HESI RN EXIT EXAM c c c
A nurse is reviewing the laboratory results of a client who has rheumatoid arthritis. Whi
c c c c c c c c c c c c c c
ch of the following findings should the nurse report to the provider?
c c c c c c c c c c c
a. WBC count 8,000 c c
b. platelets 150,000 c
c. aspartate aminotransferase 10 units c c c
d. erythrocyte sedimentation rate 75mm c c c c
(ANS- d c
A nurse is caring for a client who has generalized petechiae and ecchymoses. The nurse
c c c c c c c c c c c c c c
should expect a prescription for which of the following laboratory tests?
c c c c c c c c c c c
a. platelet count c
b. potassium level c
c. creatine clearance c
d. prealbumin
(ANS- a
c c
A nurse is caring for a client following application of a cast. Which of the following a
c c c c c c c c c c c c c c c c
ctions should the nurse take first?
c c c c c
a. place an ice pack over the cast
c c c c c c
b. palpate the pulse distal to the cast c c c c c c
c. teach the client to keep the cast clean and dry
c c c c c c c c c
d. position the casted extremity on a pillow (
c c c c c c c
ANS- b c
,A nurse is caring for a client who has vision loss. Which of the following actions should
c c c c c c c c c c c c c c c c
the nurse take? SATA
c c c c
a. keep objects in the clients room in the same place.
c c c c c c c c c
b. ensure there is high-wattage lighting in the clients room.
c c c c c c c c
c. approach the client from the side c c c c c
d. allow extra time for the client to perform tasks
c c c c c c c c
e. touch the client gently to announce presence (
c c c c c c c
ANS- a, b, d c c c
A nurse is caring for a client who is newly diagnosed with pancreatic cancer and has q
c c c c c c c c c c c c c c c c
uestions about the disease. To research the nurse should identify that which of the follo
c c c c c c c c c c c c c c
wing electronic database has the most comprehensive collection nursing articles?
c c c c c c c c c
a. medline
b. C inahl c
c. ProQuest
d. health source c
(ANS- b
c c
A nurse in the emergency department is assessing newly admitted client who is experie
c c c c c c c c c c c c c
ncing drooling and hoarseness following a brain injury. Which of the following actions
c c c c c c c c c c c c
should the nurse take first?
c c c c c
a. obtain a baseline EKG c c c
b. Obtain a blood specimen for ABG analysis c c c c c c
c. insert an 18 gauge IV catheter
c c c c c
d. Administer 100% humidified oxygen c c c c
(ANS- d c
,A nurse is planning care for a client who has unilateral paralysis and dysphagia followi
c c c c c c c c c c c c c c
ng a right hemispheric stroke. Which of the following interventions should the nurse in
c c c c c c c c c c c c c
clude in the plan? c c c
a. Place food on the left side of the client's mouth when he is ready to eat.
c c c c c c c c c c c c c c c
b. Provide total care in performing the client's ADLs.
c c c c c c c
c. Maintain the client on bed rest. c c c c c
d. Place the client's left arm on a pillow while he is sitting. (
c c c c c c c c c c c c
ANS- d c
A nurse is caring for a client who is in a seclusion room following violent behavior. T
c c c c c c c c c c c c c c c c
he client continues to display aggressive behavior. Which of the following actions sh
c c c c c c c c c c c c
ould the nurse take?
c c c
a. Confront the client about this behavior. c c c c c
b. Express sympathy for the client's situation. c c c c c
c. Speak assertively to the client. c c c c
d. Stand within 30 cm (1 ft) of the client when speaking with them. (A
c c c c c c c c c c c c c
NS- a c
A nurse is caring for a client who is receiving brachytherapy for treatment of prostate
c c c c c c c c c c c c c c
cancer. Which of the following actions should the nurse take?
c c c c c c c c c c
a. Cleanse equipment before removal from the client's room.
c c c c c c c
b. Limit the client's visitors to 30 min per day.
c c c c c c c c
c. Discard the client's linens in a double bag. c c c c c c c
d. Discard the radioactive source in a biohazard bag (
c c c c c c c c
ANS- b c
, A nurse is caring for a client who has severe preeclampsia and is receiving magnesiu
c c c c c c c c c c c c c c
m sulfate intravenously. The nurse discontinues the magnesium sulfate after the clien
c c c c c c c c c c c
t displaces toxicity. Which of the following actions should the nurse take?
c c c c c c c c c c c
a. Position the client supine c c c
b. Prepare an IV bolus of dextrose 5% in water c c c c c c c c
c. Administer methylergonovine IM c c
d. Administer calcium gluconate IV c c c c
(ANS- d c
A charge nurse is teaching new staff members about factors that increase a client's ris
c c c c c c c c c c c c c c
k to become violent. Which of the following risk factors should the nurse include as t
c c c c c c c c c c c c c c c
he best predictor of future violence?
c c c c c
a. Experiencing delusions c
b. Male gender c
c. Pervious violent behavior c c
d. A history of being in prison
c c c c c c
(ANS- c c
A nurse is preparing to perform a sterile dressing change. Which of the following actio
c c c c c c c c c c c c c c
ns should the nurse take when setting up the sterile field?
c c c c c c c c c c
a. Place the cap from the solution sterile side up on clean surface
c c c c c c c c c c c
b. Open the outermost flap of the sterile kit toward the body→ flap AWAY from th
c c c c c c c c c c c c c c
e body's first
c c
c. Place the sterile dressing within 1.25 cm (0.5in) of the edge of the sterile field →
c c c c c c c c c c c c c c c
2.5 cm (1- c c
inch) border around any sterile drape or wrap that is considered contaminated.
c c c c c c c c c c c
A nurse is reviewing the laboratory results of a client who has rheumatoid arthritis. Whi
c c c c c c c c c c c c c c
ch of the following findings should the nurse report to the provider?
c c c c c c c c c c c
a. WBC count 8,000 c c
b. platelets 150,000 c
c. aspartate aminotransferase 10 units c c c
d. erythrocyte sedimentation rate 75mm c c c c
(ANS- d c
A nurse is caring for a client who has generalized petechiae and ecchymoses. The nurse
c c c c c c c c c c c c c c
should expect a prescription for which of the following laboratory tests?
c c c c c c c c c c c
a. platelet count c
b. potassium level c
c. creatine clearance c
d. prealbumin
(ANS- a
c c
A nurse is caring for a client following application of a cast. Which of the following a
c c c c c c c c c c c c c c c c
ctions should the nurse take first?
c c c c c
a. place an ice pack over the cast
c c c c c c
b. palpate the pulse distal to the cast c c c c c c
c. teach the client to keep the cast clean and dry
c c c c c c c c c
d. position the casted extremity on a pillow (
c c c c c c c
ANS- b c
,A nurse is caring for a client who has vision loss. Which of the following actions should
c c c c c c c c c c c c c c c c
the nurse take? SATA
c c c c
a. keep objects in the clients room in the same place.
c c c c c c c c c
b. ensure there is high-wattage lighting in the clients room.
c c c c c c c c
c. approach the client from the side c c c c c
d. allow extra time for the client to perform tasks
c c c c c c c c
e. touch the client gently to announce presence (
c c c c c c c
ANS- a, b, d c c c
A nurse is caring for a client who is newly diagnosed with pancreatic cancer and has q
c c c c c c c c c c c c c c c c
uestions about the disease. To research the nurse should identify that which of the follo
c c c c c c c c c c c c c c
wing electronic database has the most comprehensive collection nursing articles?
c c c c c c c c c
a. medline
b. C inahl c
c. ProQuest
d. health source c
(ANS- b
c c
A nurse in the emergency department is assessing newly admitted client who is experie
c c c c c c c c c c c c c
ncing drooling and hoarseness following a brain injury. Which of the following actions
c c c c c c c c c c c c
should the nurse take first?
c c c c c
a. obtain a baseline EKG c c c
b. Obtain a blood specimen for ABG analysis c c c c c c
c. insert an 18 gauge IV catheter
c c c c c
d. Administer 100% humidified oxygen c c c c
(ANS- d c
,A nurse is planning care for a client who has unilateral paralysis and dysphagia followi
c c c c c c c c c c c c c c
ng a right hemispheric stroke. Which of the following interventions should the nurse in
c c c c c c c c c c c c c
clude in the plan? c c c
a. Place food on the left side of the client's mouth when he is ready to eat.
c c c c c c c c c c c c c c c
b. Provide total care in performing the client's ADLs.
c c c c c c c
c. Maintain the client on bed rest. c c c c c
d. Place the client's left arm on a pillow while he is sitting. (
c c c c c c c c c c c c
ANS- d c
A nurse is caring for a client who is in a seclusion room following violent behavior. T
c c c c c c c c c c c c c c c c
he client continues to display aggressive behavior. Which of the following actions sh
c c c c c c c c c c c c
ould the nurse take?
c c c
a. Confront the client about this behavior. c c c c c
b. Express sympathy for the client's situation. c c c c c
c. Speak assertively to the client. c c c c
d. Stand within 30 cm (1 ft) of the client when speaking with them. (A
c c c c c c c c c c c c c
NS- a c
A nurse is caring for a client who is receiving brachytherapy for treatment of prostate
c c c c c c c c c c c c c c
cancer. Which of the following actions should the nurse take?
c c c c c c c c c c
a. Cleanse equipment before removal from the client's room.
c c c c c c c
b. Limit the client's visitors to 30 min per day.
c c c c c c c c
c. Discard the client's linens in a double bag. c c c c c c c
d. Discard the radioactive source in a biohazard bag (
c c c c c c c c
ANS- b c
, A nurse is caring for a client who has severe preeclampsia and is receiving magnesiu
c c c c c c c c c c c c c c
m sulfate intravenously. The nurse discontinues the magnesium sulfate after the clien
c c c c c c c c c c c
t displaces toxicity. Which of the following actions should the nurse take?
c c c c c c c c c c c
a. Position the client supine c c c
b. Prepare an IV bolus of dextrose 5% in water c c c c c c c c
c. Administer methylergonovine IM c c
d. Administer calcium gluconate IV c c c c
(ANS- d c
A charge nurse is teaching new staff members about factors that increase a client's ris
c c c c c c c c c c c c c c
k to become violent. Which of the following risk factors should the nurse include as t
c c c c c c c c c c c c c c c
he best predictor of future violence?
c c c c c
a. Experiencing delusions c
b. Male gender c
c. Pervious violent behavior c c
d. A history of being in prison
c c c c c c
(ANS- c c
A nurse is preparing to perform a sterile dressing change. Which of the following actio
c c c c c c c c c c c c c c
ns should the nurse take when setting up the sterile field?
c c c c c c c c c c
a. Place the cap from the solution sterile side up on clean surface
c c c c c c c c c c c
b. Open the outermost flap of the sterile kit toward the body→ flap AWAY from th
c c c c c c c c c c c c c c
e body's first
c c
c. Place the sterile dressing within 1.25 cm (0.5in) of the edge of the sterile field →
c c c c c c c c c c c c c c c
2.5 cm (1- c c
inch) border around any sterile drape or wrap that is considered contaminated.
c c c c c c c c c c c
