HESI 799 RN Exit Exam

HESI 799 RN Exit Exam Related

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A 66-year-old woman is retiring and will no longer have health insurance through her place of employment. Which agency should the client be referred to by the employee health nurse for health insurance needs?

  • A. Woman, Infants, and Children program
  • B. Medicaid
  • C. Medicare
  • D. Consolidated Omnibus Budget Reconciliation Act provision
Correct Answer: C

Rationale: The correct answer is C: Medicare. Title XVII of the Social Security Act of 1965 created the Medicare Program to provide medical insurance for individuals who are 65 years or older, disabled, or have permanent kidney failure. Medicare is the appropriate agency to refer a 66-year-old woman who is retiring and losing her employment-based health insurance. Choice A, the Woman, Infants, and Children program, is not suitable for this scenario as it provides assistance for low-income pregnant women, breastfeeding women, and young children. Choice B, Medicaid, is a program that helps individuals with low income and resources cover medical costs, which may not be applicable to this woman's situation. Choice D, the Consolidated Omnibus Budget Reconciliation Act provision, known as COBRA, allows employees to continue their group health insurance coverage after leaving their job but may not be the best option for this woman in this case.

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The nurse is caring for a client with end-stage renal disease (ESRD) who is scheduled for hemodialysis. Which clinical finding is most concerning?

  • A. Blood pressure of 110/70 mmHg
  • B. Heart rate of 110 beats per minute
  • C. Fever of 100.4°F
  • D. Respiratory rate of 24 breaths per minute
Correct Answer: C

Rationale: The correct answer is C. A fever of 100.4°F is most concerning in a client with ESRD scheduled for hemodialysis because it may indicate an underlying infection that requires immediate attention. Elevated body temperature can be a sign of systemic infection, which can quickly worsen in individuals with compromised renal function. Monitoring for infection is crucial in ESRD patients to prevent complications. Choices A, B, and D are not as immediately concerning in this context. While variations in blood pressure, heart rate, and respiratory rate should be monitored, they are not as indicative of a potentially severe issue as an unexplained fever in this scenario.

The nurse is caring for a client with chronic kidney disease (CKD) who is receiving erythropoietin therapy. Which laboratory value should be monitored closely?

  • A. Serum potassium
  • B. Hemoglobin
  • C. Serum sodium
  • D. White blood cell count
Correct Answer: A

Rationale: The correct answer is A: Serum potassium. When a client with chronic kidney disease is undergoing erythropoietin therapy, monitoring serum potassium levels is crucial. Erythropoietin can stimulate red blood cell production, which may lead to an increase in potassium levels, predisposing the client to hyperkalemia. Monitoring serum potassium levels helps in early detection of hyperkalemia and appropriate intervention. Choices B, C, and D are incorrect because although hemoglobin, serum sodium, and white blood cell count are important parameters to monitor in various clinical conditions, they are not specifically associated with erythropoietin therapy in chronic kidney disease.

Following a gunshot wound to the abdomen, a young adult male had an emergency bowel resection and received multiple blood products while in the operating room. His current blood pressure is 78/52 mm Hg, he is being mechanically ventilated, and his oxygen saturation is 87%. His laboratory values include hemoglobin 7.0 g/dL, platelets 20,000/mm³, and white blood cells 1,500/mm³. Based on these assessment findings, which intervention should the nurse implement first?

  • A. Transfuse packed red blood cells.
  • B. Obtain blood and sputum cultures.
  • C. Infuse 1000 ml of normal saline.
  • D. Titrate oxygen to keep O2 saturation at 90%.
Correct Answer: A

Rationale: The client is exhibiting signs of severe anemia and hypovolemic shock, indicated by low hemoglobin levels and hypotension. The first priority is to address the low hemoglobin by transfusing packed red blood cells to improve oxygen-carrying capacity and perfusion to vital organs. While obtaining blood and sputum cultures is important for identifying potential infections, infusing normal saline can help with volume expansion but does not address the primary issue of severe anemia. Titrating oxygen to maintain an oxygen saturation of 90% is crucial but should follow the administration of packed red blood cells to optimize oxygen delivery.

A client with type 1 diabetes is admitted with hypoglycemia. Which intervention should the nurse implement first?

  • A. Administer 50% dextrose IV push
  • B. Administer 15 grams of oral glucose
  • C. Recheck the blood glucose level in 15 minutes
  • D. Administer a glucagon injection
Correct Answer: A

Rationale: Administering 50% dextrose IV push is the first priority in treating hypoglycemia to rapidly increase blood glucose levels. This choice is correct because in severe cases of hypoglycemia, when a client is admitted and unconscious or unable to swallow, intravenous administration of dextrose is crucial to quickly raise blood glucose levels. Option B, administering 15 grams of oral glucose, would be suitable for conscious clients with mild hypoglycemia who can swallow safely. Option C, rechecking blood glucose levels, should follow after immediate intervention to assess the response. Option D, administering a glucagon injection, is more suitable for cases where dextrose is not readily available or when the client does not respond to dextrose administration.

Which assessment finding indicates to the nurse a client's readiness for pulmonary function tests?

  • A. Expresses an understanding of the procedure.
  • B. NPO for 6 hrs.
  • C. No known drug allergies.
  • D. Intravenous access intact.
Correct Answer: A

Rationale: The correct answer is A: 'Expresses an understanding of the procedure.' This choice indicates that the client is mentally prepared for the pulmonary function tests, as understanding the procedure shows readiness and cooperation. Choices B, C, and D are incorrect. Choice B, 'NPO for 6 hrs,' pertains to fasting status and is not directly related to readiness for the test. Choice C, 'No known drug allergies,' is important information but does not specifically indicate readiness for pulmonary function tests. Choice D, 'Intravenous access intact,' is related to vascular access and not a direct indicator of readiness for the pulmonary function tests.

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