** HESI RN Exit Exam 2024 NGN: Pharmacology &
Complex Care Integration**
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**Question 73**
A nurse is administering intravenous potassium chloride to a client with hypokalemia. Which assessment
finding requires immediate intervention?
A. Serum potassium level of 3.8 mEq/L after 4 hours of infusion
B. Infusion site with redness and swelling extending 2 cm above the IV catheter
C. Client reports a metallic taste in the mouth
D. ECG shows tall, peaked T waves
💫ANSWER✔️✔️: B. Infusion site with redness and swelling extending 2 cm above the IV catheter
💫RATIONALE✔️✔️: Redness and swelling at the IV site indicate potassium extravasation, which can cause
tissue necrosis and severe chemical burns. The infusion must be stopped immediately. Tall, peaked T
waves indicate hyperkalemia, not hypokalemia (which shows flat T waves and U waves).
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**Question 74**
A nurse is caring for a client with cirrhosis who develops asterixis (liver flap). Which laboratory value is
most consistent with this finding?
A. Serum albumin 2.8 g/dL
B. Serum ammonia 85 mcg/dL (normal 15-45)
C. Bilirubin 4.2 mg/dL
D. INR 1.8
,💫ANSWER✔️✔️: B. Serum ammonia 85 mcg/dL
💫RATIONALE✔️✔️: Asterixis (non-rhythmic flapping tremor of the hands when wrists are extended) is a
hallmark sign of hepatic encephalopathy caused by elevated ammonia. The liver cannot convert
ammonia to urea, leading to neurotoxicity. Treatment includes lactulose and rifaximin.
---
**Question 75**
A client with heart failure is prescribed carvedilol. The nurse should instruct the client to report which
symptom immediately?
A. Dizziness when standing up quickly
B. Weight gain of 2 lbs in one day
C. Dry cough that is persistent
D. Fatigue during the first week of therapy
💫ANSWER✔️✔️: B. Weight gain of 2 lbs in one day
💫RATIONALE✔️✔️: Rapid weight gain indicates worsening fluid retention and heart failure exacerbation.
While carvedilol (a beta-blocker) can cause dizziness and fatigue initially, these are expected side
effects. Dry cough is more typical of ACE inhibitors, not carvedilol.
---
**Question 76**
A nurse is assessing a client with a traumatic brain injury. The client's blood pressure is 190/100 mm Hg,
heart rate 52 bpm, and respirations are irregular. What is the priority nursing action?
A. Administer antihypertensive medication
B. Elevate the head of the bed to 30 degrees
C. Notify the healthcare provider immediately
D. Recheck the vital signs in 15 minutes
💫ANSWER✔️✔️: C. Notify the healthcare provider immediately
, 💫RATIONALE✔️✔️: This is Cushing's triad (hypertension, bradycardia, irregular respirations), a late sign
of severely increased intracranial pressure (ICP) indicating brain herniation is imminent. The provider
must be notified for emergency interventions (mannitol, hyperventilation, surgery).
---
**Question 77**
A client is prescribed isoniazid (INH) for latent tuberculosis. Which instruction should the nurse include
in the teaching plan?
A. "Take this medication on an empty stomach with a full glass of water."
B. "Avoid eating aged cheeses, smoked fish, and drinking red wine."
C. "Report any numbness or tingling in your hands or feet to your provider."
D. "You may stop the medication once your symptoms resolve."
💫ANSWER✔️✔️: C. "Report any numbness or tingling in your hands or feet to your provider."
💫RATIONALE✔️✔️: INH can cause peripheral neuropathy due to pyridoxine (vitamin B6) depletion.
Clients should report paresthesias. Pyridoxine supplementation is often given. Option B is for MAOIs.
INH is taken for 6-9 months, not stopped early.
---
**Question 78**
A nurse is caring for a client who is 6 hours post-renal biopsy. The client reports severe flank pain and
dizziness. The nurse notes a heart rate of 120 bpm and blood pressure of 90/50 mm Hg. What is the
priority action?
A. Administer the prescribed PRN analgesic
B. Position the client flat on the affected side
C. Apply pressure to the biopsy site
D. Notify the healthcare provider immediately
💫ANSWER✔️✔️: D. Notify the healthcare provider immediately
Complex Care Integration**
---
**Question 73**
A nurse is administering intravenous potassium chloride to a client with hypokalemia. Which assessment
finding requires immediate intervention?
A. Serum potassium level of 3.8 mEq/L after 4 hours of infusion
B. Infusion site with redness and swelling extending 2 cm above the IV catheter
C. Client reports a metallic taste in the mouth
D. ECG shows tall, peaked T waves
💫ANSWER✔️✔️: B. Infusion site with redness and swelling extending 2 cm above the IV catheter
💫RATIONALE✔️✔️: Redness and swelling at the IV site indicate potassium extravasation, which can cause
tissue necrosis and severe chemical burns. The infusion must be stopped immediately. Tall, peaked T
waves indicate hyperkalemia, not hypokalemia (which shows flat T waves and U waves).
---
**Question 74**
A nurse is caring for a client with cirrhosis who develops asterixis (liver flap). Which laboratory value is
most consistent with this finding?
A. Serum albumin 2.8 g/dL
B. Serum ammonia 85 mcg/dL (normal 15-45)
C. Bilirubin 4.2 mg/dL
D. INR 1.8
,💫ANSWER✔️✔️: B. Serum ammonia 85 mcg/dL
💫RATIONALE✔️✔️: Asterixis (non-rhythmic flapping tremor of the hands when wrists are extended) is a
hallmark sign of hepatic encephalopathy caused by elevated ammonia. The liver cannot convert
ammonia to urea, leading to neurotoxicity. Treatment includes lactulose and rifaximin.
---
**Question 75**
A client with heart failure is prescribed carvedilol. The nurse should instruct the client to report which
symptom immediately?
A. Dizziness when standing up quickly
B. Weight gain of 2 lbs in one day
C. Dry cough that is persistent
D. Fatigue during the first week of therapy
💫ANSWER✔️✔️: B. Weight gain of 2 lbs in one day
💫RATIONALE✔️✔️: Rapid weight gain indicates worsening fluid retention and heart failure exacerbation.
While carvedilol (a beta-blocker) can cause dizziness and fatigue initially, these are expected side
effects. Dry cough is more typical of ACE inhibitors, not carvedilol.
---
**Question 76**
A nurse is assessing a client with a traumatic brain injury. The client's blood pressure is 190/100 mm Hg,
heart rate 52 bpm, and respirations are irregular. What is the priority nursing action?
A. Administer antihypertensive medication
B. Elevate the head of the bed to 30 degrees
C. Notify the healthcare provider immediately
D. Recheck the vital signs in 15 minutes
💫ANSWER✔️✔️: C. Notify the healthcare provider immediately
, 💫RATIONALE✔️✔️: This is Cushing's triad (hypertension, bradycardia, irregular respirations), a late sign
of severely increased intracranial pressure (ICP) indicating brain herniation is imminent. The provider
must be notified for emergency interventions (mannitol, hyperventilation, surgery).
---
**Question 77**
A client is prescribed isoniazid (INH) for latent tuberculosis. Which instruction should the nurse include
in the teaching plan?
A. "Take this medication on an empty stomach with a full glass of water."
B. "Avoid eating aged cheeses, smoked fish, and drinking red wine."
C. "Report any numbness or tingling in your hands or feet to your provider."
D. "You may stop the medication once your symptoms resolve."
💫ANSWER✔️✔️: C. "Report any numbness or tingling in your hands or feet to your provider."
💫RATIONALE✔️✔️: INH can cause peripheral neuropathy due to pyridoxine (vitamin B6) depletion.
Clients should report paresthesias. Pyridoxine supplementation is often given. Option B is for MAOIs.
INH is taken for 6-9 months, not stopped early.
---
**Question 78**
A nurse is caring for a client who is 6 hours post-renal biopsy. The client reports severe flank pain and
dizziness. The nurse notes a heart rate of 120 bpm and blood pressure of 90/50 mm Hg. What is the
priority action?
A. Administer the prescribed PRN analgesic
B. Position the client flat on the affected side
C. Apply pressure to the biopsy site
D. Notify the healthcare provider immediately
💫ANSWER✔️✔️: D. Notify the healthcare provider immediately
