RN HESI EXIT EXAM VERSION 6
QUESTIONS WITH CORRECT ANSWERS
1. A client with a history of bipolar disorder is admitted with a serum lithium level of 1.8
mEq/L. Which clinical manifestation should the nurse prioritize for immediate assessment?
A. Mild thirst and polyuria
B. Fine hand tremors and nausea
C. Slurred speech and increased energy
D. Blurred vision and muscle fasciculations
Answer: D
Conceptual Explanation: A lithium level of 1.8 mEq/L indicates moderate toxicity. The
nurse should look for signs such as blurred vision, muscle fasciculations (twitches), and
persistent GI upset. Fine tremors are expected at therapeutic levels, while blurred vision
suggests toxic accumulation.
2. A nurse is caring for a client receiving magnesium sulfate for pre-eclampsia. Which finding
is the most critical indicator of magnesium toxicity?
A. Blood pressure 150/90 mmHg
,B. Absent deep tendon reflexes
C. Respiratory rate of 14 breaths/min
D. Urinary output of 40 mL/hr
Answer: B
Conceptual Explanation: Loss of deep tendon reflexes (DTRs) is one of the earliest signs
of magnesium toxicity. While respiratory depression is also critical, it usually occurs after
DTRs are lost. A RR of 14 is within normal range.
3. A client with chronic kidney disease (CKD) has a serum potassium level of 6.4 mEq/L. Which
EKG change should the nurse expect to observe?
A. Prominent U waves
B. Prolonged PR interval and tall, peaked T waves
C. ST-segment depression
D. Shortened QT interval
Answer: B
Conceptual Explanation: Hyperkalemia (K+ > 5.0) causes tall, peaked T waves and
widening of the QRS complex, eventually leading to a prolonged PR interval or loss of the P
wave. U waves are associated with hypokalemia.
, 4. A nurse is teaching a client who has a new prescription for warfarin. Which food choice
indicates that the client understands the dietary restrictions?
A. ‘I will eat a large spinach salad every day to stay healthy.’
B. ‘I will maintain a consistent intake of green leafy vegetables.’
C. ‘I will avoid all sources of Vitamin K entirely.’
D. ‘I will increase my intake of liver and cabbage.’
Answer: B
Conceptual Explanation: Warfarin is a vitamin K antagonist. Clients do not need to avoid
vitamin K entirely but must maintain a consistent intake to avoid fluctuating INR levels.
5. An infant with suspected pyloric stenosis is admitted to the pediatric unit. Which
assessment finding is most characteristic of this condition?
A. Currant jelly-like stools
B. Abdominal distention and bile-stained vomitus
C. Visible peristaltic waves and projectile vomiting
D. Failure to pass meconium in the first 24 hours
Answer: C
Conceptual Explanation: Hypertrophic pyloric stenosis typically presents with non-
bilious projectile vomiting and visible gastric peristalsis. Currant jelly stools are associated
with intussusception.
QUESTIONS WITH CORRECT ANSWERS
1. A client with a history of bipolar disorder is admitted with a serum lithium level of 1.8
mEq/L. Which clinical manifestation should the nurse prioritize for immediate assessment?
A. Mild thirst and polyuria
B. Fine hand tremors and nausea
C. Slurred speech and increased energy
D. Blurred vision and muscle fasciculations
Answer: D
Conceptual Explanation: A lithium level of 1.8 mEq/L indicates moderate toxicity. The
nurse should look for signs such as blurred vision, muscle fasciculations (twitches), and
persistent GI upset. Fine tremors are expected at therapeutic levels, while blurred vision
suggests toxic accumulation.
2. A nurse is caring for a client receiving magnesium sulfate for pre-eclampsia. Which finding
is the most critical indicator of magnesium toxicity?
A. Blood pressure 150/90 mmHg
,B. Absent deep tendon reflexes
C. Respiratory rate of 14 breaths/min
D. Urinary output of 40 mL/hr
Answer: B
Conceptual Explanation: Loss of deep tendon reflexes (DTRs) is one of the earliest signs
of magnesium toxicity. While respiratory depression is also critical, it usually occurs after
DTRs are lost. A RR of 14 is within normal range.
3. A client with chronic kidney disease (CKD) has a serum potassium level of 6.4 mEq/L. Which
EKG change should the nurse expect to observe?
A. Prominent U waves
B. Prolonged PR interval and tall, peaked T waves
C. ST-segment depression
D. Shortened QT interval
Answer: B
Conceptual Explanation: Hyperkalemia (K+ > 5.0) causes tall, peaked T waves and
widening of the QRS complex, eventually leading to a prolonged PR interval or loss of the P
wave. U waves are associated with hypokalemia.
, 4. A nurse is teaching a client who has a new prescription for warfarin. Which food choice
indicates that the client understands the dietary restrictions?
A. ‘I will eat a large spinach salad every day to stay healthy.’
B. ‘I will maintain a consistent intake of green leafy vegetables.’
C. ‘I will avoid all sources of Vitamin K entirely.’
D. ‘I will increase my intake of liver and cabbage.’
Answer: B
Conceptual Explanation: Warfarin is a vitamin K antagonist. Clients do not need to avoid
vitamin K entirely but must maintain a consistent intake to avoid fluctuating INR levels.
5. An infant with suspected pyloric stenosis is admitted to the pediatric unit. Which
assessment finding is most characteristic of this condition?
A. Currant jelly-like stools
B. Abdominal distention and bile-stained vomitus
C. Visible peristaltic waves and projectile vomiting
D. Failure to pass meconium in the first 24 hours
Answer: C
Conceptual Explanation: Hypertrophic pyloric stenosis typically presents with non-
bilious projectile vomiting and visible gastric peristalsis. Currant jelly stools are associated
with intussusception.
