Hesi Exit Exam 🙌🏾
A client is receiving a continuous half strength tube feeding at 50ml/hour. To prepare enough
of the solution for eight hours, how many ml of full strength feeding will the nurse need?
(Enter numeric value only.) - ANS200ml . 25 ml of full strength feeding mixed with 25ml of
water provided 50ml of half strength. 25ml × 8 hours= 200ml
An elderly male client is experiencing urinary incontinence. What is the best initial nursing
action? - ANSApply an external condom catheter
3. A male Muslim client with pneumonia is scheduled to receive a dose of an intravenous
antibiotic but refuses to allow the nurse to begin the medication, stating he cannot allow
fluids to enter his body once he is cleansed for prayer. What action should the nurse
implement? - ANSReschedule administration of the antibiotic until after he completes his
prayers
UAP using a hand sanitzers that is alcohol for 2 minutes - ANStell that hand sanitizer use is
less > 2min
5.A child is to receive vancomycin (Vancocin) 40 mg/kg IV one hour before a scheduled
procedure. The child weighs 44 pounds. How many mg of the medication should the nurse
administer - ANSAnswer: 800 Rationale: First, convert the child's weight to kg: 44 pounds
divided by
2.2pound/kg = 20 kg. Next calculate the mg/kg/dose, 40 mg x 20 kg = 800mg
6. While assisting a postpartum client with perineal care, the nurse notes that her vaginal
bleeding spurts rather than trickles from the vagina. The uterine fundus is firm and the
client's vital signs are pulse 88 beats/minute; respiratory rate, 21 breaths/minute; and blood
pressure, 104/68 mmHg. What action should the nurse take next? - ANSCompare current
vital signs with previous vital signs
A 6-year old boy was hit with a bat while playing at school. He has a splinter of wood
imbedded in his eye. Which action should the school nurse take? - ANSHave the parent take
the child for emergency help
Within four weeks of childbirth, a client is admitted to the hospital for disorganized speech
bizarre behavior, and strange thoughts about her infant being possessed by demons. The
nurse identifies a nursing diagnosis of "Altered thought processes, secondary to" what
condition? - ANSPostpartum psychosis
The nurse identifies a priority diagnosis of, "Altered comfort related to menstrual cramps" for
a 25-year-old female client. Which self-care activity should the nurse emphasize in the
client's teaching plan? - ANSRegular aerobic exercise.
Psych/Alcohol/Tylenol overdose antidote - ANSGive Mucomyst
, Medical Surgical/Laxative abuses - ANSPatient -taking Milk of Magnesium
Spiritual/Documentation - ANSNative American - Allow pt's family to stay in the room
Leadership- Interpreter informed consent - ANSPt should sign the consent
Geriatrics/Emergency Rib fractures fall - ANSPulmonary embolism
A client diagnosed with major depression is being allowed a weekend pass from the
psychiatric unit. Which instruction should the nurse provide to the client's family? -
ANSInvolve the client in usual at home activities
Upon assessment, the nurse discovers that a postpartum client has persistent red lochia.
Which of the following does this assessment finding suggest to the nurse? - ANSCoagulation
disorders
The healthcare provider performs peritoneal dialysis on a client, after which 2 liters of fluid is
drained. What action should the nurse complete first? - ANSAssess vital signs.
After administering a medication through a nasogastric tube connected to suction, what
action should the nurse take first? - ANSClamp the tube
The nurse is caring for four clients: Client A 94% o2 saturation, Client B, hemoglobin of 8.;
Client C, potassium level of 3.8 and Client D appendectomy who has a white blood cell
count of 15,000. What
should the nurse implement? - ANSDetermine if Client B has two units of packed cells
available in the blood bank.
Triage question with a train wreck The psychiatric nurse is called to a train derailment that
was likely caused by a terrorist bomb. In triaging those in need of immediate care, what is
the priority ranking for these cases?
(arrange these cases in order or priority with the top item requiring the most immediate care
and the bottom item requiring the least priority care) - ANSA mother and father have just
arrived on the .
A crying child being held by another passenger. A woman sitting on the ground with a
blanket.
A middle-aged man who is wandering around
(arrange in order) = middle age woman bleeding- woman w/ blanket- child crying- mother
and father. (Mine didn't have a middle age woman bleeding, instead it had an old man
wandering and - ANScorrect order is: wandering old man, woman w/blanket, man holding
baby, and mother & father)
The nurse in the emergency department is using the simple triage and rapid transport
(START) system to assess victims of a hurricane. Which statement correctly describes a
A client is receiving a continuous half strength tube feeding at 50ml/hour. To prepare enough
of the solution for eight hours, how many ml of full strength feeding will the nurse need?
(Enter numeric value only.) - ANS200ml . 25 ml of full strength feeding mixed with 25ml of
water provided 50ml of half strength. 25ml × 8 hours= 200ml
An elderly male client is experiencing urinary incontinence. What is the best initial nursing
action? - ANSApply an external condom catheter
3. A male Muslim client with pneumonia is scheduled to receive a dose of an intravenous
antibiotic but refuses to allow the nurse to begin the medication, stating he cannot allow
fluids to enter his body once he is cleansed for prayer. What action should the nurse
implement? - ANSReschedule administration of the antibiotic until after he completes his
prayers
UAP using a hand sanitzers that is alcohol for 2 minutes - ANStell that hand sanitizer use is
less > 2min
5.A child is to receive vancomycin (Vancocin) 40 mg/kg IV one hour before a scheduled
procedure. The child weighs 44 pounds. How many mg of the medication should the nurse
administer - ANSAnswer: 800 Rationale: First, convert the child's weight to kg: 44 pounds
divided by
2.2pound/kg = 20 kg. Next calculate the mg/kg/dose, 40 mg x 20 kg = 800mg
6. While assisting a postpartum client with perineal care, the nurse notes that her vaginal
bleeding spurts rather than trickles from the vagina. The uterine fundus is firm and the
client's vital signs are pulse 88 beats/minute; respiratory rate, 21 breaths/minute; and blood
pressure, 104/68 mmHg. What action should the nurse take next? - ANSCompare current
vital signs with previous vital signs
A 6-year old boy was hit with a bat while playing at school. He has a splinter of wood
imbedded in his eye. Which action should the school nurse take? - ANSHave the parent take
the child for emergency help
Within four weeks of childbirth, a client is admitted to the hospital for disorganized speech
bizarre behavior, and strange thoughts about her infant being possessed by demons. The
nurse identifies a nursing diagnosis of "Altered thought processes, secondary to" what
condition? - ANSPostpartum psychosis
The nurse identifies a priority diagnosis of, "Altered comfort related to menstrual cramps" for
a 25-year-old female client. Which self-care activity should the nurse emphasize in the
client's teaching plan? - ANSRegular aerobic exercise.
Psych/Alcohol/Tylenol overdose antidote - ANSGive Mucomyst
, Medical Surgical/Laxative abuses - ANSPatient -taking Milk of Magnesium
Spiritual/Documentation - ANSNative American - Allow pt's family to stay in the room
Leadership- Interpreter informed consent - ANSPt should sign the consent
Geriatrics/Emergency Rib fractures fall - ANSPulmonary embolism
A client diagnosed with major depression is being allowed a weekend pass from the
psychiatric unit. Which instruction should the nurse provide to the client's family? -
ANSInvolve the client in usual at home activities
Upon assessment, the nurse discovers that a postpartum client has persistent red lochia.
Which of the following does this assessment finding suggest to the nurse? - ANSCoagulation
disorders
The healthcare provider performs peritoneal dialysis on a client, after which 2 liters of fluid is
drained. What action should the nurse complete first? - ANSAssess vital signs.
After administering a medication through a nasogastric tube connected to suction, what
action should the nurse take first? - ANSClamp the tube
The nurse is caring for four clients: Client A 94% o2 saturation, Client B, hemoglobin of 8.;
Client C, potassium level of 3.8 and Client D appendectomy who has a white blood cell
count of 15,000. What
should the nurse implement? - ANSDetermine if Client B has two units of packed cells
available in the blood bank.
Triage question with a train wreck The psychiatric nurse is called to a train derailment that
was likely caused by a terrorist bomb. In triaging those in need of immediate care, what is
the priority ranking for these cases?
(arrange these cases in order or priority with the top item requiring the most immediate care
and the bottom item requiring the least priority care) - ANSA mother and father have just
arrived on the .
A crying child being held by another passenger. A woman sitting on the ground with a
blanket.
A middle-aged man who is wandering around
(arrange in order) = middle age woman bleeding- woman w/ blanket- child crying- mother
and father. (Mine didn't have a middle age woman bleeding, instead it had an old man
wandering and - ANScorrect order is: wandering old man, woman w/blanket, man holding
baby, and mother & father)
The nurse in the emergency department is using the simple triage and rapid transport
(START) system to assess victims of a hurricane. Which statement correctly describes a
