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Exam (elaborations)

HESI 799 RN Exit Test Exam with Questions and Answers 2024/2025 RANKED A+

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HESI 799 RN Exit Test Exam with Questions and Answers 2024/2025 RANKED A+

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HESI 799 RN Exit Test Exam with Questions
and Answers 2024/2025 RANKED A+
A male client notifies the nurse that he feels short of breath and has chest pressure
radiating down his left arm. A STAT 12-lead electrocardiogram (ECG) is obtained and shows
ST segment elevation in leads II, II, aVF and V4R. The nurse collects blood samples and
gives a normal saline bolus. What action is most important for the nurse to implement?


a- Obtain the results for STAT serum cardiac biomarkers
b- Asses for contraindications for thrombolytic therapy
c- Measure ST-segment height and waveform changes.
d- Transfer for percutaneous coronary intervention (PCI) - CORRECT ANSWERS b. Asses
for contraindications for thrombolytic therapy.


Rationale: ST segment elevation myocardial infarction (STEMI) usually occurs with
complete occlusion of an epicardial coronary artery which requires early reperfusion
therapy. Screening the client for fibrinolytic therapy (B) is most important to determine PCI
option for rapid reperfusion. If the client is not a candidate for fibrinolytic therapy, then
transfer to a PCI unit or facility is indicated. Reperfusion therapy should be delayed in
STEMI (A). (C) is of significant concern in ECG interpretation with ST-segment depression,
not STEMI


An IV antibiotic is prescribed for a client with a postoperative infection. The medication is
to be administered in 4 divided doses. What schedule is best for administering this
prescription?


a. 1000, 1600, 2200, 0400 - CORRECT ANSWERS 1000, 1600, 2200, 0400


A client is receiving continuous bladder irrigation via a triple-lumen suprapubic catheter
that was placed during prostatectomy. Which report by the unlicensed assistive personnel
(UAP) requires intervention by the nurse?


a. Leakage around catheter insertion site - CORRECT ANSWERS Leakage around catheter
insertion site

,HESI 799 RN Exit Test Exam with Questions
and Answers 2024/2025 RANKED A+
A client with Addison's crisis is admitted for treatment with adrenal cortical
supplementation. Based on the client's admitting diagnosis, which findings require
immediate action by the nurse? (Select all that apply.)


A. Headache and tremors.
B. Postural hypotension.
C. Pallor and diaphoresis.
D. Skin hyperpigmentation.
E. Irregular heart beat. - CORRECT ANSWERS A. Headache and tremors.
B. Postural hypotension.
C. Pallor and diaphoresis.
E. Irregular heart beat.


Rationale: (A, B, C, and E) are correct. Addison's crisis results from an acute lack of adrenal
cortical hormones. Headache and tremors (A), as well as pallor and diaphoresis (C) may
indicate significant hypoglycemia. Hypotension (B) with pale, diaphoretic skin (C) are
indicative of progressing signs of life-threatening shock that also require immediate
nursing intervention. An irregular heart rate (E) may be the result of hyperkalemia and also
requires immediate intervention. (D) is consistent with chronic secondary adrenal
insufficiency and does not require immediate nursing intervention.


A client with rapid respirations and audible rhonchi is admitted to the intensive care unit
because of a pulmonary embolism (PE). Low-flow oxygen by nasal cannula and weight
based heparin protocol is initiated. Which intervention is most important for the nurse to
include in this client's plan of care?


a. Evaluate daily blood clotting factors. - CORRECT ANSWERS Evaluate daily blood clotting
factors.

, HESI 799 RN Exit Test Exam with Questions
and Answers 2024/2025 RANKED A+
The nurse enters a client's room to administer scheduled daily medications and observes
the client leaning forward and using pursed lip breathing. Which action is most important
for the nurse to implement first?


a. Evaluate the oxygen saturation - CORRECT ANSWERS Evaluate the oxygen saturation


During a clinic visit, a client with a kidney transplant ask, "What will happen if chronic
rejection develops?" which response is best for the nurse to provide?


a. Dialysis would need to be resumed if chronic rejection becomes a reality - CORRECT
ANSWERS Dialysis would need to be resumed if chronic rejection becomes a reality


The nurse enters a client's room and observe the unlicensed assistive personnel (UAP)
making an occupied bed as seen in the picture. What action should the nurse take first?


a. Place the side rails in an up position - CORRECT ANSWERS Place the side rails in an up
position


A client with bleeding esophageal varices receives vasopressin (Pitressin) IV. What should
the nurse monitor for during the IV infusion of this medication?


a. Chest pain and dysrhythmia - CORRECT ANSWERS Chest pain and dysrhythmia


A nurse plans to call the healthcare provider to report an 0600 serum potassium level of 2
mEq/L or mmol/L (SI), but the charge nurse tells the nurse that the healthcare provider
does not like to receive early morning calls and will make rounds later in the morning.
What action should the nurse make?


a. Contact the healthcare provider immediately to report the laboratory value regardless of
the advice - CORRECT ANSWERS Contact the healthcare provider immediately to report the
laboratory value regardless of the advice

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