HESI Comprehensive Exit Exam 1 (And Rationale)
Questions and Verified Answers
1. The nurse is monitoring
D
neurologi- cal vital signs for a
male client who lost (Neurological vital signs include serial
consciousness after falling and assessments of TPR, blood pressure, and
hitting his head. Which components of the Glas- gow coma scale
assessment finding is the (GCS), which includes verbal, mus-
earliest and most sen- sitive culoskeletal, and pupillary responses. A
indication of altered cerebral change in the client's level of consciousness,
function? as indicated by responses to commands
a. Unequal pupils. during the GCS, is the first and the most
b. Loss of central reflexes. sensitive sign of change in cerebral function.
c. Inability to open the eyes. The other assessment data choices are late
d. Change in level of signs of altered cerebral function.)
consciousness.
D
2. A nurse is planning to teach
self-care measures to a female
client
about prevention of yeast infections. (A common genital tract infection in
females is can-
Which instructions should the nurse didiasis, which is an overgrowth of the
normal vaginal
provide? flora of Candida albicans that thrives in an
a. Use a douche preparation environ- ment that is warm and moist and is
no more than once a perpetuated by tight-fitting clothing,
month. underwear, or pantyhose made of
b. Increase daily intake of fiber nonabsorbent materials. The client should
and leafy green vegetables. wear clothing that is loose fitting and
c. Select nylon underwear that absorbent, such as cotton underwear, and
is avoid using bubble-bath or bath salts which
loose-fitting, white, and further irritate sensitive genital tis- sue.
comfort- able. Douching is not recommended because it can
,HESI Comprehensive Exit Exam 1 (And Rationale)
Questions and Verified Answers
d. Avoid tight-fitting clothing and do irritate vaginal tissue, alter pH, and
contribute to
not use bubble-bath or bath fungal growth. While increasing dietary fiber
salts. intake encourages healthy, nutritional
guidelines, it is not the focus of the teaching.
Cotton, not nylon under- garments, provide
absorbancy and reduce moisture in the
perineal area.)
3.
,HESI Comprehensive Exit Exam 1 (And Rationale)
Questions and Verified Answers
A client who has active b. Primary nursing.
tuberculosis (TB) is admitted to c. Case management.
the medical unit. What action d. Functional nursing.
is most important for the nurse
to implement?
a. Place an isolation cart in the
hall- way.
b. Fit the client with a
respirator mask.
c. Don a clean gown for client
care.
d. Assign the client to a
negative air-flow room.
4. The nurse is planning to con-
duct nutritional assessments
and diet teaching to clients at
a family health clinic. Which
individual has
the greatest nutritional and
energy demands?
a. A pregnant woman.
b. A teenager beginning
puberty.
c. A 3-month-old infant.
d. A school-aged child.
5. What nursing delivery of care
pro- vides the nurse to plan
and direct care of a group of
clients over a 24-hour period?
a. Team nursing.
, HESI Comprehensive Exit Exam 1 (And Rationale)
Questions and Verified Answers
D
(Active tuberculosis requires implementation of air-
borne precautions, so the client should be assigned
to a negative pressure air-flow room. Although isola-
tion gowns and isolation carts should be implement-
ed for clients in isolation with contact precautions,
it is most important that air flow from the room is
minimized when the client has TB. The respirator
mask should be implemented when the client leaves
the isolation environment.)
A
A pregnant woman's metabolic demands are 20
to 24% more than the basic metabolic rate. The
other clients require only 15 to 20% more than the
basic metabolic rate.
B
(Primary nursing is a model of delivery of care where
a nurse is accountable for planning care for clients
around the clock. Functional nursing is a care delivery
model that provides client care by assignment of
functions or tasks. Team nursing is a care delivery
model where assignments to a group of clients are
Questions and Verified Answers
1. The nurse is monitoring
D
neurologi- cal vital signs for a
male client who lost (Neurological vital signs include serial
consciousness after falling and assessments of TPR, blood pressure, and
hitting his head. Which components of the Glas- gow coma scale
assessment finding is the (GCS), which includes verbal, mus-
earliest and most sen- sitive culoskeletal, and pupillary responses. A
indication of altered cerebral change in the client's level of consciousness,
function? as indicated by responses to commands
a. Unequal pupils. during the GCS, is the first and the most
b. Loss of central reflexes. sensitive sign of change in cerebral function.
c. Inability to open the eyes. The other assessment data choices are late
d. Change in level of signs of altered cerebral function.)
consciousness.
D
2. A nurse is planning to teach
self-care measures to a female
client
about prevention of yeast infections. (A common genital tract infection in
females is can-
Which instructions should the nurse didiasis, which is an overgrowth of the
normal vaginal
provide? flora of Candida albicans that thrives in an
a. Use a douche preparation environ- ment that is warm and moist and is
no more than once a perpetuated by tight-fitting clothing,
month. underwear, or pantyhose made of
b. Increase daily intake of fiber nonabsorbent materials. The client should
and leafy green vegetables. wear clothing that is loose fitting and
c. Select nylon underwear that absorbent, such as cotton underwear, and
is avoid using bubble-bath or bath salts which
loose-fitting, white, and further irritate sensitive genital tis- sue.
comfort- able. Douching is not recommended because it can
,HESI Comprehensive Exit Exam 1 (And Rationale)
Questions and Verified Answers
d. Avoid tight-fitting clothing and do irritate vaginal tissue, alter pH, and
contribute to
not use bubble-bath or bath fungal growth. While increasing dietary fiber
salts. intake encourages healthy, nutritional
guidelines, it is not the focus of the teaching.
Cotton, not nylon under- garments, provide
absorbancy and reduce moisture in the
perineal area.)
3.
,HESI Comprehensive Exit Exam 1 (And Rationale)
Questions and Verified Answers
A client who has active b. Primary nursing.
tuberculosis (TB) is admitted to c. Case management.
the medical unit. What action d. Functional nursing.
is most important for the nurse
to implement?
a. Place an isolation cart in the
hall- way.
b. Fit the client with a
respirator mask.
c. Don a clean gown for client
care.
d. Assign the client to a
negative air-flow room.
4. The nurse is planning to con-
duct nutritional assessments
and diet teaching to clients at
a family health clinic. Which
individual has
the greatest nutritional and
energy demands?
a. A pregnant woman.
b. A teenager beginning
puberty.
c. A 3-month-old infant.
d. A school-aged child.
5. What nursing delivery of care
pro- vides the nurse to plan
and direct care of a group of
clients over a 24-hour period?
a. Team nursing.
, HESI Comprehensive Exit Exam 1 (And Rationale)
Questions and Verified Answers
D
(Active tuberculosis requires implementation of air-
borne precautions, so the client should be assigned
to a negative pressure air-flow room. Although isola-
tion gowns and isolation carts should be implement-
ed for clients in isolation with contact precautions,
it is most important that air flow from the room is
minimized when the client has TB. The respirator
mask should be implemented when the client leaves
the isolation environment.)
A
A pregnant woman's metabolic demands are 20
to 24% more than the basic metabolic rate. The
other clients require only 15 to 20% more than the
basic metabolic rate.
B
(Primary nursing is a model of delivery of care where
a nurse is accountable for planning care for clients
around the clock. Functional nursing is a care delivery
model that provides client care by assignment of
functions or tasks. Team nursing is a care delivery
model where assignments to a group of clients are
