HESI RN CAT Exit Exam

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A 17-year-old female is seen in the school clinic for an evaluation of abdominal pain and dysmenorrhea. The client's last menstrual period was 3 weeks ago, and her vital signs are within normal limits. Which action should the nurse take first?

  • A. Refer the client to a healthcare provider for a pelvic examination
  • B. Notify the parents that the client needs to be picked up from school
  • C. Determine the date of the client's last menstrual period
  • D. Ask the client to lie down for a pelvic examination
Correct Answer: A

Rationale: The correct answer is A: Refer the client to a healthcare provider for a pelvic examination. This is the first action the nurse should take because the client is experiencing abdominal pain and dysmenorrhea, which could indicate a gynecological issue. A pelvic examination by a healthcare provider is necessary to assess for any potential reproductive system problems, such as ovarian cysts, endometriosis, or pelvic inflammatory disease. This examination will provide valuable information to diagnose and treat the underlying cause of the client's symptoms.

Choice B is incorrect because notifying the parents to pick up the client does not address the primary concern of evaluating the abdominal pain and dysmenorrhea. Choice C is also incorrect as determining the date of the client's last menstrual period, while important, does not take precedence over a thorough pelvic examination. Choice D is incorrect as asking the client to lie down for a pelvic examination should only be done by a healthcare provider in a proper clinical setting, not in a school clinic.

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A male client with diabetes mellitus takes Novolin 70/30 insulin before meals and azithromycin (Zithromax) PO daily, using medication he brought from home. When the nurse delivers his breakfast tray, the client tells the nurse that he took his insulin but forgot to take his daily dose of the Zithromax an hour before breakfast as instructed. What action should the nurse implement?

  • A. Offer to obtain a new breakfast tray in an hour so the client can take the Zithromax
  • B. Instruct the client to eat his breakfast and take the Zithromax two hours after eating
  • C. Tell the client to skip that day's dose and resume taking the Zithromax the next day
  • D. Provide a PRN dose of an antacid to take with the Zithromax right after breakfast
Correct Answer: B

Rationale: The correct answer is B: Instruct the client to eat his breakfast and take the Zithromax two hours after eating. This is the correct action because azithromycin is best absorbed when taken on an empty stomach, but if the client has already eaten, it is recommended to wait at least 2 hours after a meal before taking it. This ensures optimal absorption and effectiveness of the medication.

Choice A is incorrect because it does not address the timing issue of taking azithromycin on an empty stomach. Choice C is incorrect as skipping a dose of an antibiotic can lead to treatment failure. Choice D is incorrect as antacids can interfere with the absorption of azithromycin and should not be taken together.

A client with an electrical burn on the forearm asks the nurse why there is no feeling of pain from the burn. During the dressing change, the nurse determines that the burn is dry, waxy, and white. What information should the nurse provide this client?

  • A. The depth of tissue destruction is minor
  • B. Pain is interrupted due to nerve compression
  • C. The full thickness burn has destroyed the nerves
  • D. Second-degree burns are not usually painful
Correct Answer: C

Rationale: The correct answer is C because full-thickness burns destroy nerve endings, resulting in the absence of pain sensation. The dry, waxy, and white appearance indicates tissue destruction extending through the epidermis and dermis. Choices A and D are incorrect because dry, waxy, and white appearance signifies a deeper burn, not a minor or superficial burn, and second-degree burns typically involve pain sensation. Choice B is incorrect as nerve compression does not explain the lack of pain sensation in a full-thickness burn.

A 9-year-old received a short arm cast for a right radius. To relieve itching under the child's cast, which instructions should the nurse provide to the parents?

  • A. Blow cool air from a hair dryer under the cast
  • B. Twist the cast back and forth
  • C. Shake powder into the cast
  • D. Push a pencil under the cast edge
Correct Answer: A

Rationale: The correct answer is A: Blow cool air from a hair dryer under the cast. This method helps to relieve itching by providing airflow without causing damage to the cast or skin. It is safe and effective.

Choice B: Twisting the cast back and forth may cause discomfort or injury to the child's arm.

Choice C: Shaking powder into the cast can create a mess and may lead to skin irritation or infection.

Choice D: Pushing a pencil under the cast edge can cause damage to the skin or lead to complications.

The nurse offers diet teaching to a female college student who was diagnosed with iron-deficiency anemia following her voluntary adoption of a lacto-vegetarian diet. What nutrients should the nurse suggest this client eat to best meet her nutritional needs while allowing her to adhere to a lacto-vegetarian diet?

  • A. Drink whole milk instead of skim milk to enhance the body's production of amino acids
  • B. Take vitamin K 10mg PO daily to enhance production of red blood cells
  • C. Increase amounts of dark yellow vegetables such as carrots to fortify iron stores
  • D. Combine several legumes and grains such as beans and rice to form complete proteins
Correct Answer: D

Rationale: The correct answer is D: Combine several legumes and grains such as beans and rice to form complete proteins. This is the best option because a lacto-vegetarian diet excludes meat but includes dairy products. Legumes and grains complement each other in terms of amino acid profiles, allowing the individual to obtain all essential amino acids needed for protein synthesis. This combination ensures the client gets adequate protein intake necessary for red blood cell production without consuming meat.

A: Drinking whole milk instead of skim milk does not enhance amino acid production. Skim milk contains the same amino acids as whole milk.
B: Taking vitamin K does not enhance red blood cell production. Iron is the key nutrient needed for red blood cell production.
C: Increasing dark yellow vegetables such as carrots does not provide a significant amount of iron to fortify iron stores compared to legumes and grains.

A client receiving amlodipine (Norvasc), a calcium channel blocker, develops 1+ pitting edema around the ankles. It is most important for the nurse to obtain what additional client data?

  • A. Bladder distention
  • B. Serum albumin level
  • C. Abdominal girth
  • D. Breath sounds
Correct Answer: D

Rationale: The correct answer is D (Breath sounds). Pitting edema is a common side effect of amlodipine due to vasodilation. It can also lead to pulmonary edema, causing shortness of breath and crackles on auscultation. Therefore, assessing breath sounds is crucial to detect any signs of fluid overload and potential pulmonary complications. Bladder distention (A) is not directly related to the client's current symptoms. Serum albumin level (B) may indicate protein status but is not immediately necessary in this case. Abdominal girth (C) is more indicative of ascites or abdominal distension, not directly related to the client's edema and possible pulmonary complications.

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