HESI 799 RN Exit Exam Quizlet

HESI 799 RN Exit Exam Quizlet Related

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The nurse is caring for a client with a history of myocardial infarction who is experiencing chest pain. Which diagnostic test should the nurse anticipate preparing the client for first?

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

Rationale: Corrected Rationale: An electrocardiogram (ECG) should be performed first to assess for cardiac ischemia in a client with a history of myocardial infarction and chest pain. An ECG provides immediate information about the heart's electrical activity, helping to identify changes indicative of cardiac ischemia or infarction. Chest X-ray (Choice B) is not the initial diagnostic test for assessing chest pain related to myocardial infarction. Arterial blood gases (Choice C) are used to assess oxygenation and acid-base balance but are not the primary diagnostic test for myocardial infarction. An echocardiogram (Choice D) may provide valuable information about cardiac structure and function, but it is not the first-line diagnostic test for acute chest pain in a client with a history of myocardial infarction.

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A client with cirrhosis is admitted with jaundice and ascites. Which assessment finding is most concerning?

  • A. Peripheral edema
  • B. Confusion and altered mental status
  • C. Yellowing of the skin
  • D. Increased abdominal girth
Correct Answer: C

Rationale: In a client with cirrhosis presenting with jaundice and ascites, yellowing of the skin (icterus) is the most concerning assessment finding. This indicates significant liver dysfunction and a high level of bilirubin in the blood. Yellowing of the skin suggests a severe impairment of the liver's ability to process bilirubin, which can lead to serious complications. Peripheral edema and increased abdominal girth are common manifestations of cirrhosis but are not as acutely concerning as skin yellowing. Confusion and altered mental status are also critical findings in cirrhosis, indicating hepatic encephalopathy, but skin yellowing is more closely associated with the severity of liver dysfunction in this scenario.

A client with cirrhosis is admitted with hepatic encephalopathy. Which laboratory value is most concerning?

  • A. Serum ammonia level of 100 mcg/dl
  • B. Bilirubin level of 3.0 mg/dl
  • C. Prothrombin time of 18 seconds
  • D. Serum sodium level of 135 mEq/L
Correct Answer: A

Rationale: A serum ammonia level of 100 mcg/dl is most concerning in a client with hepatic encephalopathy. Elevated serum ammonia levels indicate significant liver dysfunction and an increased risk of worsening encephalopathy. Bilirubin level and prothrombin time are important in assessing liver function, but in the context of hepatic encephalopathy, elevated ammonia levels take precedence as they directly contribute to neurological symptoms. Serum sodium level, though important, is not the primary concern when managing hepatic encephalopathy.

A client is admitted with a diagnosis of septic shock. Which clinical finding requires immediate intervention?

  • A. Blood pressure of 90/60 mmHg
  • B. Temperature of 100.4°F
  • C. Heart rate of 120 beats per minute
  • D. Urine output of 30 ml/hour
Correct Answer: C

Rationale: In a client with septic shock, a heart rate of 120 beats per minute is a critical clinical finding that requires immediate intervention. A rapid heart rate can indicate worsening sepsis and inadequate tissue perfusion. Correcting the underlying cause of the tachycardia and stabilizing the heart rate is crucial in managing septic shock. The other options, while important, do not represent an immediate threat to the patient's condition. A blood pressure of 90/60 mmHg may be expected in septic shock, a temperature of 100.4°F is mildly elevated, and a urine output of 30 ml/hour, though decreased, may not be an immediate concern in the context of septic shock.

A client with hyperthyroidism is admitted to the postoperative unit after subtotal thyroidectomy. Which of the client's serum laboratory values requires intervention by the nurse?

  • A. Total calcium 5.0 mg/dL.
  • B. Serum sodium 140 mEq/L.
  • C. Serum potassium 4.0 mEq/L.
  • D. Serum glucose 90 mg/dL.
Correct Answer: A

Rationale: The correct answer is A. A calcium level of 5.0 mg/dL is critically low and could indicate hypoparathyroidism, a possible complication after thyroidectomy. Low calcium levels can lead to tetany, seizures, and cardiac dysrhythmias, requiring immediate intervention. Choices B, C, and D fall within the normal range and do not require immediate intervention in this scenario.

The nurse is caring for a client who is postoperative following a thyroidectomy. Which finding requires immediate intervention?

  • A. Hoarse voice
  • B. Slight difficulty swallowing
  • C. Positive Chvostek's sign
  • D. Pain at the incision site
Correct Answer: C

Rationale: A positive Chvostek's sign indicates hypocalcemia, a common complication following thyroidectomy due to inadvertent parathyroid gland injury. Immediate intervention is needed to prevent severe hypocalcemia symptoms like tetany, seizures, and laryngospasm. Hoarse voice and slight difficulty swallowing are expected post-thyroidectomy and do not require immediate intervention. Pain at the incision site is common postoperatively and can be managed with appropriate pain relief measures.

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