HESI 799 RN EXIT EXAM END OF COURSE
STUDY GUIDE LATEST UPDATED ACTUAL
TESTED QUESTIONS AND CORRECT
ANSWERS
⩥ While teaching a young male adult to use an inhaler for his newly
diagnosed asthma, the client stares into the distance and appears to be
concentrating on something other than the lesson the nurse is presenting.
What action should the nurse take
a. Remind the client that a rescue inhaler might save his life
b. Leave the client alone so that he can grieve his illness
c. Ask the client what he is thinking about at his time.
d. Gently touch the client then continue with teaching.
Answer: Ask the client what he is thinking about at his time.
⩥ After several hours of non-productive coughing, a client presents to
the emergency room complaining of chest tightness and shortness of
breath. History includes end stage chronic obstructive pulmonary disease
(COPD) and diabetes mellitus. While completing the pulmonary
assessment, the nurse hears wheezing and poor air movement bilaterally.
Which actions should the nurse implement? (Select all that apply.)
a. Apply oxygen via nasal cannula
,b. Administer PRN nebulizer treatment.
c. Obtain 12 lead electrocardiogram.
d. Monitor continuous oxygen saturation.
e. Give PRN dose of regular insulin
Answer: b. Administer PRN nebulizer treatment.
c. Obtain 12 lead electrocardiogram.
d. Monitor continuous oxygen saturation.
Rationale: A nebulizer treatment may improve the wheezing. Chest
tightness is most likely to coughing, but a 12-lead electrocardiogram is
needed to assess for cardiac ischemia. Oxygen saturation monitors for
adequate oxygenation.
⩥ The nurse caring for a 3-month-old boy one day after a pylorostomy
notices that the infant is restless, is exhibiting facial grimaces, and is
drawing his knees to his chest. What action should the nurse take?
a. Administer a prescribed analgesia for pain.
b. Increase IV infusion rate for rehydration
c. Provide additional blankets to increase body temperature
d. Feed one ounce of formula to correct hypoglycemia.
Answer: Administer a prescribed analgesia for pain
,Rationale: Since this child is exhibiting signs of pain, the prescribed
analgesic should be administered. The behavioral signs of pain in an
infant are facial grimaces, restlessness or agitation, and guarding the
area of pain, in this case by pulling the knees to the chest
⩥ A 4-year-old with acute lymphocytic leukemia (ALL) is receiving a
chemotherapy (CT) protocol that includes methotrexate (Mexate, Trexal,
MIX), an antimetabolite. Which information should the nurse provide
the parents about caring for their child?
A. Use sunblock or protective clothing when outdoors
Answer: Use sunblock or protective clothing when outdoors
⩥ Two days after admission a male client remembers that he is allergic
to eggs, and informs the nurse of the allergy. Which actions should the
nurse implement? (Select all that apply)
a. Notify the food services department of the allergy.
b. Enter the allergy information in the client's record.
c. Document the statement in the nurse's notes
d. Note the allergy on the diet intake flow sheet
e. Add egg allergy to the client's allergy arm band.
Answer: a. Notify the food services department of the allergy.
b. Enter the allergy information in the client's record.
, e. Add egg allergy to the client's allergy arm band.
Rationale: The dietary department needs to screen menu selections for
foods that are prepared with eggs. The client's chart should be clearly
marked but the statement does not need to be documented in the nurse's
note or included in the intake record. Allergy identification on the arm
band is a universal location where allergies are noted while client is
hospitalized.
⩥ The rapid response team's detects return of spontaneous circulation
(ROSC) after 2 min of continuous chest compressions. The client has a
weak, fast pulse and no respiratory effort, so the healthcare provider
performs a successful oral, intubation. What action should the nurse
implement?
a. Perform bilateral chest auscultation.
b. Resume compression for 2 minutes
c. Administer a dose of epinephrine
d. Program the monitor for cardioversion.
Answer: Perform bilateral chest auscultation
Rationale: With the ROSC and no respiratory effort intubation is
indicated, and as soon as the procedure is completed, the position of the
intubation tube should be assessed for proper placement. Auscultating
for breath sounds is the first and quickest method to use to check for
STUDY GUIDE LATEST UPDATED ACTUAL
TESTED QUESTIONS AND CORRECT
ANSWERS
⩥ While teaching a young male adult to use an inhaler for his newly
diagnosed asthma, the client stares into the distance and appears to be
concentrating on something other than the lesson the nurse is presenting.
What action should the nurse take
a. Remind the client that a rescue inhaler might save his life
b. Leave the client alone so that he can grieve his illness
c. Ask the client what he is thinking about at his time.
d. Gently touch the client then continue with teaching.
Answer: Ask the client what he is thinking about at his time.
⩥ After several hours of non-productive coughing, a client presents to
the emergency room complaining of chest tightness and shortness of
breath. History includes end stage chronic obstructive pulmonary disease
(COPD) and diabetes mellitus. While completing the pulmonary
assessment, the nurse hears wheezing and poor air movement bilaterally.
Which actions should the nurse implement? (Select all that apply.)
a. Apply oxygen via nasal cannula
,b. Administer PRN nebulizer treatment.
c. Obtain 12 lead electrocardiogram.
d. Monitor continuous oxygen saturation.
e. Give PRN dose of regular insulin
Answer: b. Administer PRN nebulizer treatment.
c. Obtain 12 lead electrocardiogram.
d. Monitor continuous oxygen saturation.
Rationale: A nebulizer treatment may improve the wheezing. Chest
tightness is most likely to coughing, but a 12-lead electrocardiogram is
needed to assess for cardiac ischemia. Oxygen saturation monitors for
adequate oxygenation.
⩥ The nurse caring for a 3-month-old boy one day after a pylorostomy
notices that the infant is restless, is exhibiting facial grimaces, and is
drawing his knees to his chest. What action should the nurse take?
a. Administer a prescribed analgesia for pain.
b. Increase IV infusion rate for rehydration
c. Provide additional blankets to increase body temperature
d. Feed one ounce of formula to correct hypoglycemia.
Answer: Administer a prescribed analgesia for pain
,Rationale: Since this child is exhibiting signs of pain, the prescribed
analgesic should be administered. The behavioral signs of pain in an
infant are facial grimaces, restlessness or agitation, and guarding the
area of pain, in this case by pulling the knees to the chest
⩥ A 4-year-old with acute lymphocytic leukemia (ALL) is receiving a
chemotherapy (CT) protocol that includes methotrexate (Mexate, Trexal,
MIX), an antimetabolite. Which information should the nurse provide
the parents about caring for their child?
A. Use sunblock or protective clothing when outdoors
Answer: Use sunblock or protective clothing when outdoors
⩥ Two days after admission a male client remembers that he is allergic
to eggs, and informs the nurse of the allergy. Which actions should the
nurse implement? (Select all that apply)
a. Notify the food services department of the allergy.
b. Enter the allergy information in the client's record.
c. Document the statement in the nurse's notes
d. Note the allergy on the diet intake flow sheet
e. Add egg allergy to the client's allergy arm band.
Answer: a. Notify the food services department of the allergy.
b. Enter the allergy information in the client's record.
, e. Add egg allergy to the client's allergy arm band.
Rationale: The dietary department needs to screen menu selections for
foods that are prepared with eggs. The client's chart should be clearly
marked but the statement does not need to be documented in the nurse's
note or included in the intake record. Allergy identification on the arm
band is a universal location where allergies are noted while client is
hospitalized.
⩥ The rapid response team's detects return of spontaneous circulation
(ROSC) after 2 min of continuous chest compressions. The client has a
weak, fast pulse and no respiratory effort, so the healthcare provider
performs a successful oral, intubation. What action should the nurse
implement?
a. Perform bilateral chest auscultation.
b. Resume compression for 2 minutes
c. Administer a dose of epinephrine
d. Program the monitor for cardioversion.
Answer: Perform bilateral chest auscultation
Rationale: With the ROSC and no respiratory effort intubation is
indicated, and as soon as the procedure is completed, the position of the
intubation tube should be assessed for proper placement. Auscultating
for breath sounds is the first and quickest method to use to check for
