HESI 266 EXAM 2025/2026 VERIFIED QUESTIONS
AND CORRECT ANSWERS GRADED A+
NIGHTINGALE
A client is diagnosed with chronic kidney disease and needsto begin dialysis.
Which condition entered on the client's medicalrecord should the nurse recognize
as a contraindication for peritoneal dialysis?
a. Nephrotic syndrom history
b. Crohn's disease with colectomy
c. Diabetes Mellitus
d. Latent Hepatitis C
b. Crohn's disease with colectomy
Rationale: Crohn's disease with colectomy. The nurse should recognize that clients
with extensive intra-abdominal surgical history are not candidates for peritoneal
dialysis, as these clients may have decreased peritoneal membrane surface areas
and scar tissue formation, which would make it insufficient for adequate dialysis
exchange.
A client is admitted to the hospital for treatment of a simple
goiter, and levothyroxine sodium is prescribed. Which symptoms
indicate to the nurse that the prescribed dosage is too high for this
client?
a. Palpitations and shortness of breath
,b. Bradycardia and constipation
c. Muscle cramping and dry, flushed skin
d. Lethargy and lack of appetite
a. Palpitations and shortness of breath
Rationales: Palpitations and shortness of breath are symptoms of thyrotoxicosis,
indicating excessive thyroid hormone levels, which could result from an overdose
of Levothyroxine Sodium.
The nurse assesses a client with cirrhosis and finds 4+ pitting edema of the feet and
legs, and massive ascites. Which mechanism contributes to edema and ascites in
clients with cirrhosis?
a. Decreased portacaval pressure with greater collateral circulation.
b. Hyperaldosteronism causing an increased sodium reabsorption in renal tubules.
c. Decreased renin-angiotensin response related to an increase in renal bloodflow.
d. Hypoalbuminemia that results in a decreased colloidal oncotic pressure.
d. Hypoalbuminemia that results in a decreased colloidal oncotic pressure.
Rationale: In Cirrhosis, liver damaged leads to decreased synthesis of albumin.
Albumin plays a crucial role in maintaining colloidal oncotic pressure, and when it
is decreased (hypoalbuminemia), fluid is more likely to leak out of blood vessels,
resulting in anemia. The same mechanism contributes to the development of
ascities in the abdominal cavity.
A client with a fracture of the right femur has had skeletal traction
,applied. Which intervention should the nurse include in the client's
nursing care plan?
a. assess the pin sites for signs of infection.
b. administer pain medication at designated intervals around the clock.
c. assess the pulse proximal to the fracture site.
d. Remove traction every provide skin care.
a. assess the pin sites for signs of infection.
Rationale: Assessing the pin sites for sign of infection is in essential for clients
with skeletal traction to detect any early signs of infection such as redness, warmth,
swelling, or purulent drainage. Prompt identification and management of pin site
infections can prevent complications.
A client with a renal calculus reports severe right flank pain, nausea, and vomiting.
Which nursing problem has the highest priority?
a. Acute pain related to renal calculus.
b. Nutritional deficit related to nausea.
c. Impaired renal function related to pain.
d. Risk for aspiration related to vomiting.
d. Risk for aspiration related to vomiting.
Rationale: Risk for aspiration related to vomiting is the highest priority because it
addresses the immediate potential for airway compromise, which can be life-
threatening if the client apriates vomitus. Ensuring the airway is protected and that
aspiration does not occur is critical.
, An adult client who recently diagnosed with glaucoma tells the nurse, "it feels like
I am driving through a tunnel." The client expresses great concern about going
blind. Which nursing instruction is most important for the nurse to provide this
client?
a. eat a diet high in caroetene
b. wear prescription glasses.
c. avoid frequent eye pressure measurements.
d. maintain prescribed eye drop regimen.
d. maintain prescribed eye drop regimen.
Rationale:
The most important instruction for the client is to adhere to the prescribed eye drop
regimen. Medications, often in the form of eye drops, are commonly used to lower
intraocular pressure and manage glaucoma. Consistent use of prescribed
medications is critical for controlling the condition and preventing further vision
loss.
After falling down the basement steps, a client brought to the
emergency department. X-ray results confirm that the client's right
leg is fractures. Following application of a leg cast, which assessment
finding warrants immediate intervention by the nurse?
a. increased temperature to lower extremity.
b. right foot pale with sluggish capillary refill.
AND CORRECT ANSWERS GRADED A+
NIGHTINGALE
A client is diagnosed with chronic kidney disease and needsto begin dialysis.
Which condition entered on the client's medicalrecord should the nurse recognize
as a contraindication for peritoneal dialysis?
a. Nephrotic syndrom history
b. Crohn's disease with colectomy
c. Diabetes Mellitus
d. Latent Hepatitis C
b. Crohn's disease with colectomy
Rationale: Crohn's disease with colectomy. The nurse should recognize that clients
with extensive intra-abdominal surgical history are not candidates for peritoneal
dialysis, as these clients may have decreased peritoneal membrane surface areas
and scar tissue formation, which would make it insufficient for adequate dialysis
exchange.
A client is admitted to the hospital for treatment of a simple
goiter, and levothyroxine sodium is prescribed. Which symptoms
indicate to the nurse that the prescribed dosage is too high for this
client?
a. Palpitations and shortness of breath
,b. Bradycardia and constipation
c. Muscle cramping and dry, flushed skin
d. Lethargy and lack of appetite
a. Palpitations and shortness of breath
Rationales: Palpitations and shortness of breath are symptoms of thyrotoxicosis,
indicating excessive thyroid hormone levels, which could result from an overdose
of Levothyroxine Sodium.
The nurse assesses a client with cirrhosis and finds 4+ pitting edema of the feet and
legs, and massive ascites. Which mechanism contributes to edema and ascites in
clients with cirrhosis?
a. Decreased portacaval pressure with greater collateral circulation.
b. Hyperaldosteronism causing an increased sodium reabsorption in renal tubules.
c. Decreased renin-angiotensin response related to an increase in renal bloodflow.
d. Hypoalbuminemia that results in a decreased colloidal oncotic pressure.
d. Hypoalbuminemia that results in a decreased colloidal oncotic pressure.
Rationale: In Cirrhosis, liver damaged leads to decreased synthesis of albumin.
Albumin plays a crucial role in maintaining colloidal oncotic pressure, and when it
is decreased (hypoalbuminemia), fluid is more likely to leak out of blood vessels,
resulting in anemia. The same mechanism contributes to the development of
ascities in the abdominal cavity.
A client with a fracture of the right femur has had skeletal traction
,applied. Which intervention should the nurse include in the client's
nursing care plan?
a. assess the pin sites for signs of infection.
b. administer pain medication at designated intervals around the clock.
c. assess the pulse proximal to the fracture site.
d. Remove traction every provide skin care.
a. assess the pin sites for signs of infection.
Rationale: Assessing the pin sites for sign of infection is in essential for clients
with skeletal traction to detect any early signs of infection such as redness, warmth,
swelling, or purulent drainage. Prompt identification and management of pin site
infections can prevent complications.
A client with a renal calculus reports severe right flank pain, nausea, and vomiting.
Which nursing problem has the highest priority?
a. Acute pain related to renal calculus.
b. Nutritional deficit related to nausea.
c. Impaired renal function related to pain.
d. Risk for aspiration related to vomiting.
d. Risk for aspiration related to vomiting.
Rationale: Risk for aspiration related to vomiting is the highest priority because it
addresses the immediate potential for airway compromise, which can be life-
threatening if the client apriates vomitus. Ensuring the airway is protected and that
aspiration does not occur is critical.
, An adult client who recently diagnosed with glaucoma tells the nurse, "it feels like
I am driving through a tunnel." The client expresses great concern about going
blind. Which nursing instruction is most important for the nurse to provide this
client?
a. eat a diet high in caroetene
b. wear prescription glasses.
c. avoid frequent eye pressure measurements.
d. maintain prescribed eye drop regimen.
d. maintain prescribed eye drop regimen.
Rationale:
The most important instruction for the client is to adhere to the prescribed eye drop
regimen. Medications, often in the form of eye drops, are commonly used to lower
intraocular pressure and manage glaucoma. Consistent use of prescribed
medications is critical for controlling the condition and preventing further vision
loss.
After falling down the basement steps, a client brought to the
emergency department. X-ray results confirm that the client's right
leg is fractures. Following application of a leg cast, which assessment
finding warrants immediate intervention by the nurse?
a. increased temperature to lower extremity.
b. right foot pale with sluggish capillary refill.
