HESI RN EXIT V2 EXAM WITH QUESTIONS AND
CORRECT ANSWERS/RATEDA+
,1. A male client with stomach cancer returns to the unit following a
total gastrectomy. He has a nasogastric tube to suction and is
receiving Lactated Ringer's solution at 75 mL/hour IV. One hour
after admission to the unit, the nurse notes 300 mL of blood in the
suction canister, the client's heart rate is 155 beats/minute, and his
blood pressure is 78/48 mmHg. In addition to reporting the finding
to the surgeon. Which action should the nurse implement first? -
ANSWER>>>>>d. Increase the infusion rate of Lactated Ringer's
solution.
2. an adult male who fell 20 feet from the roof of this home has
multiple injuries, including a right pneumothorax. Chest tubes were
inserted in the emergency department prior to his transfer to the
intensive care unit (ICU). the nurse notes that the suction control
chamber is bubbling at the
- 10 cm H2O mark, with fluctuation in the water seal, and over the
past hour 75 ml of bright red blood is measured in the collection
chamber. Which intervention should the nurse implement? -
ANSWER>>>>>a. Add sterile water to the suction control chamber.
3. A client who received hemodialysis yesterday is experiencing a
blood pressure of 200/100 mmHg, heart rate 110 beats/minute,
and respiratory rate 36 breaths/minute. The client is manifesting
shortness of breath, bilateral 2+ pedal edema, and an oxygen
saturation on room air of 89%. Which action should the nurse take
first? - ANSWER>>>>>c. Begin supplemental oxygen.
4. A client with Addison's crisis is admitted for treatment with
adrenal cortical supplementation. Based on the client's admitting
diagnosis, which findings require immediate action by the nurse?
(Select all that apply) - ANSWER>>>>>Headache and tremors
Irregular heart rate
pallor and diaphoresis
,5. An older client is admitted with fluid volume deficit and
dehydration. Which assessment finding is the best indicator of
hydration that the nurse should report to the healthcare provider?
- ANSWER>>>>>d. Skin tenting occurs when the client's forearm is
pinched.
6. After an inservice about electronic health record (EHR) security
and safeguarding client information, the nurse observes a colleague
going home with printed copies of client information in a uniform
pocket. Which action should the nurse take? - ANSWER>>>>>a. File
a detailed incident report with the specific hiring facility.
7. The nurse is evaluating a tertiary prevention program for clients
with cardiovascular disease implemented in a rural health clinic.
Which outcome indicate the program is effective? -
ANSWER>>>>>c. Clients who incurred disease complications
promptly received rehabilitation.
8. The nurse is caring for a client with chronic obstructive
pulmonary disease (COPD) who uses oxygen at 2 L/minute per
nasal cannula continuously. The nurse observes that the client is
having increased shortness of breath with respirations at 23
breaths/minute. Which action should the nurse implement first? -
ANSWER>>>>>d. Assess the delivery mechanism of the oxygen
tank, tubing, and cannula.
9. Which statement by a client who is 24 hours post-subtotal
thyroidectomy requires an immediate investigation by the nurse? -
ANSWER>>>>>When I get out of bed quickly, I feel a little dizzy."
10. An older adult male who is in his early 70's is admitted to the
emergency department because of a COPD exacerbation. This client
is struggling to breathe and the healthcare team is preparing for
endotracheal intubation. The spouse's wife, who is 30 years
younger than the client, asks the nurse to stop the procedure and
, provide the nurse a copy of the client's living will. Which action
should the nurse take? - ANSWER>>>>>b. Notify the healthcare
provider of the client's wishes.
11. An unlicensed assistive personnel (UAP) is assigned to provide
personal care for a client whose prescribed activity is bedrest with
bedside commode use. The UAP reports to the nurse that the client
is so obese that the UAP feels unable to safely assist the client in
transferring from the bed to the bedside commode. How should
the nurse respond? - ANSWER>>>>>c. Advice the client to maintain
bedrest so that safety can be ensured.
12. A nurse determines that more than 25% of the students at a
middle school are overweight. The nurse presents the information
at the parent-teacher meeting. What action is most important for
the nurse to include in the meeting? - ANSWER>>>>>c. Distribute a
shopping list of suggested healthy snack items.
13. After several months of chronic fatigue, morning stiffness, and
join pain, a young adult is diagnosed with rheumatoid arthritis, and
the healthcare provider prescribes prednisone. Which education
should the nurse provide the client with regard to taking
prednisone? - ANSWER>>>>>c. If sequential doses are missed,
notify the healthcare provider.
14. The psychiatric nurse is caring for clients on an adolescent unit.
Which client requires the nurse's immediate attention? -
ANSWER>>>>>c. An 18-year-old client with antisocial behavior who
is being yelled at by other clients
15. The nurse caring for a child with mononucleosis can expect the
child to exhibit which symptoms? - ANSWER>>>>>b. Ear pain and
fever.
CORRECT ANSWERS/RATEDA+
,1. A male client with stomach cancer returns to the unit following a
total gastrectomy. He has a nasogastric tube to suction and is
receiving Lactated Ringer's solution at 75 mL/hour IV. One hour
after admission to the unit, the nurse notes 300 mL of blood in the
suction canister, the client's heart rate is 155 beats/minute, and his
blood pressure is 78/48 mmHg. In addition to reporting the finding
to the surgeon. Which action should the nurse implement first? -
ANSWER>>>>>d. Increase the infusion rate of Lactated Ringer's
solution.
2. an adult male who fell 20 feet from the roof of this home has
multiple injuries, including a right pneumothorax. Chest tubes were
inserted in the emergency department prior to his transfer to the
intensive care unit (ICU). the nurse notes that the suction control
chamber is bubbling at the
- 10 cm H2O mark, with fluctuation in the water seal, and over the
past hour 75 ml of bright red blood is measured in the collection
chamber. Which intervention should the nurse implement? -
ANSWER>>>>>a. Add sterile water to the suction control chamber.
3. A client who received hemodialysis yesterday is experiencing a
blood pressure of 200/100 mmHg, heart rate 110 beats/minute,
and respiratory rate 36 breaths/minute. The client is manifesting
shortness of breath, bilateral 2+ pedal edema, and an oxygen
saturation on room air of 89%. Which action should the nurse take
first? - ANSWER>>>>>c. Begin supplemental oxygen.
4. A client with Addison's crisis is admitted for treatment with
adrenal cortical supplementation. Based on the client's admitting
diagnosis, which findings require immediate action by the nurse?
(Select all that apply) - ANSWER>>>>>Headache and tremors
Irregular heart rate
pallor and diaphoresis
,5. An older client is admitted with fluid volume deficit and
dehydration. Which assessment finding is the best indicator of
hydration that the nurse should report to the healthcare provider?
- ANSWER>>>>>d. Skin tenting occurs when the client's forearm is
pinched.
6. After an inservice about electronic health record (EHR) security
and safeguarding client information, the nurse observes a colleague
going home with printed copies of client information in a uniform
pocket. Which action should the nurse take? - ANSWER>>>>>a. File
a detailed incident report with the specific hiring facility.
7. The nurse is evaluating a tertiary prevention program for clients
with cardiovascular disease implemented in a rural health clinic.
Which outcome indicate the program is effective? -
ANSWER>>>>>c. Clients who incurred disease complications
promptly received rehabilitation.
8. The nurse is caring for a client with chronic obstructive
pulmonary disease (COPD) who uses oxygen at 2 L/minute per
nasal cannula continuously. The nurse observes that the client is
having increased shortness of breath with respirations at 23
breaths/minute. Which action should the nurse implement first? -
ANSWER>>>>>d. Assess the delivery mechanism of the oxygen
tank, tubing, and cannula.
9. Which statement by a client who is 24 hours post-subtotal
thyroidectomy requires an immediate investigation by the nurse? -
ANSWER>>>>>When I get out of bed quickly, I feel a little dizzy."
10. An older adult male who is in his early 70's is admitted to the
emergency department because of a COPD exacerbation. This client
is struggling to breathe and the healthcare team is preparing for
endotracheal intubation. The spouse's wife, who is 30 years
younger than the client, asks the nurse to stop the procedure and
, provide the nurse a copy of the client's living will. Which action
should the nurse take? - ANSWER>>>>>b. Notify the healthcare
provider of the client's wishes.
11. An unlicensed assistive personnel (UAP) is assigned to provide
personal care for a client whose prescribed activity is bedrest with
bedside commode use. The UAP reports to the nurse that the client
is so obese that the UAP feels unable to safely assist the client in
transferring from the bed to the bedside commode. How should
the nurse respond? - ANSWER>>>>>c. Advice the client to maintain
bedrest so that safety can be ensured.
12. A nurse determines that more than 25% of the students at a
middle school are overweight. The nurse presents the information
at the parent-teacher meeting. What action is most important for
the nurse to include in the meeting? - ANSWER>>>>>c. Distribute a
shopping list of suggested healthy snack items.
13. After several months of chronic fatigue, morning stiffness, and
join pain, a young adult is diagnosed with rheumatoid arthritis, and
the healthcare provider prescribes prednisone. Which education
should the nurse provide the client with regard to taking
prednisone? - ANSWER>>>>>c. If sequential doses are missed,
notify the healthcare provider.
14. The psychiatric nurse is caring for clients on an adolescent unit.
Which client requires the nurse's immediate attention? -
ANSWER>>>>>c. An 18-year-old client with antisocial behavior who
is being yelled at by other clients
15. The nurse caring for a child with mononucleosis can expect the
child to exhibit which symptoms? - ANSWER>>>>>b. Ear pain and
fever.
