HESI PN EXAM 110 Questions & Answers Latest Update Graded A 2023

1. An ambulatory clinic nurse is interviewing a client who is complaining of flulike symptoms. The client suddenly develops chest pain. Which question best assists the nurse to discriminate pain caused by a non cardiac problem? 3. "Does the pain get worse when you breathe in?" 2. A client with myocardial infarction (MI) has been transferred from the coronary care unit (CCU) to the general medical unit with cardiac monitoring via telemetry. The nurse assisting in caring for the client expects to note which type of activity prescribed? 2. Bathroom privileges and self-care activities 3 A client is diagnosed with thrombophlebitis. The nurse should tell the client that which prescription is indicated? 3. Bed rest, with elevation of the affected extremity 4 A client returns to the nursing unit after an above knee amputation of the right leg. In which position should the nurse place the client? 2. With the foot of the bed elevated 5. A student nurse is assigned to assist in caring for a client with acute pulmonary edema who is receiving digoxin (Lanoxin) and heparin therapy. The nursing instructor reviews the plan of care formulated by the student and tells the student that which intervention is unsafe? 1. Restricting the client's potassium intake 6. A client has an inoperable abdominal aortic aneurysm (AAA). Which measure should the nurse anticipate reinforcing when teaching the client? 3. Antihypertensives 7. A client is seen in the health care provider's office for a physical examination after experiencing unusual fatigue over the last several weeks. Height is 5 feet, 8 inches, with a weight of 220 pounds. Vital signs are temperature 98.6° F oral, pulse 86 beats per minute, respirations 18 breaths per minute, and blood pressure 184/96 mm Hg. Random blood glucose is 110 mg/dL. In order to best collect relevant data, which question should the LPN/LVN ask the client first? 4. "When was the last time you had your blood pressure checked?" 8. A nurse is collecting data from a client in an outpatient clinic and observes extensive bruising on the client’s arms. This nurse suspects the client is experiencing intimate partner abuse. Which of the following is the nurse’s priority action? Offer support and create a safe, trusting environment 9 A nurse in an urgent care clinic is caring for a client who reports recently using methylenedioxy-methamphetamine. Which of the following findings should the nurse expect? Hallucinations 10. A nurse is reinforcing teaching with a client who has a prescription for ferrous sulfate elixir. Which of the following statements by the client indicates an understanding of the teaching? I will mix the medication with water 11. A nurse is collecting data from a client who received oxytocin 10 units IM 30 min ago for excessive vaginal bleeding. Which of the following findings should the nurse expect? o Boggy fundus 3 fingerbreadths above the umbilicus 12. A nurse is attending an educational workshop about client confidentiality. Which of the following actions by the nurse indicates an understanding of the teaching? o Changes her personal login password at random intervals 13. A nurse is assisting with discharge planning for a group of clients. Which of the following clients should the nurse recommend a home health referral? o An older adult client who has heart failure and lives alone 14. A nurse is reinforcing teaching with a female client who is taking phenytoin. Which of the following instructions should the nurse include in the teaching? o You might experience swollen gums while taking this medication 15. A nurse is preparing to administer paroxetine 15 mg PO oral suspension to a client who has a depressive disorder. The amount available is 10 mg/ 5 mL. How many mL should the nurse administer?(Round answer to the nearest tenth.) • 7.5 mL 16. A nurse is reinforcing teaching with a client who is at 38 weeks of gestation and is to undergo a contraction stress test. Which of the following statements by the client indicates an understanding of the teaching? o I am having this test because my baby was nonstress test reactive during a 17. A nurse is discussing health practices with the mother of a toddler who is from a different cultural background than the nurse. Which of the following statements by the mother indicates that she practices cupping? o I sometimes place a bottle containing steam against my child’s skin 18. A nurse is reinforcing teaching with a client who has primary open-angle glaucoma and has a prescription for timolol eye drops. Which of the following statements by the client indicates an understanding of the teaching? o I should check my heart rate while taking this medication 19. A nurse is collecting data from a preschooler who has severe dehydration. Which of the following findings should the nurse expect? o Weight loss of 10% 20. A nurse is contributing to the plan of care for an older adult client. Which of the following physiological changes should the nurse consider when administering medication? o Decreased kidney function 21 A nurse is caring for a client who is taking multiple medications and asks about possible interactions. To which of the following members of the interdisciplinary team should the nurse make a referral? o Advanced practice nurse 22. A nurse is collecting data from a client who just received his first dose of sulfasalazine to treat ulcerative colitis. Which of the following findings should the nurse identify as an indication of an allergic reaction to this medication? o Dyspnea 23. A nurse is collecting nutritional data from a group of adult clients. For which of the following clients should the nurse recommend an interprofessional care conference with a dietician? o A client who has a body mass index of 32 24. A charge nurse is reinforcing teaching with a newly licensed nurse about infection control measures. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching? o Soiled dressings should be placed in a biohazard trash receptacle 25. A nurse is preparing a vitamin K injection to give to a newborn. The newborn’s mother questions the purpose of this medication. Which of the following responses should the nurse make? o This medication will decrease the risk of hemorrhage in your newborn 26. A nurse is collecting data from a client who has diabetic ketoacidosis. Which of the following findings should the nurse report to the provider? o Fruity breath odor 27. A nurse is caring for a client who has a vacuum-assisted closure system to treat a pressure ulcer. Which of the following actions should the nurse take? o Use an adhesive remover to remove tape before reapplying a dressing 28. A nurse is verifying informed consent for a client who is preoperative for a vaginal hysterectomy. Which of the following statements should the nurse identify as an indication that the client has given informed consent? o I am thankful I am done having children 29. A nurse is caring for a client who is experiencing a tonic-clonic seizure. Which of the following actions should the nurse take? o Measure the duration of the seizure o Lower the side rails of the bed when the seizure begins o Insert an oral airway into the clients mouth 30. A nurse is collecting data from a client who is at 12 weeks of gestation. The client states, “We've been trying to get pregnant for several months, but now I'm not so sure I'm ready.” Which of the following responses should the nurse make? o Many women experience feelings of ambivalence during pregnancy 31. A nurse is caring for four clients. Which of the following situations require a signed consent form? o Administering an iron injection Z-track method 32. A nurse is receiving a report on four clients. The nurse should plan to collect data from which of the following clients first? o A preschooler who has epiglottis and is drooling 33. A nurse is caring for a client who reports frequent headaches after taking chewable isosorbide dinitrate. Which of the following statements should the nurse include? o The headaches should decrease as you get used to the medication 34. A nurse is assisting in the plan of care for a female client who is to undergo a 12- lead ECG. Which of the following actions should the nurse include in the plan of care? Instruct the client to remain still while the test is performed. 35. A nurse is preparing to insert an indwelling urinary catheter for a female client who has a urinary retention. Which of the following actions should the nurse take? Open the outer package flap of the catheterization kit away from her bod y. 36. A nurse I caring for a client who has expressive aphasia following a stroke. Which of the following communication methods should the nurse use? Provide a picture board. 37. A nurse is caring for a client who is NPO and has an NG tube attached to suction for gastric decompression. Which of the following actions should the nurse take if the client experiences abdominal distention? Irrigate the tube with normal saline. 38. A nurse is assisting with admitting a client who has colorectal cancer. When Collecting data from the client, which of the following manifestations should the nurse expect? Abdominal cramps 39. A nurse is preparing to administer digoxin to a client who has heart failure. Which of the following findings should indicate to the nurse that the medication is effective? Cardiac workload decreases 40. A nurse is discussing alopecia with a client who is scheduled to begin chemotherapy. Which of the following statements should the nurse make? "Your oncologist may prescribe a cold cap to wear during treatment to reduce hair loss." 41. A nurse is reinforcing teaching about stress management techniques with a client who has moderate anxiety disorder. Which of the following responses by the client indicates an understanding of the teaching? "I will imagine myself in a calm place when I can't concentrate." 42. a nurse is caring for a female client during an outpatient clinic visit. Which of the following findings places the client at risk for coronary artery disease? The client's LDL level 43. A nurse is reinforcing teaching with a client who is at 20 weeks of gestation and will undergo routine abdominal ultrasonography the following day. Which of the following statements should the nurse include in the teaching? "You will need to have a full bladder for the procedure." 44. a nurse is reviewing the plan of care for a client who is 3 hr postoperative following a thyroidectomy. Which of the following is the priority intervention? Listen to the client for evidence of stridor. 45. A nurse in a long term care facility is reviewing information about health care associated infection with a newly licensed nurse. Which of the following information should the nurse include? Prolonged use of corticosteroids is a risk factor for infection. 46. A nurse is collecting data on a client who has post-traumatic stress disorder which of the following manifestations should the nurse expect? Hyper vigilance 47. A nurse is caring for a client who has multiple sclerosis. Which of the following manifestations should the nurse expect? Ataxia 48.A nurse is checking a newborn's vital signs. Which of the following methods of temperature measurement should the nurse use? Axillary 49. A nurse in a provider's office is collecting data from a preschooler. Which of the following findings should the nurse report to the provider? Heart rate 146/min 50. A nurse is preparing to discharge a middle adult client who is immunocompromised. Which of the following immunizations should the nurse plan to administer? Pneumococcal polysaccharide (PPSV) vaccine 51. A nurse is caring for an infant who is receiving IV fluids for dehydration. Which of the following should the nurse recognize as a positive response to therapy? Moist mucous membranes 52. A nurse is preparing a client for surgery. The client states, "I'm sure this surgery will not help me get better" Which of the following responses should the nurse make? "You're saying that you are doubtful that this procedure will benefit you." 53. A nurse at a long term care facility is transcribing new prescriptions for 4 clients. Which of the following prescriptions is accurately transcribed by the nurse? Potassium chloride 20 mEq PO every morning 54. A charge nurse in a long term care facility notices an assistant’s repeated failure to provide oral care for clients. Which of the following actions should the nurse take? Discuss the unacceptable behavior with the AP while reinforcing expectations. 55. A Nurse is reinforcing teaching with a male client who is uncircumcised about obtaining a cleancatch midstream urine specimen. Identify the sequence of actions the client should take after washing his hands. Retract the foreskin to expose the glans cleanse the penis using an antiseptic swab Begin to urinate pass the urine container into the stream collect the specimen move the container out of the stream Replace the foreskin 56. A nurse is reinforcing teaching with a client who has a new diagnosis ofItype 2 diabetes mellitus and inquires about information concerning oral anti diabetic agents. In addition to the provider, where should the nurse refer the client for information? A pharmacist Package inserts American Diabetes Association 57. A nurse is caring for four clients who are all scheduled for surgery on the same day. Which of the following nursing actions demonstrates that the nurse possesses efollowingective time management skills? Gathers all needed supplies and equipment before entering client rooms Completes one task before beginning a new task Documents the clients' preoperative vital signs when they are taken Delegates tasks to an assistive personnel (AP) that are within his range of function 58. A nurse in a long term care facility is serving on the ethics committee, which is addressing a client care dilemma. Which of the following strategies will facilitate resolving the dilemma? Determine the facts related to the dilemma. Identify possible solutions. Consider the client's wishes 59. In planning care for the patient with ulcerative colitis, the nurse identifies which nursing diagnoses as a priority? C. Fluid volume deficit 60. A nurse in a long-term care facility is assisting with an inservice for newly hired assistive personnel about legal issues within the facility. Which of the following should the nurse include as an example of assault? Informing a client the nurse is going to administer an injection even though the client refuses 61. A client tell the practical nurse (PN) that he is afraid about his scheduled surgery. How should the PN respond ? D. Tell me what is making you fell afraid 62. The practical nurse (PN) is caring for a client newly diagnosed with diabetes mellitus (DM). which finding is an early sign of hypoglycemia D. Difficulty swallowing 63. A nurse in a PACU is caring for a client who is postoperative following a knee arthroplasty using general anesthesia. Which of the following findings should the nurse report to the provider immediately? Nasal flaring is present with inspiratory stridor 64. A nurse is planning care for a group of clients. Which of the following methods should the nurse use to manage time effectively? Gather supplies prior to completing a dressing change 65. a nurse is assessing a client who is receiving peritoneal dialysis for manifestation for peritonitis. Which of the following findings should the nurse identify as the first indication of peritonitis? Abdominal pain 67. A nurse is caring for a client who is comatose and has advance directives that indicate the client does not want life sustaining measures. The client’s family wants the client to have life sustaining measures. Which of the following actions should the nurse take? Arrange for an ethics committee meeting to address the family’s concerns 68. A nurse is preparing to administer a NG tube feeding to a school age child. Which of the following actions should the nurse plan to take? Measure the tubing form the nose to the distal port 69. A nurse is reviewing the lab report of a client who has been receiving lithium carbonate for the past 12 months. The nurse notes a lithium level of 0.8. which of the following orders from the provider should the nurse expect? Administer the medication 70. A nurse is a mental health facility is airing for a child who is experiencing a panic level of anxiety. Which of the following actions should the nurse take? Encourage the client to take about his feelings 71. A nurse is teaching a group of newly licensed nurses about client advocacy. Which of the following statements by a newly licensed nurse indicates an understandings of the teaching? I will interfere if there is a conflict between a client and his provider 72. A nurse is caring for a client who has schizophrenia and is experiencing auditory hallucinations. Which of the following actions should the nurse take? offer the client headphones to listen to music. 73. A nurse is reinforcing teaching with a client about taking warfarin to treat atrial fibrillation. Which of the following statements by the client indicates an understanding of the teaching? If I forget to take a dose, I can take it later on the same day." 74. A nurse is working with an interpreter to explain a diagnostic procedure to a client who doesn't speak the same language as the nurse. Which of the following actions should the nurse take? : Ensure the interpreter is culturally compatible with the client. 75. A nurse is reinforcing discharge teaching with a client who has dependent personality disorder. Which of the following instructions should the nurse include in the discharge teaching? Demonstrate assertiveness. 76. A nurse is contributing to the discharge plan for a client who had a knee arthroplasty. Which of the following actions should the nurse identify as the priority? Check the client's mobility 77. A nurse in a longterm care facility is assisting with the admission of a client who requires oropharyngeal suctioning. Which of the following supplies does the nurse need to perform this task? : Yankauer catheter 78. A nurse is collecting data from a client who is 24 hr post op from an open colon resection, has a clamped NG tube, and is resuming a clean liquid diet. Which of the following findings should the nurse report to the provider? Client reports vomiting green-tinged fluid. 79. A nurse is caring for a client who took an overdose of Acetaminophen. Which of the following medications should the nurse plan to administer to the client? Acetyl cysteine 80. A nurse delegates the collection of a sputum specimen from a client who has tuberculosis to an assistive personnel. At which of the following times should the nurse instruct the ap to collect the specimen? As soon as the client wakes up. 81. Which action by a practical Nurse (PN) indicates the best understanding of the principles related yto medical asepsis and effective hand washing? D. Hold the hands lower than the elbow to promote microbe removal 82. The mother of a young child with eczema asks about the type of clothing that is best for her childs comfort. Which choice should the practical nurse recommend? D. cotton 84. A male client with polycythemia Vera is scheduled for phlebotomy in the unit’s procedure room. Which action should the practical nurse (PN) implement when coordinating departmental services for this procedure? B. Schedule the treatment with the special procedure department 86. A nurse observes an AP providing care to a child who is in skeletal traction. Which of the following action requires intervention? c) Placing weights as a child’s bed 87 A nurse is planning to delegate to an AP the fasting blood glucose testing for a client who has diabetes mellitus. Which of the following action should the nurse take? a) Determine if the AP is qualified to perform the test. 88 A nurse is assessing client brought to the hospital psychiatric emergency services by a law enforcement officer. The client has disorganized, incoherent speech with loose associations and religious content. You should recognize the signs and symptoms as being consistent with which of the following? b) Schizophrenia 89. A nurse is caring for a child who has infectious mononucleosis.. Which of the following findings are associated with this diagnosis? Select all that apply a) splenomegaly c) Malaise e) Sore throat 90 Nurse is performing dressing change for client was a sacral wound using negative pressure wound therapy. Which The following actions should the nurse take first? d) Determine pain level 91. A nurses caring for client recovery from the bowel surgery who has nasogastric tube connected to low intermittent suction. Which the following assessment findings should indicate to the nurse that the NG tube may not be functioning properly? c) Abdominal rigidity 92. A nurse is preparing to administer TPN with added fat supplements to a client who has malnutrition. Which of the following action should the nurse take? b) Check for an allergy to eggs 93. A charge nurse is discussing the use of applying ice to a client’s injured knee with a newly licensed nurse. Which of the following should the nurse identify as a benefit? (A/C?) c) Decreased capillary permeability 94 Nurse is developing discharge care plans for client has osteoporosis. To prevent injury the nurse should instruct the client to a) Perform weight bearing exercises 95 A nurse on acute med-surgical unit is performing assessments on a group of clients. Which is highest priority? a) The client has surgical hypoparathyroidism and positive Trousseau’s sign 96 Nurses caring for a client was congestive heart failure. Which of the following prescriptions for the provider should the nurse anticipate? c) Give the client enalapril 2.5 mg PO twice daily 97 A nurse is caring for a client who has a prescription for sertraline to treat depression. Which of the following statements by the client indicates an understanding of the medication treatment plan? c) I understand I may experience difficulty sleeping on this medication 98. A nurse has been caring for a female client who has bruises on her arms that she explains are a result of physical abuse by her husband. The client states, “I don’t know how much longer I can take this, but I’m afraid he’ll really hurt me if I leave. “Which of the following is an appropriate nursing intervention?” b) Help the client to recognize the signs of escalation of abuse behavior 99. A client was having suicidal thoughts tells the nurse “It just does not seem worth it anymore. Why not end my misery?” Which of the following responses for the nurses appropriate? b) Do you have a plan to end your life? 100. Nurse providing discharge teaching to the client who has schizophrenia and is starting therapy with Clozapine. Which of the following is the highest priority for the client to report to the provider? c) Fever 101. A nurse is preparing a client for surgery. The client states, "I'm sure this surgery will not help me get better" Which of the following responses should the nurse make "You're saying that you are doubtful that this procedure will benefit you. " 102. A nurse at a long term care facility is transcribing new prescriptions for 4 client s. Which of the following prescriptions is accurately transcribed by the nurse? ANS: Potassium chloride 20 mEq PO every morning 103. A charge nurse in a long term care facility notices an assistants repeated failure to provide oral care for clients. Which of the following actions should the nurse take? Discuss the unacceptable behavior with the AP while reinforcing expectations. 104. A Nurse is reinforcing teaching with a male client who is uncircumcised about obtaining a cleancatch midstream urine specimen. Identify the sequence of actions the client should take after washing his hands. Retract the foreskin to expose the glans cleanse the penis using an antiseptic swab Begin to urinate pass the urine container into the stream collect the specimen move the container out of the stream Replace the foreskin 105. A nurse is reinforcing teaching with a client who has a new diagnosis of type 2 diabetes mellitus and inquires about information concerning oral anti diabetic agents. In addition to the provider, where should the nurse refer the client for information? A pharmacist Package inserts American Diabetes Association 106. A nurse is caring for four clients who are all scheduled for surgery on the same day. Which of the following nursing actions demonstrates that the nurse possesses effective time management skills? Gathers all needed supplies and equipment before entering client rooms Completes one task before beginning a new task Documents the clients' preoperative vital signs when they are taken Delegates tasks to an assistive personnel (AP) that are within his range of function 107. A nurse in a long term care facility is serving on the ethics committee, which is addressing a client care dilemma. Which of the following strategies will facilitate resolving the dilemma? Determine the facts related to the dilemma. Identify possible solutions. Consider the client's wishes. 108. A clients daughters phones the charge nurse to report that the night nurse did not provide good care of her mother. Which response should the practical nurse make? c. Tell the daughter to talk with the units nurse manager. 109. A nurse is caring for a client who speaks a language different from the nurse. Which of the following actions should the nurse take? use a facility based interpreter of the same sex as the client 110. A nurse is caring for a 1 day old newborn who has jaundice and is receiving phototherapy. Which of the following actions should the nurse take? Ensure that the newborn wears a diaper