HESI RN EXIT EXAM V2 INET PROCTORED
QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES ||
100% GUARANTEED PASS!!
LATEST VERSION
1.
A nurse is caring for a client with chronic obstructive pulmonary disease (COPD)
who is receiving oxygen via nasal cannula at 2 L/min. Which finding requires
immediate intervention?
A. Oxygen saturation of 90%
B. Barrel-shaped chest
C. Increasing somnolence
D. Use of accessory muscles during breathing
Correct Answer: C
Rationale:Increasing somnolence may indicate carbon dioxide retention and
impending respiratory failure in a client with COPD. An oxygen saturation of 90%
is acceptable for COPD, barrel chest is expected, and accessory muscle use is
common with exertion.
,2.
A postoperative client reports sudden shortness of breath and chest pain. The nurse
notes tachycardia and hypotension. Which action should the nurse take first?
A. Administer prescribed analgesics
B. Elevate the head of the bed
C. Apply oxygen via non-rebreather mask
D. Obtain a stat chest X-ray
Correct Answer: C
Rationale: These findings are consistent with a possible pulmonary embolism.
Immediate high-flow oxygen is the priority to improve oxygenation before
diagnostic testing or positioning.
3.
A nurse is teaching a client newly diagnosed with type 1 diabetes mellitus about
insulin administration. Which statement indicates a need for further teaching?
A. “I will rotate injection sites within the same area.”
B. “I should inject insulin into scar tissue.”
C. “I will check my blood glucose before injecting.”
D. “I should use a new needle for each injection.”
Correct Answer: B
Rationale: Insulin should not be injected into scar tissue due to unpredictable
absorption. Rotating sites within the same anatomical area promotes consistent
absorption.
4.
A client with heart failure is prescribed furosemide. Which laboratory value should
the nurse monitor most closely?
A. Sodium
B. Potassium
,C. Calcium
D. Magnesium
Correct Answer: B
Rationale: Loop diuretics such as furosemide can cause significant potassium loss,
increasing the risk for dysrhythmias.
5.
A nurse is caring for a client with suspected meningitis. Which intervention is the
highest priority?
A. Administer antipyretics
B. Initiate droplet precautions
C. Obtain blood cultures
D. Perform frequent neurologic checks
Correct Answer: B
Rationale: Meningitis is highly contagious. Initiating droplet precautions protects
others and must occur immediately, even before diagnostic confirmation.
6.
A nurse assesses a client with a chest tube following thoracic surgery. Which
finding requires immediate intervention?
A. Tidaling in the water-seal chamber
B. Continuous bubbling in the water-seal chamber
C. Serosanguinous drainage of 50 mL in 8 hours
D. Chest tube secured with occlusive dressing
Correct Answer: B
Rationale: Continuous bubbling in the water-seal chamber indicates an air leak
and requires prompt assessment of the system and client.
, 7.
A client receiving total parenteral nutrition (TPN) suddenly develops diaphoresis
and confusion. Which action should the nurse take first?
A. Stop the TPN infusion
B. Check the client’s blood glucose
C. Administer insulin
D. Notify the healthcare provider
Correct Answer: B
Rationale: These symptoms suggest hypoglycemia or hyperglycemia. Blood
glucose assessment is the priority before interventions are initiated.
8.
A nurse is caring for a client with a new colostomy. Which intervention best
promotes independence?
A. Performing ostomy care for the client
B. Providing written instructions only
C. Encouraging the client to participate in ostomy care
D. Referring the client to home health services
Correct Answer: C
Rationale: Encouraging hands-on participation promotes independence,
confidence, and long-term self-management.
9.
A client with preeclampsia reports a severe headache and visual disturbances.
Which medication should the nurse anticipate administering?
A. Oxytocin
B. Magnesium sulfate
C. Methylergonovine
D. Terbutaline
QUESTIONS AND CORRECT DETAILED
ANSWERS WITH RATIONALES ||
100% GUARANTEED PASS!!
LATEST VERSION
1.
A nurse is caring for a client with chronic obstructive pulmonary disease (COPD)
who is receiving oxygen via nasal cannula at 2 L/min. Which finding requires
immediate intervention?
A. Oxygen saturation of 90%
B. Barrel-shaped chest
C. Increasing somnolence
D. Use of accessory muscles during breathing
Correct Answer: C
Rationale:Increasing somnolence may indicate carbon dioxide retention and
impending respiratory failure in a client with COPD. An oxygen saturation of 90%
is acceptable for COPD, barrel chest is expected, and accessory muscle use is
common with exertion.
,2.
A postoperative client reports sudden shortness of breath and chest pain. The nurse
notes tachycardia and hypotension. Which action should the nurse take first?
A. Administer prescribed analgesics
B. Elevate the head of the bed
C. Apply oxygen via non-rebreather mask
D. Obtain a stat chest X-ray
Correct Answer: C
Rationale: These findings are consistent with a possible pulmonary embolism.
Immediate high-flow oxygen is the priority to improve oxygenation before
diagnostic testing or positioning.
3.
A nurse is teaching a client newly diagnosed with type 1 diabetes mellitus about
insulin administration. Which statement indicates a need for further teaching?
A. “I will rotate injection sites within the same area.”
B. “I should inject insulin into scar tissue.”
C. “I will check my blood glucose before injecting.”
D. “I should use a new needle for each injection.”
Correct Answer: B
Rationale: Insulin should not be injected into scar tissue due to unpredictable
absorption. Rotating sites within the same anatomical area promotes consistent
absorption.
4.
A client with heart failure is prescribed furosemide. Which laboratory value should
the nurse monitor most closely?
A. Sodium
B. Potassium
,C. Calcium
D. Magnesium
Correct Answer: B
Rationale: Loop diuretics such as furosemide can cause significant potassium loss,
increasing the risk for dysrhythmias.
5.
A nurse is caring for a client with suspected meningitis. Which intervention is the
highest priority?
A. Administer antipyretics
B. Initiate droplet precautions
C. Obtain blood cultures
D. Perform frequent neurologic checks
Correct Answer: B
Rationale: Meningitis is highly contagious. Initiating droplet precautions protects
others and must occur immediately, even before diagnostic confirmation.
6.
A nurse assesses a client with a chest tube following thoracic surgery. Which
finding requires immediate intervention?
A. Tidaling in the water-seal chamber
B. Continuous bubbling in the water-seal chamber
C. Serosanguinous drainage of 50 mL in 8 hours
D. Chest tube secured with occlusive dressing
Correct Answer: B
Rationale: Continuous bubbling in the water-seal chamber indicates an air leak
and requires prompt assessment of the system and client.
, 7.
A client receiving total parenteral nutrition (TPN) suddenly develops diaphoresis
and confusion. Which action should the nurse take first?
A. Stop the TPN infusion
B. Check the client’s blood glucose
C. Administer insulin
D. Notify the healthcare provider
Correct Answer: B
Rationale: These symptoms suggest hypoglycemia or hyperglycemia. Blood
glucose assessment is the priority before interventions are initiated.
8.
A nurse is caring for a client with a new colostomy. Which intervention best
promotes independence?
A. Performing ostomy care for the client
B. Providing written instructions only
C. Encouraging the client to participate in ostomy care
D. Referring the client to home health services
Correct Answer: C
Rationale: Encouraging hands-on participation promotes independence,
confidence, and long-term self-management.
9.
A client with preeclampsia reports a severe headache and visual disturbances.
Which medication should the nurse anticipate administering?
A. Oxytocin
B. Magnesium sulfate
C. Methylergonovine
D. Terbutaline
