PN HESI EXIT EXAM PRACTICE
QUESTIONS AND ANSWERS
1. A nurse is caring for a client who is receiving a continuous intravenous infusion of heparin.
Which of the following laboratory values should the nurse monitor to evaluate the
effectiveness of the therapy?
A. Prothrombin time (PT)
B. International Normalized Ratio (INR)
C. Activated partial thromboplastin time (aPTT)
D. Platelet count
Answer: C
Conceptual Explanation: Activated partial thromboplastin time (aPTT) is used to monitor
the effectiveness of heparin therapy. PT and INR are used for warfarin therapy, while
platelet counts monitor for heparin-induced thrombocytopenia but not the anticoagulation
efficacy.
,2. A client is prescribed digoxin for heart failure. Which of the following clinical
manifestations should the nurse identify as an early sign of digoxin toxicity?
A. Hyperkalemia
B. Tachycardia
C. Increased urinary output
D. Anorexia and nausea
Answer: D
Conceptual Explanation: Early signs of digoxin toxicity include gastrointestinal symptoms
such as anorexia, nausea, and vomiting, as well as neurological symptoms like blurred
vision or yellow halos.
3. The nurse is reinforcing discharge teaching for a client with a new prescription for warfarin.
Which of the following statements by the client indicates a need for further teaching?
A. I will increase my intake of dark green leafy vegetables.
B. I will use an electric razor for shaving.
C. I will report any unusual bruising to my doctor.
D. I will avoid taking aspirin while on this medication.
Answer: A
, Conceptual Explanation: Dark green leafy vegetables are high in Vitamin K, which is the
antagonist to warfarin. The client should maintain a consistent intake rather than
increasing it, as sudden increases can decrease the drug’s effectiveness.
4. Which client should the nurse see first after receiving the morning shift report?
A. A client who is post-operative day 1 and reports sudden shortness of breath.
B. A client with heart failure who gained 2 lbs in 24 hours.
C. A client with a chest tube who has 50 mL of drainage in the last hour.
D. A client with diabetes whose morning blood glucose is 160 mg/dL.
Answer: A
Conceptual Explanation: Sudden shortness of breath in a post-operative client may
indicate a pulmonary embolism, which is a life-threatening emergency and requires
immediate assessment.
5. A nurse is providing care for a client who has a prescription for a clear liquid diet. Which of
the following items should the nurse offer the client?
A. Vanilla pudding
B. Orange juice with pulp
C. Sherbet
D. Apple juice
Answer: D
QUESTIONS AND ANSWERS
1. A nurse is caring for a client who is receiving a continuous intravenous infusion of heparin.
Which of the following laboratory values should the nurse monitor to evaluate the
effectiveness of the therapy?
A. Prothrombin time (PT)
B. International Normalized Ratio (INR)
C. Activated partial thromboplastin time (aPTT)
D. Platelet count
Answer: C
Conceptual Explanation: Activated partial thromboplastin time (aPTT) is used to monitor
the effectiveness of heparin therapy. PT and INR are used for warfarin therapy, while
platelet counts monitor for heparin-induced thrombocytopenia but not the anticoagulation
efficacy.
,2. A client is prescribed digoxin for heart failure. Which of the following clinical
manifestations should the nurse identify as an early sign of digoxin toxicity?
A. Hyperkalemia
B. Tachycardia
C. Increased urinary output
D. Anorexia and nausea
Answer: D
Conceptual Explanation: Early signs of digoxin toxicity include gastrointestinal symptoms
such as anorexia, nausea, and vomiting, as well as neurological symptoms like blurred
vision or yellow halos.
3. The nurse is reinforcing discharge teaching for a client with a new prescription for warfarin.
Which of the following statements by the client indicates a need for further teaching?
A. I will increase my intake of dark green leafy vegetables.
B. I will use an electric razor for shaving.
C. I will report any unusual bruising to my doctor.
D. I will avoid taking aspirin while on this medication.
Answer: A
, Conceptual Explanation: Dark green leafy vegetables are high in Vitamin K, which is the
antagonist to warfarin. The client should maintain a consistent intake rather than
increasing it, as sudden increases can decrease the drug’s effectiveness.
4. Which client should the nurse see first after receiving the morning shift report?
A. A client who is post-operative day 1 and reports sudden shortness of breath.
B. A client with heart failure who gained 2 lbs in 24 hours.
C. A client with a chest tube who has 50 mL of drainage in the last hour.
D. A client with diabetes whose morning blood glucose is 160 mg/dL.
Answer: A
Conceptual Explanation: Sudden shortness of breath in a post-operative client may
indicate a pulmonary embolism, which is a life-threatening emergency and requires
immediate assessment.
5. A nurse is providing care for a client who has a prescription for a clear liquid diet. Which of
the following items should the nurse offer the client?
A. Vanilla pudding
B. Orange juice with pulp
C. Sherbet
D. Apple juice
Answer: D
