HESI Exit Practice Questions and
Rationale (2) questions and answers
2026\2027 A+ Grade
The nurse has completed giving discharge instructions to a client who has had a total joint replacement
(TJR) of the knee with a metal prosthetic system. The nurse determines that the client understands the
instructions if the client makes which statement?
1."Changes in the shape of the knee are expected."
2."Fever, redness, and increased pain are expected."
3."All caregivers should be told about the metal implant."
4."Bleeding gums or black stools may occur, but this is normal."
- correct answer 3
A TJR is also known as a total joint arthroplasty (TJA). The client must inform other caregivers of the
presence of the metal implant because certain tests and procedures will need to be avoided. After total
knee replacement, the client should report signs and symptoms of infection and any changes in the
shape of the knee. These could indicate developing complications. With a metal implant, the client may
be on anticoagulant therapy and should report adverse effects of this therapy, including bleeding from a
variety of sources, and the client will need antibiotic prophylaxis for invasive procedures.
The nurse is caring for a client after the application of a plaster cast for a fractured left radius. The nurse
should suspect impairment with the neurovascular status of the client's casted extremity if which
findings are noted? Select all that apply.
1.Capillary refill is less than 3 seconds 2.Pulses present and with swollen, pink fingers
3.Client report of severe, deep, unrelenting pain
4.Client report of pain as nurse assesses finger movement
5.Client report of numbness and tingling sensation in the fingers
- correct answer 3, 4, 5
The pressure in compartment syndrome, if unrelieved, will cause permanent damage to nerve and
muscle tissue distal to the pressure. Circulatory damage may result in necrosis. Nerve and muscle
,damage may result in permanent contractures, deformity of the extremity, and functional impairment.
Normal capillary refill time is 3 seconds or less. Pink appearance and a pulse indicate adequate blood
flow; swelling is expected after a fracture. Client report of severe, deep, unrelenting pain; client report
of numbness and tingling sensation; and client report of pain as the nurse assesses finger movement are
indicative of development of compartment syndrome.
A client with a 4-day-old lumbar vertebral fracture is experiencing muscle spasms. Which are
interventions to aid the client in relieving the spasm? Select all that apply.
1.Ice
2.Heat
3.Analgesics
4.Muscle relaxers
5.Intermittent traction
- correct answer 2, 3, 4, 5
Heat, analgesics, muscle relaxers, and traction all may be used to relieve the pain of muscle spasm in the
client with a vertebral fracture. Ice is applied to a painful site only for the first 48 to 72 hours (depending
on the health care provider's preference) after an injury. Application of ice to the spine of a client could
be uncomfortable and could result in feelings of being chilled.
The nurse is caring for a client who had surgery to repair a fractured left-sided hip using a posterior
approach. In implementing hip precautions, which action should the nurse teach the client to avoid?
1.Crossing legs at the ankle
2.Using an elevated toilet seat 3.Placing a pillow between the legs 4.Keeping the legs abducted from the
midline
- correct answer 1
Following surgery to repair a fractured hip using a posterior approach, client education should include
the following: avoiding crossing the legs at the ankle or the knee, using an elevated toilet seat, placing a
pillow between the legs while lying down for the first 6 weeks, keeping the legs abducted from the
midline, and keeping the hip in a neutral position at all times.
An older client is diagnosed with osteoporosis. The nurse teaches the client about self-care measures,
knowing that the client is most at risk for which problem as a result of this disorder of the bones?
1.Anemia
2.Fractures
,3.Infection
4.Muscle sprains
- correct answer 2
The client is most at risk for fractures as a result of osteoporosis. Although other complications can
occur, fracture is the greatest concern. Anemia and infection can occur with bone marrow disorders,
and muscle sprains are unrelated to osteoporosis.
A client with a new medication prescription for allopurinol asks the nurse, "I know this is for gout, but
how does it work?" The nurse plans to reply based on which medication action?
1.Allopurinol decreases uric acid production.
2.Allopurinol reduces the production of fibrinogen.
3.Allopurinol decreases the risk of sulfa crystal formation in the urine. 4.Allopurinol prevents influx of
calcium ions during cell depolarization.
- correct answer 1
Allopurinol is classified as an antigout medication. It decreases uric acid production by inhibiting the
xanthine oxidase enzyme, and it reduces uric acid concentrations in both serum and urine. The other
options are incorrect.
The nurse is caring for a client diagnosed with osteitis deformans (Paget's disease). Which does the
nurse identify as the cause of the client's stooped posture and bowing of lower extremities?
1.Muscle metabolism and growth 2.Bone resorption and regeneration 3.Nervous system impulse
transmission 4.Joint integrity and synovial fluid production
- correct answer 2
Paget's disease is characterized by skeletal deformities resulting from abnormal bone resorption
followed by abnormal regeneration. It is not caused by problems with muscle, nervous system, or joint
functioning.
A client has been diagnosed with gout, and the nurse provides dietary instructions. The nurse
determines that the client needs additional teaching if the client states that it is acceptable to eat which
food?
1.Carrots
2.Tapioca
3.Chocolate
, 4.Chicken liver
- correct answer 4
Liver and other organ meats should be omitted from the diet of a client who has gout because of their
high purine content. Purines are a form of protein. The food items identified in the other options
contain negligible amounts of purines and may be consumed freely by the client with gout.
Diagnostic studies are prescribed for a client with suspected Paget's disease. In reviewing the client's
record, the nurse would expect to note that the health care provider has prescribed which laboratory
study?
1.Platelet count
2.Alkaline phosphatase
3.White blood cell count
4.Complete blood cell count
- correct answer 2
Paget's disease is a chronic metabolic disorder in which bone is excessively broken down and reformed.
The result is bone that is structurally disorganized, causing bone to be weak with increased risk for
bowing of long bones and fractures. Diagnostic laboratory findings for Paget's disease include an
elevated serum alkaline phosphatase level and elevated urinary hydroxyproline excretion. The
remaining options are unrelated to diagnostic evaluation of this disease.
A client is to receive a prescription for methocarbamol. The nurse provides instructions to the client
about the medication. Which client statement would indicate a need for further education?
1."My urine may turn brown or green." 2."I might get some nasal congestion from this medication."
3."This medication is prescribed to help relieve my muscle spasms."
4."If my vision becomes blurred, I don't need to be concerned about it."
- correct answer 4
Methocarbamol is a muscle relaxant that works by blocking nerve impulses (or pain sensations) that are
sent to the brain. The client needs to be told that the urine may turn brown, black, or green. Other
adverse effects include blurred vision, nasal congestion, urticaria, and rash. The client needs to be
instructed to notify the health care provider if these side/adverse effects occur.
The nurse is planning measures to increase bed mobility for a client in skeletal leg traction. Which item
should the nurse consider to be most helpful for this client?
1.Television
Rationale (2) questions and answers
2026\2027 A+ Grade
The nurse has completed giving discharge instructions to a client who has had a total joint replacement
(TJR) of the knee with a metal prosthetic system. The nurse determines that the client understands the
instructions if the client makes which statement?
1."Changes in the shape of the knee are expected."
2."Fever, redness, and increased pain are expected."
3."All caregivers should be told about the metal implant."
4."Bleeding gums or black stools may occur, but this is normal."
- correct answer 3
A TJR is also known as a total joint arthroplasty (TJA). The client must inform other caregivers of the
presence of the metal implant because certain tests and procedures will need to be avoided. After total
knee replacement, the client should report signs and symptoms of infection and any changes in the
shape of the knee. These could indicate developing complications. With a metal implant, the client may
be on anticoagulant therapy and should report adverse effects of this therapy, including bleeding from a
variety of sources, and the client will need antibiotic prophylaxis for invasive procedures.
The nurse is caring for a client after the application of a plaster cast for a fractured left radius. The nurse
should suspect impairment with the neurovascular status of the client's casted extremity if which
findings are noted? Select all that apply.
1.Capillary refill is less than 3 seconds 2.Pulses present and with swollen, pink fingers
3.Client report of severe, deep, unrelenting pain
4.Client report of pain as nurse assesses finger movement
5.Client report of numbness and tingling sensation in the fingers
- correct answer 3, 4, 5
The pressure in compartment syndrome, if unrelieved, will cause permanent damage to nerve and
muscle tissue distal to the pressure. Circulatory damage may result in necrosis. Nerve and muscle
,damage may result in permanent contractures, deformity of the extremity, and functional impairment.
Normal capillary refill time is 3 seconds or less. Pink appearance and a pulse indicate adequate blood
flow; swelling is expected after a fracture. Client report of severe, deep, unrelenting pain; client report
of numbness and tingling sensation; and client report of pain as the nurse assesses finger movement are
indicative of development of compartment syndrome.
A client with a 4-day-old lumbar vertebral fracture is experiencing muscle spasms. Which are
interventions to aid the client in relieving the spasm? Select all that apply.
1.Ice
2.Heat
3.Analgesics
4.Muscle relaxers
5.Intermittent traction
- correct answer 2, 3, 4, 5
Heat, analgesics, muscle relaxers, and traction all may be used to relieve the pain of muscle spasm in the
client with a vertebral fracture. Ice is applied to a painful site only for the first 48 to 72 hours (depending
on the health care provider's preference) after an injury. Application of ice to the spine of a client could
be uncomfortable and could result in feelings of being chilled.
The nurse is caring for a client who had surgery to repair a fractured left-sided hip using a posterior
approach. In implementing hip precautions, which action should the nurse teach the client to avoid?
1.Crossing legs at the ankle
2.Using an elevated toilet seat 3.Placing a pillow between the legs 4.Keeping the legs abducted from the
midline
- correct answer 1
Following surgery to repair a fractured hip using a posterior approach, client education should include
the following: avoiding crossing the legs at the ankle or the knee, using an elevated toilet seat, placing a
pillow between the legs while lying down for the first 6 weeks, keeping the legs abducted from the
midline, and keeping the hip in a neutral position at all times.
An older client is diagnosed with osteoporosis. The nurse teaches the client about self-care measures,
knowing that the client is most at risk for which problem as a result of this disorder of the bones?
1.Anemia
2.Fractures
,3.Infection
4.Muscle sprains
- correct answer 2
The client is most at risk for fractures as a result of osteoporosis. Although other complications can
occur, fracture is the greatest concern. Anemia and infection can occur with bone marrow disorders,
and muscle sprains are unrelated to osteoporosis.
A client with a new medication prescription for allopurinol asks the nurse, "I know this is for gout, but
how does it work?" The nurse plans to reply based on which medication action?
1.Allopurinol decreases uric acid production.
2.Allopurinol reduces the production of fibrinogen.
3.Allopurinol decreases the risk of sulfa crystal formation in the urine. 4.Allopurinol prevents influx of
calcium ions during cell depolarization.
- correct answer 1
Allopurinol is classified as an antigout medication. It decreases uric acid production by inhibiting the
xanthine oxidase enzyme, and it reduces uric acid concentrations in both serum and urine. The other
options are incorrect.
The nurse is caring for a client diagnosed with osteitis deformans (Paget's disease). Which does the
nurse identify as the cause of the client's stooped posture and bowing of lower extremities?
1.Muscle metabolism and growth 2.Bone resorption and regeneration 3.Nervous system impulse
transmission 4.Joint integrity and synovial fluid production
- correct answer 2
Paget's disease is characterized by skeletal deformities resulting from abnormal bone resorption
followed by abnormal regeneration. It is not caused by problems with muscle, nervous system, or joint
functioning.
A client has been diagnosed with gout, and the nurse provides dietary instructions. The nurse
determines that the client needs additional teaching if the client states that it is acceptable to eat which
food?
1.Carrots
2.Tapioca
3.Chocolate
, 4.Chicken liver
- correct answer 4
Liver and other organ meats should be omitted from the diet of a client who has gout because of their
high purine content. Purines are a form of protein. The food items identified in the other options
contain negligible amounts of purines and may be consumed freely by the client with gout.
Diagnostic studies are prescribed for a client with suspected Paget's disease. In reviewing the client's
record, the nurse would expect to note that the health care provider has prescribed which laboratory
study?
1.Platelet count
2.Alkaline phosphatase
3.White blood cell count
4.Complete blood cell count
- correct answer 2
Paget's disease is a chronic metabolic disorder in which bone is excessively broken down and reformed.
The result is bone that is structurally disorganized, causing bone to be weak with increased risk for
bowing of long bones and fractures. Diagnostic laboratory findings for Paget's disease include an
elevated serum alkaline phosphatase level and elevated urinary hydroxyproline excretion. The
remaining options are unrelated to diagnostic evaluation of this disease.
A client is to receive a prescription for methocarbamol. The nurse provides instructions to the client
about the medication. Which client statement would indicate a need for further education?
1."My urine may turn brown or green." 2."I might get some nasal congestion from this medication."
3."This medication is prescribed to help relieve my muscle spasms."
4."If my vision becomes blurred, I don't need to be concerned about it."
- correct answer 4
Methocarbamol is a muscle relaxant that works by blocking nerve impulses (or pain sensations) that are
sent to the brain. The client needs to be told that the urine may turn brown, black, or green. Other
adverse effects include blurred vision, nasal congestion, urticaria, and rash. The client needs to be
instructed to notify the health care provider if these side/adverse effects occur.
The nurse is planning measures to increase bed mobility for a client in skeletal leg traction. Which item
should the nurse consider to be most helpful for this client?
1.Television
