HESI 799 RN Exit Exam

HESI 799 RN Exit Exam Related

Review HESI 799 RN Exit Exam related questions and content

A client with a history of chronic heart failure is admitted with shortness of breath and crackles in the lungs. Which diagnostic test should the nurse anticipate preparing the client for first?

  • A. Chest X-ray
  • B. Arterial blood gases (ABGs)
  • C. Echocardiogram
  • D. Electrocardiogram (ECG)
Correct Answer: C

Rationale: The correct answer is C: Echocardiogram. An echocardiogram should be performed first to assess ventricular function and evaluate the cause of shortness of breath and crackles in a client with heart failure. An echocardiogram provides valuable information about the heart's structure and function, helping to identify potential issues related to heart failure. Chest X-ray (Choice A) may be done to assess for changes in heart size or fluid in the lungs but does not directly assess heart function. Arterial blood gases (Choice B) may provide information about oxygenation but do not directly evaluate heart function. An electrocardiogram (Choice D) assesses the heart's electrical activity but does not provide detailed information about ventricular function, which is crucial in heart failure management.

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A client with chronic kidney disease (CKD) is admitted with hyperkalemia. Which assessment finding is most concerning?

  • A. Bradycardia
  • B. Muscle weakness
  • C. Peaked T waves on the ECG
  • D. Decreased deep tendon reflexes
Correct Answer: C

Rationale: The correct answer is C: Peaked T waves on the ECG. In hyperkalemia, elevated potassium levels can affect the heart's electrical activity, leading to changes on the ECG such as peaked T waves. This finding is concerning as it can progress to serious cardiac arrhythmias, including ventricular tachycardia and fibrillation. Bradycardia (choice A) and decreased deep tendon reflexes (choice D) are not typically associated with hyperkalemia. While muscle weakness (choice B) can occur in hyperkalemia due to its effect on neuromuscular function, the most concerning assessment finding indicating the need for immediate intervention in this scenario is peaked T waves on the ECG.

A male client is prescribed clozapine (Clozaril), an antipsychotic medication, for the management of schizophrenia. Which client history should the nurse report to the healthcare provider before administering the first dose of this medication?

  • A. History of depression
  • B. History of cardiac arrhythmia
  • C. History of seizures
  • D. History of diabetes mellitus
Correct Answer: B

Rationale: The correct answer is B: History of cardiac arrhythmia. Clozapine can lead to severe cardiovascular problems, making it crucial to report any history of cardiac arrhythmia to the healthcare provider before administering the medication. Choices A, C, and D are less concerning in this context as they are not directly associated with potential serious complications related to clozapine use.

A client is admitted with a possible myocardial infarction. Which laboratory test result is most indicative of a myocardial infarction?

  • A. Serum creatine kinase (CK)
  • B. Serum troponin
  • C. Serum myoglobin
  • D. C-reactive protein (CRP)
Correct Answer: B

Rationale: Serum troponin is the most specific and sensitive indicator of myocardial infarction. Troponin levels rise within 3-4 hours after myocardial damage, peak at 10-24 hours, and remain elevated for up to 10-14 days. Creatine kinase (CK) and myoglobin can also be elevated in myocardial infarction, but troponin is more specific to cardiac muscle damage. C-reactive protein (CRP) is a marker of inflammation and is not specific for myocardial infarction.

An older female client tells the nurse that her muscles have gradually been getting weaker over time. What is the best initial response by the nurse?

  • A. Explain that this is an expected occurrence with aging.
  • B. Observe the lower extremities for signs of muscle atrophy.
  • C. Review the medical record for recent diagnostic test results.
  • D. Ask the client to describe the changes that have occurred.
Correct Answer: D

Rationale: The best initial response by the nurse should be to ask the client to describe the changes that have occurred. This open-ended question allows the nurse to gather valuable information directly from the client, aiding in assessing the situation accurately and formulating an appropriate care plan. Choice A is incorrect as assuming muscle weakness is an expected occurrence with aging without further assessment may overlook potential underlying issues. Choice B is premature as it jumps straight to physical examination without first gathering subjective data. Choice C is unnecessary at this point as reviewing diagnostic test results should come after initial assessment and data collection from the client.

A client with a history of hypertension is admitted with a blood pressure of 200/110 mmHg. Which intervention should the nurse implement first?

  • A. Administer an antihypertensive medication as prescribed.
  • B. Monitor the client's urine output.
  • C. Administer oxygen therapy as prescribed.
  • D. Obtain an arterial blood gas (ABG) sample.
Correct Answer: D

Rationale: The correct answer is to obtain an arterial blood gas (ABG) sample. In a client with severe hypertension, it is essential to assess for metabolic or respiratory acidosis which can be done through an ABG sample. Administering antihypertensive medication without assessing the acid-base status of the client can lead to potential complications. Monitoring urine output and administering oxygen therapy are important interventions but are not the priority in this situation where the focus should be on assessing acidosis.

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