HESI EXIT RN V4 QUESTIONS AND
ANSWERS WITH SOLUTIONS 2024
1. The nurse is caring for a pre-adolescent client in skeletal Dunlop traction. Which nursing intervention
is appropriate for this child?
A) Make certain the child is maintained in correct body alignment.
B) Be sure the traction weights touch the end of the bed.
C) Adjust the head and foot of the bed for the child's comfort
D) Release the traction for 15-20 minutes every 6 hours PRN. - ANSWER A: Make certain the child is
maintained in correct body alignment.
2. The nurse is assessing a healthy child at the 2 year check up. Which of the following should the nurse
report immediately to the health care provider?
A) Height and weight percentiles vary widely
B) Growth pattern appears to have slowed
C) Recumbent and standing height are different
D) Short term weight changes are uneven - ANSWER A: Height and weight percentiles vary widely
3. The parents of a 2 year-old child report that he has been holding his breath whenever he has temper
tantrums. What is the best action by the nurse?
A) Teach the parents how to perform cardiopulmonary resuscitation
B) Recommend that the parents give in when he holds his breath to prevent anoxia
C) Advise the parents to ignore breath holding because breathing will begin as a reflex
D) Instruct the parents on how to reason with the child about possible harmful effects - ANSWER C:
Advise the parents to ignore breath holding because breathing will begin as a reflex
4. The nurse is assessing a client in the emergency room. Which statement suggests that the problem is
acute angina?
,A) "My pain is deep in my chest behind my sternum."
B) "When I sit up the pain gets worse."
C) "As I take a deep breath the pain gets worse."
D) "The pain is right here in my stomach area." - ANSWER A: "My pain is deep in my chest behind my
sternum."
5. The nurse is assessing the mental status of a client admitted with possible organic brain disorder.
Which of these questions will best assess the function of the client's recent memory?
A) "Name the year." "What season is this?" (pause for answer after each question)
B) "Subtract 7 from 100 and then subtract 7 from that." (pause for answer) "Now continue to subtract 7
from the new number."
C) "I am going to say the names of three things and I want you to repeat them after me: blue, ball, pen."
D) "What is this on my wrist?" (point to your watch) Then ask, "What is the purpose of it?" - ANSWER C:
"I am going to say the names of three things and I want you to repeat them after me: blue, ball, pen."
6. In planning care for a 6 month-old infant, what must the nurse provide to assist in the development of
trust?
A) Food
B) Warmth
C) Security
D) Comfort - ANSWER C: Security
7. A nurse has just received a medication order which is not legible. Which statement best reflects
assertive communication?
A) "I cannot give this medication as it is written. I have no idea of what you mean."
B) "Would you please clarify what you have written so I am sure I am reading it correctly?"
C) "I am having difficulty reading your handwriting. It would save me time if you would be more careful."
,D) "Please print in the future so I do not have to spend extra time attempting to read your writing." -
ANSWER B) "Would you please clarify what you have written so I am sure I am reading it correctly?"
8. What is the most important consideration when teaching parents how to reduce risks in the home?
A) Age and knowledge level of the parents
B) Proximity to emergency services
C) Number of children in the home
D) Age of children in the home - ANSWER D: Age of children in the home
9. A 35 year-old client with sickle cell crisis is talking on the telephone but stops as the nurse enters the
room to request something for pain. The nurse should
A) Administer a placebo
B) Encourage increased fluid intake
C) Administer the prescribed analgesia
D) Recommend relaxation exercises for pain control - ANSWER C: Administer the prescribed analgesia
10. While caring for a toddler with croup, which initial sign of croup requires the nurse's immediate
attention?
A) Respiratory rate of 42
B) Lethargy for the past hour
C) Apical pulse of 54
D) Coughing up copious secretions - ANSWER A: Respiratory rate of 30
11. A client is admitted with low T3 and T4 levels and an elevated TSH level. On initial assessment, the
nurse would anticipate which of the following assessment findings?
A) Lethargy
, B) Heat intolerance
C) Diarrhea
D) Skin eruptions - ANSWER A: Lethargy
12. The emergency room nurse admits a child who experienced a seizure at school. The father comments
that this is the first occurrence, and denies any family history of epilepsy. What is the best response by
the nurse?
A) "Do not worry. Epilepsy can be treated with medications."
B) "The seizure may or may not mean your child has epilepsy."
C) "Since this was the first convulsion, it may not happen again."
D) "Long term treatment will prevent future seizures." - ANSWER B: "The seizure may or may not mean
your child has epilepsy."
13. Alcohol and drug abuse impairs judgment and increases risk taking behavior. What nursing diagnosis
best applies?
A) Risk for injury
B) Risk for knowledge deficit
C) Altered thought process
D) Disturbance in self-esteem - ANSWER A: Risk for injury
14. The nurse is caring for a 10 month-old infant who is has oxygen via mask. It is important for the nurse
to maintain patency of which of these areas?
A) Mouth
B) Nasal passages
C) Back of throat
D) Bronchials - ANSWER B: Nasal passages
ANSWERS WITH SOLUTIONS 2024
1. The nurse is caring for a pre-adolescent client in skeletal Dunlop traction. Which nursing intervention
is appropriate for this child?
A) Make certain the child is maintained in correct body alignment.
B) Be sure the traction weights touch the end of the bed.
C) Adjust the head and foot of the bed for the child's comfort
D) Release the traction for 15-20 minutes every 6 hours PRN. - ANSWER A: Make certain the child is
maintained in correct body alignment.
2. The nurse is assessing a healthy child at the 2 year check up. Which of the following should the nurse
report immediately to the health care provider?
A) Height and weight percentiles vary widely
B) Growth pattern appears to have slowed
C) Recumbent and standing height are different
D) Short term weight changes are uneven - ANSWER A: Height and weight percentiles vary widely
3. The parents of a 2 year-old child report that he has been holding his breath whenever he has temper
tantrums. What is the best action by the nurse?
A) Teach the parents how to perform cardiopulmonary resuscitation
B) Recommend that the parents give in when he holds his breath to prevent anoxia
C) Advise the parents to ignore breath holding because breathing will begin as a reflex
D) Instruct the parents on how to reason with the child about possible harmful effects - ANSWER C:
Advise the parents to ignore breath holding because breathing will begin as a reflex
4. The nurse is assessing a client in the emergency room. Which statement suggests that the problem is
acute angina?
,A) "My pain is deep in my chest behind my sternum."
B) "When I sit up the pain gets worse."
C) "As I take a deep breath the pain gets worse."
D) "The pain is right here in my stomach area." - ANSWER A: "My pain is deep in my chest behind my
sternum."
5. The nurse is assessing the mental status of a client admitted with possible organic brain disorder.
Which of these questions will best assess the function of the client's recent memory?
A) "Name the year." "What season is this?" (pause for answer after each question)
B) "Subtract 7 from 100 and then subtract 7 from that." (pause for answer) "Now continue to subtract 7
from the new number."
C) "I am going to say the names of three things and I want you to repeat them after me: blue, ball, pen."
D) "What is this on my wrist?" (point to your watch) Then ask, "What is the purpose of it?" - ANSWER C:
"I am going to say the names of three things and I want you to repeat them after me: blue, ball, pen."
6. In planning care for a 6 month-old infant, what must the nurse provide to assist in the development of
trust?
A) Food
B) Warmth
C) Security
D) Comfort - ANSWER C: Security
7. A nurse has just received a medication order which is not legible. Which statement best reflects
assertive communication?
A) "I cannot give this medication as it is written. I have no idea of what you mean."
B) "Would you please clarify what you have written so I am sure I am reading it correctly?"
C) "I am having difficulty reading your handwriting. It would save me time if you would be more careful."
,D) "Please print in the future so I do not have to spend extra time attempting to read your writing." -
ANSWER B) "Would you please clarify what you have written so I am sure I am reading it correctly?"
8. What is the most important consideration when teaching parents how to reduce risks in the home?
A) Age and knowledge level of the parents
B) Proximity to emergency services
C) Number of children in the home
D) Age of children in the home - ANSWER D: Age of children in the home
9. A 35 year-old client with sickle cell crisis is talking on the telephone but stops as the nurse enters the
room to request something for pain. The nurse should
A) Administer a placebo
B) Encourage increased fluid intake
C) Administer the prescribed analgesia
D) Recommend relaxation exercises for pain control - ANSWER C: Administer the prescribed analgesia
10. While caring for a toddler with croup, which initial sign of croup requires the nurse's immediate
attention?
A) Respiratory rate of 42
B) Lethargy for the past hour
C) Apical pulse of 54
D) Coughing up copious secretions - ANSWER A: Respiratory rate of 30
11. A client is admitted with low T3 and T4 levels and an elevated TSH level. On initial assessment, the
nurse would anticipate which of the following assessment findings?
A) Lethargy
, B) Heat intolerance
C) Diarrhea
D) Skin eruptions - ANSWER A: Lethargy
12. The emergency room nurse admits a child who experienced a seizure at school. The father comments
that this is the first occurrence, and denies any family history of epilepsy. What is the best response by
the nurse?
A) "Do not worry. Epilepsy can be treated with medications."
B) "The seizure may or may not mean your child has epilepsy."
C) "Since this was the first convulsion, it may not happen again."
D) "Long term treatment will prevent future seizures." - ANSWER B: "The seizure may or may not mean
your child has epilepsy."
13. Alcohol and drug abuse impairs judgment and increases risk taking behavior. What nursing diagnosis
best applies?
A) Risk for injury
B) Risk for knowledge deficit
C) Altered thought process
D) Disturbance in self-esteem - ANSWER A: Risk for injury
14. The nurse is caring for a 10 month-old infant who is has oxygen via mask. It is important for the nurse
to maintain patency of which of these areas?
A) Mouth
B) Nasal passages
C) Back of throat
D) Bronchials - ANSWER B: Nasal passages
