HESI Exit Practice Questions and
Rationale (2)
The nurse has completed giving discharge instructions to a client who has had a total joint
replacement (TJR) of the knee with a metal prosthetic system. The nurse determines that the
client understands the instructions if the client makes which statement?
1."Changes in the shape of the knee are expected."
2."Fever, redness, and increased pain are expected."
3."All caregivers should be told about the metal implant."
4."Bleeding gums or black stools may occur, but this is normal." - ANS3
A TJR is also known as a total joint arthroplasty (TJA). The client must inform other caregivers
of the presence of the metal implant because certain tests and procedures will need to be
avoided. After total knee replacement, the client should report signs and symptoms of infection
and any changes in the shape of the knee. These could indicate developing complications. With
a metal implant, the client may be on anticoagulant therapy and should report adverse effects of
this therapy, including bleeding from a variety of sources, and the client will need antibiotic
prophylaxis for invasive procedures.
The nurse is caring for a client after the application of a plaster cast for a fractured left radius.
The nurse should suspect impairment with the neurovascular status of the client's casted
extremity if which findings are noted? Select all that apply.
1.Capillary refill is less than 3 seconds 2.Pulses present and with swollen, pink fingers
3.Client report of severe, deep, unrelenting pain
4.Client report of pain as nurse assesses finger movement
5.Client report of numbness and tingling sensation in the fingers - ANS3, 4, 5
The pressure in compartment syndrome, if unrelieved, will cause permanent damage to nerve
and muscle tissue distal to the pressure. Circulatory damage may result in necrosis. Nerve and
muscle damage may result in permanent contractures, deformity of the extremity, and functional
impairment. Normal capillary refill time is 3 seconds or less. Pink appearance and a pulse
indicate adequate blood flow; swelling is expected after a fracture. Client report of severe, deep,
unrelenting pain; client report of numbness and tingling sensation; and client report of pain as
the nurse assesses finger movement are indicative of development of compartment syndrome.
A client with a 4-day-old lumbar vertebral fracture is experiencing muscle spasms. Which are
interventions to aid the client in relieving the spasm? Select all that apply.
1.Ice
2.Heat
3.Analgesics
4.Muscle relaxers
5.Intermittent traction - ANS2, 3, 4, 5
,Heat, analgesics, muscle relaxers, and traction all may be used to relieve the pain of muscle
spasm in the client with a vertebral fracture. Ice is applied to a painful site only for the first 48 to
72 hours (depending on the health care provider's preference) after an injury. Application of ice
to the spine of a client could be uncomfortable and could result in feelings of being chilled.
The nurse is caring for a client who had surgery to repair a fractured left-sided hip using a
posterior approach. In implementing hip precautions, which action should the nurse teach the
client to avoid?
1.Crossing legs at the ankle
2.Using an elevated toilet seat 3.Placing a pillow between the legs 4.Keeping the legs abducted
from the midline - ANS1
Following surgery to repair a fractured hip using a posterior approach, client education should
include the following: avoiding crossing the legs at the ankle or the knee, using an elevated
toilet seat, placing a pillow between the legs while lying down for the first 6 weeks, keeping the
legs abducted from the midline, and keeping the hip in a neutral position at all times.
An older client is diagnosed with osteoporosis. The nurse teaches the client about self-care
measures, knowing that the client is most at risk for which problem as a result of this disorder of
the bones?
1.Anemia
2.Fractures
3.Infection
4.Muscle sprains - ANS2
The client is most at risk for fractures as a result of osteoporosis. Although other complications
can occur, fracture is the greatest concern. Anemia and infection can occur with bone marrow
disorders, and muscle sprains are unrelated to osteoporosis.
A client with a new medication prescription for allopurinol asks the nurse, "I know this is for gout,
but how does it work?" The nurse plans to reply based on which medication action?
1.Allopurinol decreases uric acid production.
2.Allopurinol reduces the production of fibrinogen.
3.Allopurinol decreases the risk of sulfa crystal formation in the urine. 4.Allopurinol prevents
influx of calcium ions during cell depolarization. - ANS1
Allopurinol is classified as an antigout medication. It decreases uric acid production by inhibiting
the xanthine oxidase enzyme, and it reduces uric acid concentrations in both serum and urine.
The other options are incorrect.
The nurse is caring for a client diagnosed with osteitis deformans (Paget's disease). Which does
the nurse identify as the cause of the client's stooped posture and bowing of lower extremities?
1.Muscle metabolism and growth 2.Bone resorption and regeneration 3.Nervous system
impulse transmission 4.Joint integrity and synovial fluid production - ANS2
Paget's disease is characterized by skeletal deformities resulting from abnormal bone resorption
followed by abnormal regeneration. It is not caused by problems with muscle, nervous system,
or joint functioning.
,A client has been diagnosed with gout, and the nurse provides dietary instructions. The nurse
determines that the client needs additional teaching if the client states that it is acceptable to eat
which food?
1.Carrots
2.Tapioca
3.Chocolate
4.Chicken liver - ANS4
Liver and other organ meats should be omitted from the diet of a client who has gout because of
their high purine content. Purines are a form of protein. The food items identified in the other
options contain negligible amounts of purines and may be consumed freely by the client with
gout.
Diagnostic studies are prescribed for a client with suspected Paget's disease. In reviewing the
client's record, the nurse would expect to note that the health care provider has prescribed
which laboratory study?
1.Platelet count
2.Alkaline phosphatase
3.White blood cell count
4.Complete blood cell count - ANS2
Paget's disease is a chronic metabolic disorder in which bone is excessively broken down and
reformed. The result is bone that is structurally disorganized, causing bone to be weak with
increased risk for bowing of long bones and fractures. Diagnostic laboratory findings for Paget's
disease include an elevated serum alkaline phosphatase level and elevated urinary
hydroxyproline excretion. The remaining options are unrelated to diagnostic evaluation of this
disease.
A client is to receive a prescription for methocarbamol. The nurse provides instructions to the
client about the medication. Which client statement would indicate a need for further education?
1."My urine may turn brown or green." 2."I might get some nasal congestion from this
medication."
3."This medication is prescribed to help relieve my muscle spasms."
4."If my vision becomes blurred, I don't need to be concerned about it." - ANS4
Methocarbamol is a muscle relaxant that works by blocking nerve impulses (or pain sensations)
that are sent to the brain. The client needs to be told that the urine may turn brown, black, or
green. Other adverse effects include blurred vision, nasal congestion, urticaria, and rash. The
client needs to be instructed to notify the health care provider if these side/adverse effects
occur.
The nurse is planning measures to increase bed mobility for a client in skeletal leg traction.
Which item should the nurse consider to be most helpful for this client?
1.Television
2.Fracture bedpan
3.Overhead trapeze
, 4.Reading materials - ANS3
The use of an overhead trapeze is extremely helpful for a client to move about in bed and to get
on and off the bedpan. This device has the greatest value in increasing overall bed mobility.
Television and reading materials, although helpful in reducing boredom and providing
distraction, do not increase bed mobility. A fracture bedpan is useful in reducing discomfort with
elimination.
The nurse is caring for a client who sustained an open fracture and is diagnosed with acute
osteomyelitis of the right lower extremity. Which intervention should the nurse plan to perform?
1.Apply ice to the affected area. 2.Perform sterile dressing changes. 3.Instruct the client on leg
exercises. 4.Measure the leg circumference daily. - ANS2
Osteomyelitis is a severe infection of the bone, bone marrow, and surrounding soft tissue.
Clinical manifestations include constant bone pain unrelieved by rest that worsens with activity;
swelling, tenderness, and warmth at the infection site; restricted movement of the affected part;
fever, night sweats, chills, restlessness, nausea, and malaise. Option 2 is the correct option, as
treatment of osteomyelitis often includes surgical debridement and requires sterile dressing
changes. Option 1 is incorrect, as osteomyelitis is an infection and applying ice to the area will
not help any swelling and may cause vasoconstriction. Option 3 is incorrect, as movement
worsens the pain and some immobilization of the affected limb (e.g., splint, traction) is usually
indicated. Option 4, measuring leg circumference daily, is not necessary.
The health care provider has prescribed a lidocaine 5% patch for a client with a diagnosis of
neck pain due to osteoarthritis. Which should the nurse tell the client regarding this medication?
1.The medication patch will act as a local anesthetic.
2.The medication patch acts by decreasing muscle spasms.
3.The medication is prescribed to cause the skin to peel below the patch.
4.Apply a heating pad to the area after applying the medication patch to increase the
effectiveness. - ANS1
A lidocaine patch provides a local anesthetic effect to the site of application. The medication
does not act in a systemic manner. It is not prescribed to cause the skin to peel, so if this
reaction occurs, the health care provider should be notified. A heating pad should not be applied
because irritation or burning of the skin may occur.
The nurse witnessed a vehicle hit a pedestrian. The victim is dazed and tries to get up. A leg
appears fractured. Which intervention should the nurse take?
1.Try to reduce the fracture manually. 2.Assist the victim to get up and walk to the sidewalk.
3.Leave the victim for a few moments to call an ambulance.
4.Stay with the victim and encourage him or her to remain still. - ANS4
With a suspected fracture, the victim is not moved unless it is dangerous to remain in that spot.
The nurse should remain with the victim and have someone else call for emergency help. A
fracture is not reduced at the scene. Before the victim is moved, the site of fracture is
immobilized to prevent further injury.
Rationale (2)
The nurse has completed giving discharge instructions to a client who has had a total joint
replacement (TJR) of the knee with a metal prosthetic system. The nurse determines that the
client understands the instructions if the client makes which statement?
1."Changes in the shape of the knee are expected."
2."Fever, redness, and increased pain are expected."
3."All caregivers should be told about the metal implant."
4."Bleeding gums or black stools may occur, but this is normal." - ANS3
A TJR is also known as a total joint arthroplasty (TJA). The client must inform other caregivers
of the presence of the metal implant because certain tests and procedures will need to be
avoided. After total knee replacement, the client should report signs and symptoms of infection
and any changes in the shape of the knee. These could indicate developing complications. With
a metal implant, the client may be on anticoagulant therapy and should report adverse effects of
this therapy, including bleeding from a variety of sources, and the client will need antibiotic
prophylaxis for invasive procedures.
The nurse is caring for a client after the application of a plaster cast for a fractured left radius.
The nurse should suspect impairment with the neurovascular status of the client's casted
extremity if which findings are noted? Select all that apply.
1.Capillary refill is less than 3 seconds 2.Pulses present and with swollen, pink fingers
3.Client report of severe, deep, unrelenting pain
4.Client report of pain as nurse assesses finger movement
5.Client report of numbness and tingling sensation in the fingers - ANS3, 4, 5
The pressure in compartment syndrome, if unrelieved, will cause permanent damage to nerve
and muscle tissue distal to the pressure. Circulatory damage may result in necrosis. Nerve and
muscle damage may result in permanent contractures, deformity of the extremity, and functional
impairment. Normal capillary refill time is 3 seconds or less. Pink appearance and a pulse
indicate adequate blood flow; swelling is expected after a fracture. Client report of severe, deep,
unrelenting pain; client report of numbness and tingling sensation; and client report of pain as
the nurse assesses finger movement are indicative of development of compartment syndrome.
A client with a 4-day-old lumbar vertebral fracture is experiencing muscle spasms. Which are
interventions to aid the client in relieving the spasm? Select all that apply.
1.Ice
2.Heat
3.Analgesics
4.Muscle relaxers
5.Intermittent traction - ANS2, 3, 4, 5
,Heat, analgesics, muscle relaxers, and traction all may be used to relieve the pain of muscle
spasm in the client with a vertebral fracture. Ice is applied to a painful site only for the first 48 to
72 hours (depending on the health care provider's preference) after an injury. Application of ice
to the spine of a client could be uncomfortable and could result in feelings of being chilled.
The nurse is caring for a client who had surgery to repair a fractured left-sided hip using a
posterior approach. In implementing hip precautions, which action should the nurse teach the
client to avoid?
1.Crossing legs at the ankle
2.Using an elevated toilet seat 3.Placing a pillow between the legs 4.Keeping the legs abducted
from the midline - ANS1
Following surgery to repair a fractured hip using a posterior approach, client education should
include the following: avoiding crossing the legs at the ankle or the knee, using an elevated
toilet seat, placing a pillow between the legs while lying down for the first 6 weeks, keeping the
legs abducted from the midline, and keeping the hip in a neutral position at all times.
An older client is diagnosed with osteoporosis. The nurse teaches the client about self-care
measures, knowing that the client is most at risk for which problem as a result of this disorder of
the bones?
1.Anemia
2.Fractures
3.Infection
4.Muscle sprains - ANS2
The client is most at risk for fractures as a result of osteoporosis. Although other complications
can occur, fracture is the greatest concern. Anemia and infection can occur with bone marrow
disorders, and muscle sprains are unrelated to osteoporosis.
A client with a new medication prescription for allopurinol asks the nurse, "I know this is for gout,
but how does it work?" The nurse plans to reply based on which medication action?
1.Allopurinol decreases uric acid production.
2.Allopurinol reduces the production of fibrinogen.
3.Allopurinol decreases the risk of sulfa crystal formation in the urine. 4.Allopurinol prevents
influx of calcium ions during cell depolarization. - ANS1
Allopurinol is classified as an antigout medication. It decreases uric acid production by inhibiting
the xanthine oxidase enzyme, and it reduces uric acid concentrations in both serum and urine.
The other options are incorrect.
The nurse is caring for a client diagnosed with osteitis deformans (Paget's disease). Which does
the nurse identify as the cause of the client's stooped posture and bowing of lower extremities?
1.Muscle metabolism and growth 2.Bone resorption and regeneration 3.Nervous system
impulse transmission 4.Joint integrity and synovial fluid production - ANS2
Paget's disease is characterized by skeletal deformities resulting from abnormal bone resorption
followed by abnormal regeneration. It is not caused by problems with muscle, nervous system,
or joint functioning.
,A client has been diagnosed with gout, and the nurse provides dietary instructions. The nurse
determines that the client needs additional teaching if the client states that it is acceptable to eat
which food?
1.Carrots
2.Tapioca
3.Chocolate
4.Chicken liver - ANS4
Liver and other organ meats should be omitted from the diet of a client who has gout because of
their high purine content. Purines are a form of protein. The food items identified in the other
options contain negligible amounts of purines and may be consumed freely by the client with
gout.
Diagnostic studies are prescribed for a client with suspected Paget's disease. In reviewing the
client's record, the nurse would expect to note that the health care provider has prescribed
which laboratory study?
1.Platelet count
2.Alkaline phosphatase
3.White blood cell count
4.Complete blood cell count - ANS2
Paget's disease is a chronic metabolic disorder in which bone is excessively broken down and
reformed. The result is bone that is structurally disorganized, causing bone to be weak with
increased risk for bowing of long bones and fractures. Diagnostic laboratory findings for Paget's
disease include an elevated serum alkaline phosphatase level and elevated urinary
hydroxyproline excretion. The remaining options are unrelated to diagnostic evaluation of this
disease.
A client is to receive a prescription for methocarbamol. The nurse provides instructions to the
client about the medication. Which client statement would indicate a need for further education?
1."My urine may turn brown or green." 2."I might get some nasal congestion from this
medication."
3."This medication is prescribed to help relieve my muscle spasms."
4."If my vision becomes blurred, I don't need to be concerned about it." - ANS4
Methocarbamol is a muscle relaxant that works by blocking nerve impulses (or pain sensations)
that are sent to the brain. The client needs to be told that the urine may turn brown, black, or
green. Other adverse effects include blurred vision, nasal congestion, urticaria, and rash. The
client needs to be instructed to notify the health care provider if these side/adverse effects
occur.
The nurse is planning measures to increase bed mobility for a client in skeletal leg traction.
Which item should the nurse consider to be most helpful for this client?
1.Television
2.Fracture bedpan
3.Overhead trapeze
, 4.Reading materials - ANS3
The use of an overhead trapeze is extremely helpful for a client to move about in bed and to get
on and off the bedpan. This device has the greatest value in increasing overall bed mobility.
Television and reading materials, although helpful in reducing boredom and providing
distraction, do not increase bed mobility. A fracture bedpan is useful in reducing discomfort with
elimination.
The nurse is caring for a client who sustained an open fracture and is diagnosed with acute
osteomyelitis of the right lower extremity. Which intervention should the nurse plan to perform?
1.Apply ice to the affected area. 2.Perform sterile dressing changes. 3.Instruct the client on leg
exercises. 4.Measure the leg circumference daily. - ANS2
Osteomyelitis is a severe infection of the bone, bone marrow, and surrounding soft tissue.
Clinical manifestations include constant bone pain unrelieved by rest that worsens with activity;
swelling, tenderness, and warmth at the infection site; restricted movement of the affected part;
fever, night sweats, chills, restlessness, nausea, and malaise. Option 2 is the correct option, as
treatment of osteomyelitis often includes surgical debridement and requires sterile dressing
changes. Option 1 is incorrect, as osteomyelitis is an infection and applying ice to the area will
not help any swelling and may cause vasoconstriction. Option 3 is incorrect, as movement
worsens the pain and some immobilization of the affected limb (e.g., splint, traction) is usually
indicated. Option 4, measuring leg circumference daily, is not necessary.
The health care provider has prescribed a lidocaine 5% patch for a client with a diagnosis of
neck pain due to osteoarthritis. Which should the nurse tell the client regarding this medication?
1.The medication patch will act as a local anesthetic.
2.The medication patch acts by decreasing muscle spasms.
3.The medication is prescribed to cause the skin to peel below the patch.
4.Apply a heating pad to the area after applying the medication patch to increase the
effectiveness. - ANS1
A lidocaine patch provides a local anesthetic effect to the site of application. The medication
does not act in a systemic manner. It is not prescribed to cause the skin to peel, so if this
reaction occurs, the health care provider should be notified. A heating pad should not be applied
because irritation or burning of the skin may occur.
The nurse witnessed a vehicle hit a pedestrian. The victim is dazed and tries to get up. A leg
appears fractured. Which intervention should the nurse take?
1.Try to reduce the fracture manually. 2.Assist the victim to get up and walk to the sidewalk.
3.Leave the victim for a few moments to call an ambulance.
4.Stay with the victim and encourage him or her to remain still. - ANS4
With a suspected fracture, the victim is not moved unless it is dangerous to remain in that spot.
The nurse should remain with the victim and have someone else call for emergency help. A
fracture is not reduced at the scene. Before the victim is moved, the site of fracture is
immobilized to prevent further injury.
