Exit Hesi Practice Questions
Nursing Fundamentals: Key Concepts and Clinical Applications
Medication Administration & Patient Safety
1. Prioritizing Patient Communication During Medication Rounds
Scenario: A practical nurse (PN) enters a male client's room for routine morning medication
administration and finds the client on the phone.
Best Action: B. Wait for the client to excuse himself from the telephone conversation and
observe the client taking the medication.
o Rationale: This ensures correct patient identification and direct observation of
medication ingestion, adhering to safety protocols. Leaving medication unattended or
documenting refusal prematurely compromises patient safety.
Postoperative Care & Respiratory Management
2. Managing Chest Tubes Post-Lobectomy
Scenario: A client admitted post left lobectomy has two chest tubes with suction at 20 cm water
pressure, tidying with respirations, and bubbling.
PN Implementation: C. Maintain system integrity to promote lung re-expansion.
o Key Principle: The observed tidying and bubbling indicate the system is working
correctly to facilitate negative pressure and lung re-expansion. Clamping the tube is
contraindicated without a specific order, and notifying the RN for a functioning system is
unnecessary. Applying an occlusive dressing is not indicated at this stage.
3. Infection Control & Communicable Diseases
Scenario: The mother of a 9-month-old diagnosed with Respiratory Syncytial Virus (RSV)
inquires about attending a birthday party the next day.
PN Response: A. Do not expose other children as the virus is very contagious even without
direct contact.
o Emphasis: RSV is highly contagious, especially to young children. Preventing exposure is
crucial to limit the spread of infection.
Cultural Sensitivity & Patient Assessment
4. Addressing Sensitive Topics in Patient History
, Scenario: During admission assessment of a young adult female Korean exchange student with
abdominal pain, she looks away when asked about sexual activity, despite answering other
questions easily.
PN Action: D. Watch the client's response when asked a different question.
o Rationale: Observe for consistent non-verbal cues. While offering an interpreter or
rephrasing might be considered later, initially observing her general demeanor can provide
insights into whether the discomfort is specific to this topic or a broader communication
barrier. Avoid omitting crucial assessment information.
Postoperative Care Following Total Hip Replacement
5. Immediate Postoperative Positioning for Hip Precautions
Immediate Postoperative Intervention: B. Keep client's hip aligned with knees abducted.
o Critical Action: Maintaining hip abduction prevents dislocation of the new joint, a
primary concern in the immediate postoperative period. Other interventions are important
but secondary to preventing this critical complication.
Patient Education & Medication Compliance
6. Addressing Alternative Therapies and Prescribed Medications
Scenario: A client confides in the PN about substituting herbal supplements for prescribed high
blood pressure medication.
First PN Response: A. Ask the client's reason for choosing to take herbs instead of
prescribed drugs.
o Therapeutic Communication: Understanding the client's rationale is the first step in
addressing their decision and providing appropriate education.
Patient Identification & Medication Safety in Long-Term Care
7. Ensuring Correct Patient Identification for Medication Administration
Scenario: A disoriented resident in a long-term care facility lacks an identification band or
picture.
Best Nursing Action: D. Confirm the room and bed numbers with those on the medication
record.
o Safety Protocol: Cross-referencing the room and bed number with the medication record
provides an immediate and verifiable way to enhance identification in the absence of
standard identifiers. Asking unfamiliar staff or relying solely on re-orientation is less
reliable. Holding medication indefinitely can delay necessary treatment.
Burn Care & Fluid Balance
, 8. Recognizing Critical Observations in Burn Patients
Scenario: An adult client with 40% partial and full-thickness burns has been admitted.
Most Important Immediate Report: D. Urinary Output of 20ml/hr.
o Critical Indicator: Severely decreased urinary output in a burn patient indicates
inadequate fluid resuscitation and potential renal hypoperfusion, a life-threatening
complication requiring immediate attention.
Blood Transfusion Reactions
9. Responding to Signs of a Transfusion Reaction
Scenario: A 12-year-old receiving a blood transfusion reports "itchy" skin and appears flushed
15 minutes after the start.
First PN Action: B. Stop the transfusion.
o Immediate Intervention: These are classic signs of a transfusion reaction. The
transfusion must be stopped immediately to prevent a more severe reaction.
Dermatological Assessment & Reporting
10. Assessing and Responding to Skin Lesions
Scenario: A PN notes a crusted 0.7 cm lesion on an older adult's forehead during a focused skin
assessment.
PN Action: A. Report the finding to the healthcare provider.
o Professional Responsibility: Any new or suspicious skin lesion should be reported to the
healthcare provider for further evaluation and diagnosis, as it could be precancerous or
require treatment.
Neurological Assessment & Medication Side Effects
11. Identifying Potential Medication-Related Movement Disorders
Scenario: An older male client on psychotropic medications exhibits uncontrollable hand
movements and excessive eye blinking.
Medical Record Review: C. Screening for tardive dyskinesia.
o Possible Cause: These movements are characteristic of tardive dyskinesia, a potential
side effect of long-term psychotropic medication use. Reviewing the tardive dyskinesia
screening results is most relevant.
Geriatric Care & Incontinence Management
12. Understanding Muscles Involved in Kegel Exercises
Nursing Fundamentals: Key Concepts and Clinical Applications
Medication Administration & Patient Safety
1. Prioritizing Patient Communication During Medication Rounds
Scenario: A practical nurse (PN) enters a male client's room for routine morning medication
administration and finds the client on the phone.
Best Action: B. Wait for the client to excuse himself from the telephone conversation and
observe the client taking the medication.
o Rationale: This ensures correct patient identification and direct observation of
medication ingestion, adhering to safety protocols. Leaving medication unattended or
documenting refusal prematurely compromises patient safety.
Postoperative Care & Respiratory Management
2. Managing Chest Tubes Post-Lobectomy
Scenario: A client admitted post left lobectomy has two chest tubes with suction at 20 cm water
pressure, tidying with respirations, and bubbling.
PN Implementation: C. Maintain system integrity to promote lung re-expansion.
o Key Principle: The observed tidying and bubbling indicate the system is working
correctly to facilitate negative pressure and lung re-expansion. Clamping the tube is
contraindicated without a specific order, and notifying the RN for a functioning system is
unnecessary. Applying an occlusive dressing is not indicated at this stage.
3. Infection Control & Communicable Diseases
Scenario: The mother of a 9-month-old diagnosed with Respiratory Syncytial Virus (RSV)
inquires about attending a birthday party the next day.
PN Response: A. Do not expose other children as the virus is very contagious even without
direct contact.
o Emphasis: RSV is highly contagious, especially to young children. Preventing exposure is
crucial to limit the spread of infection.
Cultural Sensitivity & Patient Assessment
4. Addressing Sensitive Topics in Patient History
, Scenario: During admission assessment of a young adult female Korean exchange student with
abdominal pain, she looks away when asked about sexual activity, despite answering other
questions easily.
PN Action: D. Watch the client's response when asked a different question.
o Rationale: Observe for consistent non-verbal cues. While offering an interpreter or
rephrasing might be considered later, initially observing her general demeanor can provide
insights into whether the discomfort is specific to this topic or a broader communication
barrier. Avoid omitting crucial assessment information.
Postoperative Care Following Total Hip Replacement
5. Immediate Postoperative Positioning for Hip Precautions
Immediate Postoperative Intervention: B. Keep client's hip aligned with knees abducted.
o Critical Action: Maintaining hip abduction prevents dislocation of the new joint, a
primary concern in the immediate postoperative period. Other interventions are important
but secondary to preventing this critical complication.
Patient Education & Medication Compliance
6. Addressing Alternative Therapies and Prescribed Medications
Scenario: A client confides in the PN about substituting herbal supplements for prescribed high
blood pressure medication.
First PN Response: A. Ask the client's reason for choosing to take herbs instead of
prescribed drugs.
o Therapeutic Communication: Understanding the client's rationale is the first step in
addressing their decision and providing appropriate education.
Patient Identification & Medication Safety in Long-Term Care
7. Ensuring Correct Patient Identification for Medication Administration
Scenario: A disoriented resident in a long-term care facility lacks an identification band or
picture.
Best Nursing Action: D. Confirm the room and bed numbers with those on the medication
record.
o Safety Protocol: Cross-referencing the room and bed number with the medication record
provides an immediate and verifiable way to enhance identification in the absence of
standard identifiers. Asking unfamiliar staff or relying solely on re-orientation is less
reliable. Holding medication indefinitely can delay necessary treatment.
Burn Care & Fluid Balance
, 8. Recognizing Critical Observations in Burn Patients
Scenario: An adult client with 40% partial and full-thickness burns has been admitted.
Most Important Immediate Report: D. Urinary Output of 20ml/hr.
o Critical Indicator: Severely decreased urinary output in a burn patient indicates
inadequate fluid resuscitation and potential renal hypoperfusion, a life-threatening
complication requiring immediate attention.
Blood Transfusion Reactions
9. Responding to Signs of a Transfusion Reaction
Scenario: A 12-year-old receiving a blood transfusion reports "itchy" skin and appears flushed
15 minutes after the start.
First PN Action: B. Stop the transfusion.
o Immediate Intervention: These are classic signs of a transfusion reaction. The
transfusion must be stopped immediately to prevent a more severe reaction.
Dermatological Assessment & Reporting
10. Assessing and Responding to Skin Lesions
Scenario: A PN notes a crusted 0.7 cm lesion on an older adult's forehead during a focused skin
assessment.
PN Action: A. Report the finding to the healthcare provider.
o Professional Responsibility: Any new or suspicious skin lesion should be reported to the
healthcare provider for further evaluation and diagnosis, as it could be precancerous or
require treatment.
Neurological Assessment & Medication Side Effects
11. Identifying Potential Medication-Related Movement Disorders
Scenario: An older male client on psychotropic medications exhibits uncontrollable hand
movements and excessive eye blinking.
Medical Record Review: C. Screening for tardive dyskinesia.
o Possible Cause: These movements are characteristic of tardive dyskinesia, a potential
side effect of long-term psychotropic medication use. Reviewing the tardive dyskinesia
screening results is most relevant.
Geriatric Care & Incontinence Management
12. Understanding Muscles Involved in Kegel Exercises
