HESI RN
HESI RN Exit Exam Capstone Questions
Question 1 of 5
A client is admitted to the emergency department after a motor vehicle accident. The client has a Glasgow Coma Scale (GCS) score of 10. What does this score indicate?
Correct Answer: B
Rationale: A Glasgow Coma Scale score of 10 falls into the range of moderate impairment, indicating the need for further assessment and monitoring.
Question 2 of 5
To prevent unnecessary hypoxia during suctioning of a tracheostomy, the nurse must
Correct Answer: A
Rationale: Suctioning for more than 10 seconds can cause hypoxia, so it should be limited to 10 seconds at most.
Question 3 of 5
A client is receiving morphine for postoperative pain. What is the nurse's priority assessment?
Correct Answer: A
Rationale: Monitoring respiratory rate helps assess for respiratory depression, a common side effect of morphine.
Question 4 of 5
A scrub nurse preparing for the first surgery of the day asks if a 3-minute surgical hand scrub is adequate. What should the circulating nurse advise?
Correct Answer: B
Rationale: The circulating nurse should advise the scrub nurse to extend the hand scrub to 5 minutes for thorough preparation, particularly for the first surgery of the day.
Question 5 of 5
A client with atrial fibrillation is prescribed warfarin, and their INR is elevated. What is the nurse's priority action?
Correct Answer: D
Rationale: An elevated INR in clients taking warfarin increases the risk of bleeding. The nurse should notify the healthcare provider immediately and hold the next dose of warfarin to prevent complications.
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