HESI Exit 2
46. A female client has been taking a high dose of prednisone, a corticosteroid, for several
months. After stopping the medication abruptly, the client reports feeling "very tired". Which
nursing intervention is most important for the nurse to implement? - ANSMeasure vital signs
47. A male client reports the onset of numbness and tingling in his fingers and around his
mouth. Which lab is important for the nurse to review before contacting the health care
provider? - ANSSerum calcium
48. What explanation is best for the nurse to provide a client who asks the purpose of using the
log-rolling technique for turning? - ANSThe technique is intended to maintain straight spinal
alignment.
49. A client receiving chemotherapy has severe neutropenia. Which snack is best for the nurse
to recommend to the client? - ANSBaked apples topped with dried raisins
50. Which action should the school nurse take first when conducting a screening for scoliosis? -
ANSInspect for symmetrical shoulder height.
51. An unlicensed assistive personnel (UAP) assigned to obtain client vital signs reports to the
charge nurse that a client has a weak pulse with a rate of 44 beat/ minutes. What action should
the charge nurse implement? - ANSAssign a practical nurse (LPN) to determine if an apical
radial deficit is present
52. After a sudden loss of consciousness, a female client is taken to the ED and initial
assessment indicate that her blood glucose level is critically low. Once her glucose level is
stabilized, the client reports that was recently diagnosed with anorexia nervosa and is being
treated at an outpatient clinic. Which intervention is more important to include in this client's
discharge plan? - ANSEncourage a low-carbohydrate and high-protein diet
53. A client with a peripherally inserted central catheter (PICC) line has a fever. What client
assessment is most important for the nurse to perform? - ANSObserve the antecubital fossa for
inflammation.
54. The nurse administers an antibiotic to a client with respiratory tract infection. To evaluate the
medication's effectiveness, which laboratory values should the nurse monitor? Select all that
apply - ANSWhite blood cell (WBC) count
Sputum culture and sensitivity
55. A client is admitted to isolation with the diagnosis of active tuberculosis. Which infection
control measures should the nurse implement? - ANSNegative pressure environment
, 56. A school nurse is called to the soccer field because a child has a nose bleed (epistaxis). In
what position should the nurse place the child? - ANSSitting up and leaning forward
57. A young adult who is hit with a baseball bat on the temporal area of the left skull is
conscious when admitted to the ED and is transferred to the Neurological Unit to be monitored
for signs of closed head injury. Which assessment finding is indicative of a developing epidural
hematoma? - ANSAltered consciousness within the first 24 hours after injury.
58. A female client with breast cancer who completed her first chemotherapy treatment today at
an out-patient center is preparing for discharge. Which behavior indicates that the client
understands her care needs - ANSRented movies and borrowed books to use while passing
time at home
59. Which instruction should the nurse provide a pregnant client who is complaining of
heartburn? - ANSEat small meal throughout the day to avoid a full stomach.
60. A client is admitted to the intensive care unit with diabetes insipidus due to a pituitary gland
tumor. Which potential complication should the nurse monitor closely? - ANSHypokalemia
61. A female client reports she has not had a bowel movement for 3 days, but now is defecating
frequent small amount of liquid stool. Which action should the nurse implement? - ANSDigitally
check the client for a fecal impaction
62. After changing to a new brand of laundry detergent, an adult male reports that he has a fine
itchy rash. Which assessment finding warrants immediate intervention by the nurse? -
ANSBilateral Wheezing.
63. The nurse should teach the parents of a 6 year-old recently diagnosed with asthma that the
symptom of acute episode of asthma are due to which physiological response? -
ANSInflammation of the mucous membrane & bronchospasm
64. A 10 year old who has terminal brain cancer asks the nurse, "What will happen to my body
when I die?" How should the nurse respond? - ANS"The heart will stop beating & you will stop
breathing."
65. The nurse is assessing a 3-month-old infant who had a pylorotomy yesterday. This child
should be medicated for pain based on which findings? Select all that apply: - ANSRestlessness
Clenched Fist
Increased pulse rate
Increased respiratory rate.
66. The nurse is preparing to administer an oral antibiotic to a client with unilateral weakness,
ptosis, mouth drooping and, aspiration pneumonia. What is the priority nursing assessment that
46. A female client has been taking a high dose of prednisone, a corticosteroid, for several
months. After stopping the medication abruptly, the client reports feeling "very tired". Which
nursing intervention is most important for the nurse to implement? - ANSMeasure vital signs
47. A male client reports the onset of numbness and tingling in his fingers and around his
mouth. Which lab is important for the nurse to review before contacting the health care
provider? - ANSSerum calcium
48. What explanation is best for the nurse to provide a client who asks the purpose of using the
log-rolling technique for turning? - ANSThe technique is intended to maintain straight spinal
alignment.
49. A client receiving chemotherapy has severe neutropenia. Which snack is best for the nurse
to recommend to the client? - ANSBaked apples topped with dried raisins
50. Which action should the school nurse take first when conducting a screening for scoliosis? -
ANSInspect for symmetrical shoulder height.
51. An unlicensed assistive personnel (UAP) assigned to obtain client vital signs reports to the
charge nurse that a client has a weak pulse with a rate of 44 beat/ minutes. What action should
the charge nurse implement? - ANSAssign a practical nurse (LPN) to determine if an apical
radial deficit is present
52. After a sudden loss of consciousness, a female client is taken to the ED and initial
assessment indicate that her blood glucose level is critically low. Once her glucose level is
stabilized, the client reports that was recently diagnosed with anorexia nervosa and is being
treated at an outpatient clinic. Which intervention is more important to include in this client's
discharge plan? - ANSEncourage a low-carbohydrate and high-protein diet
53. A client with a peripherally inserted central catheter (PICC) line has a fever. What client
assessment is most important for the nurse to perform? - ANSObserve the antecubital fossa for
inflammation.
54. The nurse administers an antibiotic to a client with respiratory tract infection. To evaluate the
medication's effectiveness, which laboratory values should the nurse monitor? Select all that
apply - ANSWhite blood cell (WBC) count
Sputum culture and sensitivity
55. A client is admitted to isolation with the diagnosis of active tuberculosis. Which infection
control measures should the nurse implement? - ANSNegative pressure environment
, 56. A school nurse is called to the soccer field because a child has a nose bleed (epistaxis). In
what position should the nurse place the child? - ANSSitting up and leaning forward
57. A young adult who is hit with a baseball bat on the temporal area of the left skull is
conscious when admitted to the ED and is transferred to the Neurological Unit to be monitored
for signs of closed head injury. Which assessment finding is indicative of a developing epidural
hematoma? - ANSAltered consciousness within the first 24 hours after injury.
58. A female client with breast cancer who completed her first chemotherapy treatment today at
an out-patient center is preparing for discharge. Which behavior indicates that the client
understands her care needs - ANSRented movies and borrowed books to use while passing
time at home
59. Which instruction should the nurse provide a pregnant client who is complaining of
heartburn? - ANSEat small meal throughout the day to avoid a full stomach.
60. A client is admitted to the intensive care unit with diabetes insipidus due to a pituitary gland
tumor. Which potential complication should the nurse monitor closely? - ANSHypokalemia
61. A female client reports she has not had a bowel movement for 3 days, but now is defecating
frequent small amount of liquid stool. Which action should the nurse implement? - ANSDigitally
check the client for a fecal impaction
62. After changing to a new brand of laundry detergent, an adult male reports that he has a fine
itchy rash. Which assessment finding warrants immediate intervention by the nurse? -
ANSBilateral Wheezing.
63. The nurse should teach the parents of a 6 year-old recently diagnosed with asthma that the
symptom of acute episode of asthma are due to which physiological response? -
ANSInflammation of the mucous membrane & bronchospasm
64. A 10 year old who has terminal brain cancer asks the nurse, "What will happen to my body
when I die?" How should the nurse respond? - ANS"The heart will stop beating & you will stop
breathing."
65. The nurse is assessing a 3-month-old infant who had a pylorotomy yesterday. This child
should be medicated for pain based on which findings? Select all that apply: - ANSRestlessness
Clenched Fist
Increased pulse rate
Increased respiratory rate.
66. The nurse is preparing to administer an oral antibiotic to a client with unilateral weakness,
ptosis, mouth drooping and, aspiration pneumonia. What is the priority nursing assessment that
