HESI EXAM 1 CAPSTONE: Questions & Answers
1. An angry client visits the primary healthcare provider’s office and requests a copy of their
medical records. The client is angry after being placed on hold several times for over 10
minutes when requesting an appointment. What should the nurse tell this client?
You answered this question Incorrectly
1. All client appointment calls are transferred to the scheduling clerk.
2. The client will have to speak to the primary healthcare provider.
3. A copy of the record may be obtained within 24 hours of the request.
4. Medical records must stay within the facility unless requested by another primary
healthcare provider.
Rationale
Strategies
3. Correct: The client has the right to the personal medical record. Generally, a period of time is
required to get the record copied. The client may be charged for the copy.
This assures the client that the request will receive attention.
1. Incorrect: This response dismisses the client's feelings and may only anger the client
further. The response does not address the reason for the client's anger. The statement may
be true; however, the client does have the right to request and receive a copy of the medical
record.
2. Incorrect: The primary healthcare provider does not have to be contacted, as there should
be policies in place to grant the request for a copy of the medical record. Also, telling the client
to speak to the healthcare provider would not address the reason for the client's anger. This
would dismiss the client's feelings.
4. Incorrect: The client has a right to the medical record. Records may also be requested by
other providers with consent of the client. The client's feelings should be addressed and the
client should be informed that the medical record will be provided as requested.
Question:
A nurse is planning to provide information regarding suicide to a high school assembly. What
information should the nurse include?
You answered this question Incorrectly
, 1. Do not keep secrets for the suicidal person.
2. Express concern for a person expressing thoughts of suicide.
3. Teens often don't mean what they say, so only take suicide seriously if grades are
dropping as well.
1., 2., 4. & 5. Correct: If a person reveals that suicide is being considered, this should never be
kept secret. Help should be sought for the person immediately. It is also important to be direct
and non-secretive with suicidal clients. It is appropriate to express concern for their thoughts.
The use of empathy, warmth and concern indicates to the client that their feelings are being
understood and viewed as real, which helps to build trust with the client. Resources for
assistance are important to include in all health teaching programs. The teens need to know
what resources are readily available if someone is considering suicide. The client
contemplating suicide should not be left alone. This is for the client's safety until further
assistance can be obtained
3. Incorrect: Most clients who commit suicide have told at least one person that they were
contemplating suicide before thy actually committed the act. Therefore, suicidal comments
should be considered important risk factors that require evaluation, and all comments should
be taken seriously. Anyone expressing suicidal feelings needs immediate attention.
Question:
The nurse should question which prescription for a client diagnosed with acute heart failure?
You answered this question Correctly
1. 2 gram of sodium (Na) diet.
2. Digoxin 0.25 mg IV q 4 hours times 3 doses.
3. Furosemide 40 mg IVP stat.
4. Start IV with NS at 125 mL/hr.
• Rationale
• Strategies
,4. Correct: The client is in fluid overload and does not need the normal saline (NS) at 125 mL/hr.
NS is an isotonic solution. It goes in the vascular space and stays there without shifting out to
the cells. This could cause additional overload in the vascular space as well as cause the BP to
increase. The other prescriptions are acceptable.
1. Incorrect: This is an appropriate measure Na restricted diet will help to lower the serum Na
and decrease H2O retention. This does not need questioning.
2. Incorrect: Digoxin is a digitalis glycoside. It slows conduction and strengthens the force of
contraction of the heart. Therefore, this medication that increases cardiac contractility and
reduces the heart rate does not need questioning.
3. Incorrect: Furosemide is a diuretic. It enhances renal excretion of Na and H 2O and reduces
systemic and pulmonary congestion. This medication prescription does not need questioning.
Question:
The nurse is preparing to administer nadolol to a hospitalized client. Which client data would
indicate to the nurse that the medication should be held and the primary healthcare provider
notified?
You answered this question Incorrectly
1. Blood pressure 102/68
2. Glucose 118
3. UOP 440 mL over previous 8 hour shift.
4. Correct: This is a beta blocker. It slows the heart rate. If a client’s heart rate is less
than 60 beats per minute, notify the primary healthcare provider and ask if the client
should receive this medication. Administering a beta blocker to a client who has a
heart rate less than 60 could possibly cause the client to develop symptomatic
bradycardia and hypotension.
1. Incorrect: If the client’s BP drops below 90/60, this beta blocker should be held and the
primary healthcare provider notified. The BP in this option is high enough to administer the
medication, but the BP in clients on beta blockers should be monitored and the client should be
taught about signs and symptoms of hypotension.
, 2. Incorrect: This is a normal glucose level. If the client is a diabetic, beta blockers can mask
the signs of hypoglycemia. There diabetics on beta blockers should monitor their blood sugar
carefully.
3. Incorrect: Urinary output is adequate. Beta blockers do not alter renal function. However, if
pulse and BP are reduced too much, renal perfusion could ultimately be affected.
Question:
Which signs and symptoms would the nurse expect to see in a client who has taken prednisone
for two months?
You answered this question Correctly
. Decreased facial hair
2., 3. & 5. Correct: Decreased wound healing is a side effect with prolonged steroid use due to
the immunosuppressive effects. All steroid medications, such as prednisone, can lead to
sodium retention which then leads to dose related fluid retention. Hypertension is seen due to
this fluid and sodium retention. Cushingoid appearance (moon face) is a side effect that is
created from the abnormal redistribution of fat from prolonged steroid use.
1. Incorrect: Within one month after corticosteroid administration, weight gain is seen rather
than weight loss.
4. Incorrect: Facial and body hair increase with prolonged steroid use. This excessive growth
of body hair, known as hirsutism, is one of the numerous potential side effects of prednisone.
Question:
Which interventions should be included in the plan of care for an adult client with constipation?
1. An angry client visits the primary healthcare provider’s office and requests a copy of their
medical records. The client is angry after being placed on hold several times for over 10
minutes when requesting an appointment. What should the nurse tell this client?
You answered this question Incorrectly
1. All client appointment calls are transferred to the scheduling clerk.
2. The client will have to speak to the primary healthcare provider.
3. A copy of the record may be obtained within 24 hours of the request.
4. Medical records must stay within the facility unless requested by another primary
healthcare provider.
Rationale
Strategies
3. Correct: The client has the right to the personal medical record. Generally, a period of time is
required to get the record copied. The client may be charged for the copy.
This assures the client that the request will receive attention.
1. Incorrect: This response dismisses the client's feelings and may only anger the client
further. The response does not address the reason for the client's anger. The statement may
be true; however, the client does have the right to request and receive a copy of the medical
record.
2. Incorrect: The primary healthcare provider does not have to be contacted, as there should
be policies in place to grant the request for a copy of the medical record. Also, telling the client
to speak to the healthcare provider would not address the reason for the client's anger. This
would dismiss the client's feelings.
4. Incorrect: The client has a right to the medical record. Records may also be requested by
other providers with consent of the client. The client's feelings should be addressed and the
client should be informed that the medical record will be provided as requested.
Question:
A nurse is planning to provide information regarding suicide to a high school assembly. What
information should the nurse include?
You answered this question Incorrectly
, 1. Do not keep secrets for the suicidal person.
2. Express concern for a person expressing thoughts of suicide.
3. Teens often don't mean what they say, so only take suicide seriously if grades are
dropping as well.
1., 2., 4. & 5. Correct: If a person reveals that suicide is being considered, this should never be
kept secret. Help should be sought for the person immediately. It is also important to be direct
and non-secretive with suicidal clients. It is appropriate to express concern for their thoughts.
The use of empathy, warmth and concern indicates to the client that their feelings are being
understood and viewed as real, which helps to build trust with the client. Resources for
assistance are important to include in all health teaching programs. The teens need to know
what resources are readily available if someone is considering suicide. The client
contemplating suicide should not be left alone. This is for the client's safety until further
assistance can be obtained
3. Incorrect: Most clients who commit suicide have told at least one person that they were
contemplating suicide before thy actually committed the act. Therefore, suicidal comments
should be considered important risk factors that require evaluation, and all comments should
be taken seriously. Anyone expressing suicidal feelings needs immediate attention.
Question:
The nurse should question which prescription for a client diagnosed with acute heart failure?
You answered this question Correctly
1. 2 gram of sodium (Na) diet.
2. Digoxin 0.25 mg IV q 4 hours times 3 doses.
3. Furosemide 40 mg IVP stat.
4. Start IV with NS at 125 mL/hr.
• Rationale
• Strategies
,4. Correct: The client is in fluid overload and does not need the normal saline (NS) at 125 mL/hr.
NS is an isotonic solution. It goes in the vascular space and stays there without shifting out to
the cells. This could cause additional overload in the vascular space as well as cause the BP to
increase. The other prescriptions are acceptable.
1. Incorrect: This is an appropriate measure Na restricted diet will help to lower the serum Na
and decrease H2O retention. This does not need questioning.
2. Incorrect: Digoxin is a digitalis glycoside. It slows conduction and strengthens the force of
contraction of the heart. Therefore, this medication that increases cardiac contractility and
reduces the heart rate does not need questioning.
3. Incorrect: Furosemide is a diuretic. It enhances renal excretion of Na and H 2O and reduces
systemic and pulmonary congestion. This medication prescription does not need questioning.
Question:
The nurse is preparing to administer nadolol to a hospitalized client. Which client data would
indicate to the nurse that the medication should be held and the primary healthcare provider
notified?
You answered this question Incorrectly
1. Blood pressure 102/68
2. Glucose 118
3. UOP 440 mL over previous 8 hour shift.
4. Correct: This is a beta blocker. It slows the heart rate. If a client’s heart rate is less
than 60 beats per minute, notify the primary healthcare provider and ask if the client
should receive this medication. Administering a beta blocker to a client who has a
heart rate less than 60 could possibly cause the client to develop symptomatic
bradycardia and hypotension.
1. Incorrect: If the client’s BP drops below 90/60, this beta blocker should be held and the
primary healthcare provider notified. The BP in this option is high enough to administer the
medication, but the BP in clients on beta blockers should be monitored and the client should be
taught about signs and symptoms of hypotension.
, 2. Incorrect: This is a normal glucose level. If the client is a diabetic, beta blockers can mask
the signs of hypoglycemia. There diabetics on beta blockers should monitor their blood sugar
carefully.
3. Incorrect: Urinary output is adequate. Beta blockers do not alter renal function. However, if
pulse and BP are reduced too much, renal perfusion could ultimately be affected.
Question:
Which signs and symptoms would the nurse expect to see in a client who has taken prednisone
for two months?
You answered this question Correctly
. Decreased facial hair
2., 3. & 5. Correct: Decreased wound healing is a side effect with prolonged steroid use due to
the immunosuppressive effects. All steroid medications, such as prednisone, can lead to
sodium retention which then leads to dose related fluid retention. Hypertension is seen due to
this fluid and sodium retention. Cushingoid appearance (moon face) is a side effect that is
created from the abnormal redistribution of fat from prolonged steroid use.
1. Incorrect: Within one month after corticosteroid administration, weight gain is seen rather
than weight loss.
4. Incorrect: Facial and body hair increase with prolonged steroid use. This excessive growth
of body hair, known as hirsutism, is one of the numerous potential side effects of prednisone.
Question:
Which interventions should be included in the plan of care for an adult client with constipation?
