HESI (HEALTH EDUCATION SYSTEM INCORPORATED) EXIT EXAM VERSION 2

The Lpn/Lvn Is Preparing To Ambulate a Postoperative Client After Cardiac Surgery.
The Nurse Plans To Do Which To Enable The Client To Best Tolerate The
Ambulation?
Premedicate The Client With An Analgesic Before Ambulating.


A Client Is Wearing a Continuous Cardiac Monitor, Which Begins To Alarm At The
Nurse's Station. The Nurse Sees No Electrocardiographic Complexes On The Screen.
The Nurse Should Do Which First?
Check The Client Status And Lead Placement.


The Lpn/Lvn In a Medical Unit Is Caring For a Client With Heart Failure. The Client
Suddenly Develops Extreme Dyspnea, Tachycardia, And Lung Crackles, And The
Nurse Suspects Pulmonary Edema. The Nurse Immediately Notifies The Registered
Nurse And Expects Which Interventions To Be Prescribed? Select All That Apply.
1. Administering Oxygen
2. Inserting a Foley Catheter
3. Administering Furosemide (Lasix)

The Nurse Is Monitoring a Client Following Cardioversion. Which Observations
Should Be Of Highest Priority To The Nurse?
Status Of Airway

,The Nurse Is Assisting In Caring For The Client Immediately After Insertion Of a
Permanent Demand Pacemaker Via The Right Subclavian Vein. The Nurse Prevents
Dislodgement Of The Pacing Catheter By Implementing Which Intervention?
Limiting Movement And Abduction Of The Right Arm

A Client Diagnosed With Thrombophlebitis 1 Day Ago Suddenly Complains Of
Chest Pain And Shortness Of Breath, And The Client Is Visibly Anxious. The
Lpn/Lvn Understands That a Life-Threatening Complication Of This Condition Is
Which?
Pulmonary Embolism

A 24-Year-Old Man Seeks Medical Attention For Complaints Of Claudication In The
Arch Of The Foot. The Nurse Also Notes Superficial Thrombophlebitis Of The
Lower Leg. The Nurse Should Check The Client For Which Next?
Smoking History

The Nurse Has Reinforced Instructions To The Client With Raynaud's Disease About
Self-Management Of The Disease Process. The Nurse Determines That The Client
Needs Further Teaching If The Client States Which?
"Moving To a Warmer Climate Should Help."

A Client With Myocardial Infarction Suddenly Becomes Tachycardic, Shows Signs
Of Air Hunger, And Begins Coughing Frothy, Pink-Tinged Sputum. The Nurse
Listens To Breath Sounds, Expecting To Hear Which Breath Sounds Bilaterally?
Crackles

The Lpn/Lvn Is Collecting Data On a Client With a Diagnosis Of Right-
Sided Heart Failure. The Nurse Should Expect To Note Which Specific Characteristic
Of This Condition?
Dependent Edema


The Lpn/Lvn Is Checking The Neurovascular Status Of a Client Who Returned To
The Surgical Nursing Unit 4 Hours Ago After Undergoing An Aortoiliac Bypass
Graft. The Affected Leg Is Warm, And The Nurse Notes Redness And Edema. The
Pedal Pulse Is Palpable And Unchanged From Admission. The Nurse Interprets That
The Neurovascular Status Is Which?
Normal, Caused By Increased Blood Flow Through The Leg

A Client With a Diagnosis Of Rapid Rate Atrial Fibrillation Asks The Nurse Why
The Health Care Provider Is Going To Perform Carotid Massage. The Lpn/Lvn
Responds That This Procedure May Stimulate Which?
Vagus Nerve To Slow The Heart Rate

A Client Is Admitted To The Hospital With Possible Rheumatic Endocarditis. The
Lpn/Lvn Should Check For a History Of Which Type Of Infection?
Staphylococcal Infection

Client Has An Unna Boot Applied For Treatment Of a Venous Stasis Leg Ulcer. The
Lpn/Lvn Notes That The Client's Toes Are Mottled, And Cool And The Client

, Verbalizes Some Numbness And Tingling Of The Foot. Which Interpretation Should
The Nurse Make Of These Findings?
The Boot Has Been Applied Too Tightly

A Client With Angina Complains That The Anginal Pain Is Prolonged And Severe
And Occurs At The Same Time Each Day, Most Often In The Morning. On Further
Data Collection, The Nurse Notes That The Pain Occurs In The Absence Of
Precipitating Factors. How Should The Lpn/Lvn Best Describe This Type Of Anginal
Pain?
Variant Angina

The Lpn/Lvn Is Monitoring a Client With An Abdominal Aortic Aneurysm (Aaa).
Which Finding Is Probably Unrelated To The Aaa?
Hyperactive Bowel Sounds In The Area
An Emergency Department Client Who Complains Of Slightly Improved But
Unrelieved Chest Pain For 2 Days Is Reluctant To Take a Nitroglycerin Sublingual
Tablet Offered By The Nurse. The Client States, "I Don't Need That—My Dad Takes
That For His Heart. There's Nothing Wrong With My Heart." Which Description Best
Describes The Client's Response?
Denial

A Client Is Scheduled For a Cardiac Catheterization Using a Radiopaque Dye. The
Lpn/Lvn Checks Which Most Critical Item Before The Procedure?
Prior Reaction To Contrast Media

A Client Is Scheduled For a Dipyridamole Thallium Scan. The Lpn/ Lvn Should
Check To Make Sure That The Client Has Not Consumed Which Substance Before
The Procedure?
Caffeine

An Ambulatory Clinic Nurse Is Interviewing a Client Who Is Complaining Of Flulike
Symptoms. The Client Suddenly Develops Chest Pain. Which Question Best Assists
The Nurse To Discriminate Pain Caused By a Non Cardiac Problem?
"Does The Pain Get Worse When You Breathe In?"

A Client With Myocardial Infarction (Mi) Has Been Transferred From The Coronary
Care Unit (Ccu) To The General Medical Unit With Cardiac Monitoring Via
Telemetry. The Nurse Assisting In Caring For The Client Expects To Note Which
Type Of Activity Prescribed?
Bathroom Privileges And Self-Care Activities

The Lpn/Lvn Is Preparing To Care For a Client Who Will Be Arriving From The
Recovery Room After An Above-The-Knee Amputation. The Nurse Ensures That
Which Priority Item Is Available For Emergency Use?
Surgical Tournique

A Client Is Diagnosed With Thrombophlebitis. The Nurse Should Tell The Client
That Which Prescription Is Indicated?
Bed Rest, With Elevation Of The Affected Extremity