HESI RN EXIT EXAM QUESTIONS WITH ACTUAL CORRECT
DETAILED ANSWERS ALREADY GRADED A+
The nurse is giving preop instructions to a 14 yr old scheduled to correct a spinal curvature.
Which statement best demonstrates that learning has taken place? - ANSWERS-I understand I
will be in a body cast and I will show you hoy you taught me to turn
To take the vital signs of a 4 month old child which order will give the most accurate results? -
ANSWERS-Respiratory rate, heart rate, rectal temperature
AN otoscope exam of a child's ear reveals a tympanic membrane that is pearly gray, slightly
bulging and not movable. What action should the nurse take next? - ANSWERS-Ask the child if
he has has a cold, runny nose or any ear pain lately
Which restraint should be used for a toddler after a cleft palate repair? - ANSWERS-elbow
What preoperative nursing intervention should be included in the plan of care for an infant with
pyloric stenosis? - ANSWERS-Observe for projectile vomiting
A six month old returns from surgery with elbow restraints in place. What nursing intervention
should be included when caring for any restrained child? - ANSWERS-remove restraints one at a
time and provide range of motion exercise
,A two year old with Down Syndrome is brought to the clinic for his regular physical exam. The
nurse knows which problem is frequently associated with Down Syndrome? - ANSWERS-
Congenital Heart Disease
When assessing a child with asthma the nurse should expect intercostal retractions during -
ANSWERS-inspiration
When planning the care for a child who has had a cleft lip repair, the nurse knows that crying
should be minimized because it - ANSWERS-stresses the suture line
A client with a productive cough has obtained a sputum specimen for culture as instructed.
What action is the best initial nursing action? - ANSWERS-Administer the first dose of prescribed
antibiotic therapy
A client is brought to the Emergency Department by ambulance in cardiac arrest with CPR in
progress. The client is intubated and receiving 100% O2 per ambu bag. The nurse determines
the client is cyanotic, cold, and diaphoretic. Which assessment is most important to obtain? -
ANSWERS-deep tendon reflexes
After a hospitalization for Syndrome of Inappropriate Antidiuretic Hormone (SIADH), a client
develops pontine myselinolysis. Which intervention should the nurse implement first? -
ANSWERS-Reorientate client to his room
A male client with heart failure (HF) calls the clinic and reports he cannot put his shoes on
because they are too tight. Which additional information should the nurse obtain? - ANSWERS-
Has his weight changed in the last several days
An older adult with a long hx of COPD is admitted with progressive shortness of breath and a
persistent cough. She is anxious and is complaining of a dry mouth. Which intervention should
the nurse implement? - ANSWERS-Apply a high flow venturi mask
,A client with a hx of asthma and bronchitis arrives at the clinic with SOB, productive cough with
thickened tenacious mucous and the inability to walk up a flight of stairs without experiencing
breathlessness. Which action is important for the nurse to instruct the client about self care? -
ANSWERS-Increase the daily intake of oral fluids to to liquefy secretions
A cardiac catherization of a client with heart disease indicates the following blockages 95% LAD
99% proximal circumflex and 95% proximal RCA. The client later asks the nurse "what does all
that mean for me" - ANSWERS-3 main arteries have major blockages with only 1 to 5% of blood
flow getting through to the heart muscle
The nurse is caring for a client with a lower left pulmonary abscess which position should the
nurse instruct the client to maintain - ANSWERS-left lateral
A client with cholelithiasis has a gallstone lodged in the common bile duct and is unable to eat
or drink without nausea and vomiting. Which finding should the nurse report to the healthcare
provider - ANSWERS-yellow sclera
While caring for a client with Amyotrophic Lateral Sclerosis (ALS), the nurse performs a neuro
assessment every 4 hours. which assessment finding warrants immediate intervention by the
nurse? - ANSWERS-Increasing Anxiety
The nurse is providing preoperative education for a Jewish client scheduled to receive a
xenograft to promote burn healing. Which info should the nurse provide this client? - ANSWERS-
The xenograft is taken from nonhuman sources
A male client who had colon surgery 3 days ago is anxious and requests assistance to reposition.
The wound dehiscences and eviscerates. The nurse moistens an available sterile dressing and
places it over the wound which intervention should the nurse implement next? - ANSWERS-
prepare the client to return to the operating room
, A client with carcinoma of the lung is complaining of weakness and has a serum sodium level of
117 mEq/L. Which nursing problem should the nurse include in this client's plan of care? -
ANSWERS-Fluid volume excess
A female client enters the clinic and insists on being seen. She is weak, nervous, and reports a
racing heart beat and recent weight loss of 15 pounds. After ruling out substance withdrawal,
the healthcare provider suspects hyperthyroidism and admits her for further testing. Which
action should the nurse implement? - ANSWERS-space the clients care to provide periods of rest
The nurse is teaching the client with glomerulonephritis about self care which dietary
recommendations should the nurse encourage the client to follow? - ANSWERS-restrict intake
by limiting meats and other high protein foods
An overweight, young adult male who was recently diagnosed with type 2 diabetes mellitus is
admitted for a hernia repair. He tells the nurse that he is feeling very weak and jittery. Which
actions should the nurse implement? - ANSWERS-- assess his skin temp and moisture
- document anxiety on the surgical checklist
-administer a PRN dose of regular insulin
A client with Cushings Syndrome is recovering from an elective laparoscopic procedure. Which
assessment finding warrants immediate intervention by the nurse? - ANSWERS-irregular apical
pulse
An adult client with primary Raynauds phenomenon develops pallor and then cyanosis of her
finger. After warming her hands the fingers turn red and the client reports a burning sensation.
What action should the nurse take? - ANSWERS-secure a pulse oximeter to monitor the clients
oxygen saturation
A male client with muscular dystrophy fell in his home and is admitted with a right hip fracture.
His right foot is cool with palpable pedal pulses. Lungs are coarse with diminished breath
sounds. Vital signs are temp 101, heart rate 128 bpm, respirations 28 bpm and BP 122/82 .
DETAILED ANSWERS ALREADY GRADED A+
The nurse is giving preop instructions to a 14 yr old scheduled to correct a spinal curvature.
Which statement best demonstrates that learning has taken place? - ANSWERS-I understand I
will be in a body cast and I will show you hoy you taught me to turn
To take the vital signs of a 4 month old child which order will give the most accurate results? -
ANSWERS-Respiratory rate, heart rate, rectal temperature
AN otoscope exam of a child's ear reveals a tympanic membrane that is pearly gray, slightly
bulging and not movable. What action should the nurse take next? - ANSWERS-Ask the child if
he has has a cold, runny nose or any ear pain lately
Which restraint should be used for a toddler after a cleft palate repair? - ANSWERS-elbow
What preoperative nursing intervention should be included in the plan of care for an infant with
pyloric stenosis? - ANSWERS-Observe for projectile vomiting
A six month old returns from surgery with elbow restraints in place. What nursing intervention
should be included when caring for any restrained child? - ANSWERS-remove restraints one at a
time and provide range of motion exercise
,A two year old with Down Syndrome is brought to the clinic for his regular physical exam. The
nurse knows which problem is frequently associated with Down Syndrome? - ANSWERS-
Congenital Heart Disease
When assessing a child with asthma the nurse should expect intercostal retractions during -
ANSWERS-inspiration
When planning the care for a child who has had a cleft lip repair, the nurse knows that crying
should be minimized because it - ANSWERS-stresses the suture line
A client with a productive cough has obtained a sputum specimen for culture as instructed.
What action is the best initial nursing action? - ANSWERS-Administer the first dose of prescribed
antibiotic therapy
A client is brought to the Emergency Department by ambulance in cardiac arrest with CPR in
progress. The client is intubated and receiving 100% O2 per ambu bag. The nurse determines
the client is cyanotic, cold, and diaphoretic. Which assessment is most important to obtain? -
ANSWERS-deep tendon reflexes
After a hospitalization for Syndrome of Inappropriate Antidiuretic Hormone (SIADH), a client
develops pontine myselinolysis. Which intervention should the nurse implement first? -
ANSWERS-Reorientate client to his room
A male client with heart failure (HF) calls the clinic and reports he cannot put his shoes on
because they are too tight. Which additional information should the nurse obtain? - ANSWERS-
Has his weight changed in the last several days
An older adult with a long hx of COPD is admitted with progressive shortness of breath and a
persistent cough. She is anxious and is complaining of a dry mouth. Which intervention should
the nurse implement? - ANSWERS-Apply a high flow venturi mask
,A client with a hx of asthma and bronchitis arrives at the clinic with SOB, productive cough with
thickened tenacious mucous and the inability to walk up a flight of stairs without experiencing
breathlessness. Which action is important for the nurse to instruct the client about self care? -
ANSWERS-Increase the daily intake of oral fluids to to liquefy secretions
A cardiac catherization of a client with heart disease indicates the following blockages 95% LAD
99% proximal circumflex and 95% proximal RCA. The client later asks the nurse "what does all
that mean for me" - ANSWERS-3 main arteries have major blockages with only 1 to 5% of blood
flow getting through to the heart muscle
The nurse is caring for a client with a lower left pulmonary abscess which position should the
nurse instruct the client to maintain - ANSWERS-left lateral
A client with cholelithiasis has a gallstone lodged in the common bile duct and is unable to eat
or drink without nausea and vomiting. Which finding should the nurse report to the healthcare
provider - ANSWERS-yellow sclera
While caring for a client with Amyotrophic Lateral Sclerosis (ALS), the nurse performs a neuro
assessment every 4 hours. which assessment finding warrants immediate intervention by the
nurse? - ANSWERS-Increasing Anxiety
The nurse is providing preoperative education for a Jewish client scheduled to receive a
xenograft to promote burn healing. Which info should the nurse provide this client? - ANSWERS-
The xenograft is taken from nonhuman sources
A male client who had colon surgery 3 days ago is anxious and requests assistance to reposition.
The wound dehiscences and eviscerates. The nurse moistens an available sterile dressing and
places it over the wound which intervention should the nurse implement next? - ANSWERS-
prepare the client to return to the operating room
, A client with carcinoma of the lung is complaining of weakness and has a serum sodium level of
117 mEq/L. Which nursing problem should the nurse include in this client's plan of care? -
ANSWERS-Fluid volume excess
A female client enters the clinic and insists on being seen. She is weak, nervous, and reports a
racing heart beat and recent weight loss of 15 pounds. After ruling out substance withdrawal,
the healthcare provider suspects hyperthyroidism and admits her for further testing. Which
action should the nurse implement? - ANSWERS-space the clients care to provide periods of rest
The nurse is teaching the client with glomerulonephritis about self care which dietary
recommendations should the nurse encourage the client to follow? - ANSWERS-restrict intake
by limiting meats and other high protein foods
An overweight, young adult male who was recently diagnosed with type 2 diabetes mellitus is
admitted for a hernia repair. He tells the nurse that he is feeling very weak and jittery. Which
actions should the nurse implement? - ANSWERS-- assess his skin temp and moisture
- document anxiety on the surgical checklist
-administer a PRN dose of regular insulin
A client with Cushings Syndrome is recovering from an elective laparoscopic procedure. Which
assessment finding warrants immediate intervention by the nurse? - ANSWERS-irregular apical
pulse
An adult client with primary Raynauds phenomenon develops pallor and then cyanosis of her
finger. After warming her hands the fingers turn red and the client reports a burning sensation.
What action should the nurse take? - ANSWERS-secure a pulse oximeter to monitor the clients
oxygen saturation
A male client with muscular dystrophy fell in his home and is admitted with a right hip fracture.
His right foot is cool with palpable pedal pulses. Lungs are coarse with diminished breath
sounds. Vital signs are temp 101, heart rate 128 bpm, respirations 28 bpm and BP 122/82 .
