BSN 395 HESI REAL EXAM QUESTIONS AND
CORRECT ANSWERS WITH EXPLANATIONS
FOR A GUARANTEED PASS
A client is admitted to the mental health unit with a chief complaint of crying,
depressed mood, and sleeping difficulties. While talking about the death of a
friend, the client states, "I can't believe this happened." Which statement by
the nurse is most therapeutic?
A."It sounds like you're feeling very sad."
B."Tell me more about how you're feeling."
C."How often do you have crying spells?"
D."Do you want to talk about these feelings?"
B
It is most therapeutic to ask an open-ended question and encourage the
client to explore his or her feelings (B). (A) is a leading response, and the
client may not be feeling sad. (C and D) are close-ended questions that do
not facilitate communication.
Which instruction should the nurse provide to a client whose vision is being
tested with a Snellen chart?
A.Stand on a line drawn 10 feet from the chart.
B.Read each sentence slowly and carefully.
C.Cover one eye while reading the chart with the other.
D.Begin by identifying the first line that is hard to read.
,C
Each eye should be tested separately (C) because visual acuity can vary
from one eye to the other. A Snellen chart scores vision in comparison with
what a person with normal vision can read at a distance of 20 feet (A). The
Snellen chart is comprised of letters, not sentences (B). The client should be
instructed to begin at or near the top of the chart with the line that can be
easily read, moving down until a line is reached that cannot be read (D)
The nurse assists the health care provider with an amniocentesis during the
third trimester of pregnancy. Which intervention(s) would the nurse expect to
implement after the procedure? (Select all that apply.)
A.Monitor maternal vital signs for hemorrhage.
B.Instruct the woman to report any contractions.
C.Ensure that the woman has a full bladder prior to beginning.
D.Monitor fetal heart rate for 1 hour after the procedure.
E.Place the client in a side-lying position.
ABD
These are safe measures to implement during an amniocentesis to monitor
for and prevent complications (A, B, and D). During late pregnancy the
bladder should be emptied so that it will not be punctured, but during early
pregnancy the bladder must be full to push the uterus upward (C). The
woman should be placed in a supine position with her hands across her chest
(E).
Which nursing intervention(s) should be implemented when caring for a
client with bipolar disorder in the manic phase? (Select all that apply.)
A.Report lithium level of 2.0 mEq/L to the primary health care provider.
,B.Encourage competitive physical activities as part of the client's therapy.
C.Provide an environment with increased stimuli to engage the client.
D.Maintain consistent salt levels in the diet when client is taking lithium.
E.Assess the client's nutritional and hydration status.
ADE
A therapeutic level for serum lithium is 0.5 to 1.5 mEq/L, and the client with
2.0 mEq/L is experiencing toxicity (A). Consistent salt levels are important
when taking lithium to maintain a therapeutic level (D). Because of the
client's manic state, the client is at risk for impaired nutrition and
dehydration; therefore, they should be assessed (E). Noncompetitive physical
activities should be encouraged because of the risk for agitation (B), and
decreased environmental stimuli is therapeutic for the manic phase (C).
A child with nephrotic syndrome is receiving prednisone (Deltasone). Which
choice of breakfast foods at a fast food restaurant indicates that the mother
understands the dietary guidelines necessary for her child?
A.French toast sticks and orange juice
B.Sausage egg muffin and grape juice
C.Canadian bacon slices and hot chocolate
D.Toasted oat cereal and low-fat milk
D
A child receiving a corticosteroid for nephrotic syndrome should follow a low-
sodium, low-fat, and low-sugar diet. Based on these guidelines, the best
breakfast choice is (D). (A) is high in fat and sugar. (B and C) are high in fat
and sodium.
A nurse who has recently completed orientation is beginning work in the
labor and delivery unit for the first time. When making assignments, which
client should the charge nurse assign to this new nurse?
, A.A primigravida who is 8 cm dilated after 14 hours of labor
B.A client scheduled for a repeat cesarean birth at 38 weeks' gestation
C.A client being induced for fetal demise at 20 weeks' gestation
D.A multiparous client who is dilated 5 cm and 50% effaced
D
The new nurse should be assigned the least complicated client to gain
experience and confidence, as well as protect client safety. Of the clients
available for assignment, (D) is progressing well and is the least complicated.
(A, B and C) have actual or potential complications and should be assigned
to a more experienced nurse.
A client with human immunodeficiency virus (HIV) infection has white lesions
in the oral cavity that resemble milk curds. Nystatin (Mycostatin) preparation
is prescribed as a swish and swallow. Which information is most important for
the nurse to provide the client?
A.Oral hygiene should be performed before the medication. B.Antifungal
medications are available in tablet, suppository, and liquid forms.
C.Candida albicans is the organism that causes the white lesions in the
mouth.
D.The dietary intake of dairy and spicy foods should be limited.
A
HIV infection causes depression of cell-mediated immunity that allows an
overgrowth of Candida albicans (oral moniliasis), which appears as white,
cheesy plaque or lesions that resemble milk curds. To ensure effective
contact of the medication with the oral lesions, oral liquids should be
consumed and oral hygiene performed before swishing the liquid Mycostatin
(A). (B and C) provide the client with additional information about the
pathogenesis and treatment of opportunistic infections, but (A) allows the
client to participate in self-care of the oral infection. Dietary restriction of
CORRECT ANSWERS WITH EXPLANATIONS
FOR A GUARANTEED PASS
A client is admitted to the mental health unit with a chief complaint of crying,
depressed mood, and sleeping difficulties. While talking about the death of a
friend, the client states, "I can't believe this happened." Which statement by
the nurse is most therapeutic?
A."It sounds like you're feeling very sad."
B."Tell me more about how you're feeling."
C."How often do you have crying spells?"
D."Do you want to talk about these feelings?"
B
It is most therapeutic to ask an open-ended question and encourage the
client to explore his or her feelings (B). (A) is a leading response, and the
client may not be feeling sad. (C and D) are close-ended questions that do
not facilitate communication.
Which instruction should the nurse provide to a client whose vision is being
tested with a Snellen chart?
A.Stand on a line drawn 10 feet from the chart.
B.Read each sentence slowly and carefully.
C.Cover one eye while reading the chart with the other.
D.Begin by identifying the first line that is hard to read.
,C
Each eye should be tested separately (C) because visual acuity can vary
from one eye to the other. A Snellen chart scores vision in comparison with
what a person with normal vision can read at a distance of 20 feet (A). The
Snellen chart is comprised of letters, not sentences (B). The client should be
instructed to begin at or near the top of the chart with the line that can be
easily read, moving down until a line is reached that cannot be read (D)
The nurse assists the health care provider with an amniocentesis during the
third trimester of pregnancy. Which intervention(s) would the nurse expect to
implement after the procedure? (Select all that apply.)
A.Monitor maternal vital signs for hemorrhage.
B.Instruct the woman to report any contractions.
C.Ensure that the woman has a full bladder prior to beginning.
D.Monitor fetal heart rate for 1 hour after the procedure.
E.Place the client in a side-lying position.
ABD
These are safe measures to implement during an amniocentesis to monitor
for and prevent complications (A, B, and D). During late pregnancy the
bladder should be emptied so that it will not be punctured, but during early
pregnancy the bladder must be full to push the uterus upward (C). The
woman should be placed in a supine position with her hands across her chest
(E).
Which nursing intervention(s) should be implemented when caring for a
client with bipolar disorder in the manic phase? (Select all that apply.)
A.Report lithium level of 2.0 mEq/L to the primary health care provider.
,B.Encourage competitive physical activities as part of the client's therapy.
C.Provide an environment with increased stimuli to engage the client.
D.Maintain consistent salt levels in the diet when client is taking lithium.
E.Assess the client's nutritional and hydration status.
ADE
A therapeutic level for serum lithium is 0.5 to 1.5 mEq/L, and the client with
2.0 mEq/L is experiencing toxicity (A). Consistent salt levels are important
when taking lithium to maintain a therapeutic level (D). Because of the
client's manic state, the client is at risk for impaired nutrition and
dehydration; therefore, they should be assessed (E). Noncompetitive physical
activities should be encouraged because of the risk for agitation (B), and
decreased environmental stimuli is therapeutic for the manic phase (C).
A child with nephrotic syndrome is receiving prednisone (Deltasone). Which
choice of breakfast foods at a fast food restaurant indicates that the mother
understands the dietary guidelines necessary for her child?
A.French toast sticks and orange juice
B.Sausage egg muffin and grape juice
C.Canadian bacon slices and hot chocolate
D.Toasted oat cereal and low-fat milk
D
A child receiving a corticosteroid for nephrotic syndrome should follow a low-
sodium, low-fat, and low-sugar diet. Based on these guidelines, the best
breakfast choice is (D). (A) is high in fat and sugar. (B and C) are high in fat
and sodium.
A nurse who has recently completed orientation is beginning work in the
labor and delivery unit for the first time. When making assignments, which
client should the charge nurse assign to this new nurse?
, A.A primigravida who is 8 cm dilated after 14 hours of labor
B.A client scheduled for a repeat cesarean birth at 38 weeks' gestation
C.A client being induced for fetal demise at 20 weeks' gestation
D.A multiparous client who is dilated 5 cm and 50% effaced
D
The new nurse should be assigned the least complicated client to gain
experience and confidence, as well as protect client safety. Of the clients
available for assignment, (D) is progressing well and is the least complicated.
(A, B and C) have actual or potential complications and should be assigned
to a more experienced nurse.
A client with human immunodeficiency virus (HIV) infection has white lesions
in the oral cavity that resemble milk curds. Nystatin (Mycostatin) preparation
is prescribed as a swish and swallow. Which information is most important for
the nurse to provide the client?
A.Oral hygiene should be performed before the medication. B.Antifungal
medications are available in tablet, suppository, and liquid forms.
C.Candida albicans is the organism that causes the white lesions in the
mouth.
D.The dietary intake of dairy and spicy foods should be limited.
A
HIV infection causes depression of cell-mediated immunity that allows an
overgrowth of Candida albicans (oral moniliasis), which appears as white,
cheesy plaque or lesions that resemble milk curds. To ensure effective
contact of the medication with the oral lesions, oral liquids should be
consumed and oral hygiene performed before swishing the liquid Mycostatin
(A). (B and C) provide the client with additional information about the
pathogenesis and treatment of opportunistic infections, but (A) allows the
client to participate in self-care of the oral infection. Dietary restriction of
