A
,ALL HESI EXIT Questions and Answers Test
Bank; A+ Rated Guide (2022)
271. A client receives a new prescription for simvastatin (Zocor) 5 mg PO daily
at bedtime. What action should the nurse take?
(correct Administer the medication as prescribed with a glass of
Answer- water
272. Which client should the nurse assess frequently because of the risk for
overflow incontinence?
A client Who is confused and frequently forgets to go to the bathroom
273. While monitoring a client during a seizure, which interventions should the
nurse implement? (Select all that apply)
(correct Answer-
Move obstacle away from client
Monitor physical movements
Observe for a patent airway
Record the duration of the seizure
,274. A male client with a long history of alcoholism is admitted because of mild
confusion and fine motor tremors. He reports that he quit drinking alcohol and
stopped smoking cigarettes one month ago after his brother died of lung
cancer.
Which intervention is most important for the nurses to include in the client's plan
of care?
(correct Observe for changes in level of
Answer- consciousness.
275. An older adult female admitted to the intensive care unit (ICU) with a
possible stroke is intubated with ventilator setting of tidal volume 600, PlO2
40%, and respiratory rate of 12 breaths/minute. The arterial blood gas (ABG)
results after intubation are PH 7.31. PaCO2 60, PaO2 104, SPO2 98%, HCO3
23. To normalize the client's ABG finding, which action is required? correct
Answer- Increase ventilator rate.
276. The mother of the 12- month-old with cystic fibrosis reports that her child is
experiencing increasing congestion despite the use of chest physical therapy
(CPT) twice a day, and has also experiences a loss of appetite. What
instruction should the nurse provide?
(correct Answer- CPT should be performed more frequently, but at least an hour
before meals.
277. The nurse is evaluating the diet teaching of a client with hypertension. What
dinner selection indicates that the client understands the dietary
recommendation for hypertension?
(correct Answer- Baked pork chop, applesauce, corn on the cob, 2% milk, and
keylime pie
278. A client with type 2 diabetes mellitus is admitted for frequent hyperglycemic
episodes and a glycosylated hemoglobin (HbA1c) of 10%. Insulin glargine 10
units subcutaneously once a day at bedtime and a sliding scale with insulin
aspart q6h are prescribed. What action should the nurse include in this client's
plan of care?
(correct Answer- Fingerstick glucose assessment q6h with meals
, Review with the client proper foot care and prevention of injury
Coordinate carbohydrate controlled meals at consistent times and intervals
Teach subcutaneous injection technique, site rotation and insulin management
279. Which problem reported by a client taking lovastatin requires the most
immediate fallow up by the nurse?
(correct Answer- Muscle pain
280. While assessing a client's chest tube (CT), the nurse discovers bubbling in the
water seal chamber of the chest tube collection device. The client's vital signs
are: blood pressure of 80/40 mmHg, heart rate 120 beats/minutes, respiratory
rate 32 breaths/minutes, oxygen saturation 88%. Which interventions should
the nurse implement?
(correct Answer- Provide supplemental oxygen
Auscultate bilateral lung fields
Reinforce occlusive CT dressing
281. Before leaving the room of a confused client, the nurse notes that a half bow
knot was used to attach the client's wrist restraints to the movable portion of
the client's bed frame. What action should the nurse take before leaving the
room?
(correct Ensure that the knot can be quickly
Answer- released.
282. Oral antibiotics are prescribed for an 18-month-old toddler with severe otitis
media. An antipyrine and benzocaine-otic also prescribed for pain and
inflammation. What instruction should the nurse emphasize concerning the
installation of the antipyrine/benzocaine otic solution?
(correct Answer- Have the child lie with the ear up for one to two minute after
installation.
283. An older adult male is admitted with complications related to chronic
obstructive pulmonary disease (COPD). He reports progressive dyspnea that
worsens on exertion and his weakness has increased over the past month. The
,ALL HESI EXIT Questions and Answers Test
Bank; A+ Rated Guide (2022)
271. A client receives a new prescription for simvastatin (Zocor) 5 mg PO daily
at bedtime. What action should the nurse take?
(correct Administer the medication as prescribed with a glass of
Answer- water
272. Which client should the nurse assess frequently because of the risk for
overflow incontinence?
A client Who is confused and frequently forgets to go to the bathroom
273. While monitoring a client during a seizure, which interventions should the
nurse implement? (Select all that apply)
(correct Answer-
Move obstacle away from client
Monitor physical movements
Observe for a patent airway
Record the duration of the seizure
,274. A male client with a long history of alcoholism is admitted because of mild
confusion and fine motor tremors. He reports that he quit drinking alcohol and
stopped smoking cigarettes one month ago after his brother died of lung
cancer.
Which intervention is most important for the nurses to include in the client's plan
of care?
(correct Observe for changes in level of
Answer- consciousness.
275. An older adult female admitted to the intensive care unit (ICU) with a
possible stroke is intubated with ventilator setting of tidal volume 600, PlO2
40%, and respiratory rate of 12 breaths/minute. The arterial blood gas (ABG)
results after intubation are PH 7.31. PaCO2 60, PaO2 104, SPO2 98%, HCO3
23. To normalize the client's ABG finding, which action is required? correct
Answer- Increase ventilator rate.
276. The mother of the 12- month-old with cystic fibrosis reports that her child is
experiencing increasing congestion despite the use of chest physical therapy
(CPT) twice a day, and has also experiences a loss of appetite. What
instruction should the nurse provide?
(correct Answer- CPT should be performed more frequently, but at least an hour
before meals.
277. The nurse is evaluating the diet teaching of a client with hypertension. What
dinner selection indicates that the client understands the dietary
recommendation for hypertension?
(correct Answer- Baked pork chop, applesauce, corn on the cob, 2% milk, and
keylime pie
278. A client with type 2 diabetes mellitus is admitted for frequent hyperglycemic
episodes and a glycosylated hemoglobin (HbA1c) of 10%. Insulin glargine 10
units subcutaneously once a day at bedtime and a sliding scale with insulin
aspart q6h are prescribed. What action should the nurse include in this client's
plan of care?
(correct Answer- Fingerstick glucose assessment q6h with meals
, Review with the client proper foot care and prevention of injury
Coordinate carbohydrate controlled meals at consistent times and intervals
Teach subcutaneous injection technique, site rotation and insulin management
279. Which problem reported by a client taking lovastatin requires the most
immediate fallow up by the nurse?
(correct Answer- Muscle pain
280. While assessing a client's chest tube (CT), the nurse discovers bubbling in the
water seal chamber of the chest tube collection device. The client's vital signs
are: blood pressure of 80/40 mmHg, heart rate 120 beats/minutes, respiratory
rate 32 breaths/minutes, oxygen saturation 88%. Which interventions should
the nurse implement?
(correct Answer- Provide supplemental oxygen
Auscultate bilateral lung fields
Reinforce occlusive CT dressing
281. Before leaving the room of a confused client, the nurse notes that a half bow
knot was used to attach the client's wrist restraints to the movable portion of
the client's bed frame. What action should the nurse take before leaving the
room?
(correct Ensure that the knot can be quickly
Answer- released.
282. Oral antibiotics are prescribed for an 18-month-old toddler with severe otitis
media. An antipyrine and benzocaine-otic also prescribed for pain and
inflammation. What instruction should the nurse emphasize concerning the
installation of the antipyrine/benzocaine otic solution?
(correct Answer- Have the child lie with the ear up for one to two minute after
installation.
283. An older adult male is admitted with complications related to chronic
obstructive pulmonary disease (COPD). He reports progressive dyspnea that
worsens on exertion and his weakness has increased over the past month. The
