understanding of the side effects of phenytoin, such as gingival hyperplasia, which can be mitigated by good oral hygiene practices. Option A is incorrect because acne is not a common side effect of phenytoin, so calling the healthcare provider for this reason is unnecessary. Option C is incorrect because skipping a dose of phenytoin can lead to a decrease in the medication's effectiveness and potentially trigger seizures. Option D is incorrect because stopping phenytoin abruptly can be dangerous and lead to rebound seizures. The educational context here is to emphasize the importance of accurate medication knowledge and adherence to prescribed regimens in managing epilepsy effectively. It is crucial to educate parents on the proper administration and potential side effects of antiepileptic medications to ensure the safety and well-being of the child.
Question 2 of 5
Which of these findings should the nurse report immediately after a client has a liver biopsy?
Correct Answer: D
Rationale: The correct answer is D, severe abdominal pain. After a liver biopsy, severe abdominal pain is a critical finding that requires immediate reporting as it may indicate internal bleeding or damage to the liver. The other vital signs provided in choices A, B, and C are within normal limits and may not be directly related to complications post liver biopsy. Therefore, the priority is to address the severe abdominal pain promptly to prevent any further complications.
Question 3 of 5
A nurse is caring for a 73-year-old male client with Alzheimer's disease. Which action should the nurse take to enhance the client's nutritional intake?
Correct Answer: B
Rationale: Offering frequent snacks of foods the client enjoys is the most appropriate action to enhance the nutritional intake of a client with Alzheimer's disease. This approach helps to ensure that the client receives an adequate amount of nutrients throughout the day, especially when larger meals might be challenging for individuals with Alzheimer's. Encouraging large meals in one sitting (Choice A) may overwhelm the client and lead to decreased food intake. While foods high in fiber (Choice C) are beneficial for digestion, the primary focus should be on providing foods the client enjoys to increase intake. Discouraging eating late at night (Choice D) is not directly related to enhancing nutritional intake in this scenario.
Question 4 of 5
The nurse is caring for a client who is post-op after a hip replacement. Which of the following nursing actions is most appropriate to prevent dislocation of the hip?
Correct Answer: B
Rationale: Using an abduction pillow between the client's legs is the most appropriate nursing action to prevent dislocation after hip replacement surgery. An abduction pillow helps maintain proper alignment and prevents the hip from dislocating. Placing the client in a high Fowler's position (Choice A) or encouraging them to sit upright for long periods (Choice D) may not provide the necessary support and stability needed to prevent hip dislocation. Encouraging the client to cross their legs while sitting (Choice C) can increase the risk of hip dislocation and should be avoided.
Question 5 of 5
A client with a diagnosis of bipolar disorder has been referred to a local boarding home for consideration for placement. The social worker telephoned the hospital unit for information about the client's mental status and adjustment. The appropriate response of the nurse should be which of these statements?
Correct Answer: D
Rationale: The correct answer is D: "I need to get the client's written consent before I release any information to you." In this scenario, the nurse must obtain the client's written consent before disclosing any information to the social worker. This process ensures compliance with privacy laws like HIPAA, which are designed to protect client confidentiality. Choice A is incorrect because it does not address the need for consent. Choice B is incorrect as it is unprofessional and does not focus on obtaining consent. Choice C is incorrect as it suggests information can be shared without consent, which goes against privacy laws.