EXIT HESI - COMPREHENSIVE PN EXAM
A PRACTICE QUESTIONS PERFECTLY
SOLVED
A ynurse ywho yhas yrecently ycompleted yorientation yis ybeginning ywork yin ythe ylabor
yand ydelivery yunit yfor ythe yfirst ytime. yWhen ymaking yassignments, ywhich yclient
yshould ythe ycharge ynurse yassign yto ythis ynew ynurse? y- yA ymultiparous yclient ywho yis
ydilated y5 ycm yand y50% yeffaced
A yclient ywith yhuman yimmunodeficiency yvirus y(HIV) yinfection yhas ywhite ylesions yin
ythe yoral ycavity ythat yresemble ymilk ycurds. yNystatin y(Mycostatin) ypreparation yis
yprescribed yas ya yswish yand yswallow. yWhich yinformation yis ymost yimportant yfor ythe
ynurse yto yprovide ythe yclient? y- yOral yhygiene yshould ybe yperformed ybefore ythe
ymedication.
A yclient ywho yis yadmitted ywith yemphysema yis yhaving ydifficulty ybreathing. yIn ywhich
yposition yshould ythe ynurse yplace ythe yclient? y- ySitting yupright yand yforward ywith yboth
yarms ysupported yon yan yover ythe ybed ytable
A yclient ywith ychronic yrenal yinsufficiency y(CRI) yis ytaking y25 ymg yof
yhydrochlorothiazide y(HCTZ) yPO yand y40 ymg yof yfurosemide y(Lasix) yPO ydaily.
yToday, yat ya yroutine yclinic yvisit, ythe yclient's yserum ypotassium ylevel yis y4 ymEq/L.
yWhat yis ythe ymost ylikely ycause yof ythis yclient's ypotassium ylevel? y- yThe yclient's
yrenal yfunction yhas yaffected yhis ypotassium ylevel.
A yregistered ynurse y(RN) ydelivers ytelehealth yservices yto yclients yvia yelectronic
ycommunication. yWhich ynursing yaction ycreates ythe ygreatest yrisk yfor yprofessional
yliability yand yhas ythe ypotential yfor ya ymalpractice ylawsuit? y- ySending ymedical
yrecords yto yhealth ycare yproviders yvia ythe yInternet
Which ypathophysiologic yresponse ysupports ythe ycontraindication yfor yopioids, ysuch
yas ymorphine, yin yclients ywith yincreased yintracranial ypressure y(ICP)?
A.Sedation yproduced yby yopioids yis ya yresult yof ya yprolonged yhalf-life ywhen ythe yICP
yis yelevated.
yB.Higher ydoses yof yopioids yare yrequired ywhen ycerebral yblood yflow yis yreduced yby
yan yelevated yICP.
yC.Dysphoria yfrom yopioids ycontributes yto yaltered ylevels yof yconsciousness ywith yan
yelevated yICP.
D.Opioids ysuppress yrespirations, ywhich yincreases yPco2 yand ycontributes yto yan
yelevated yICP. y- yD
,The ygreatest yrisk yassociated ywith yopioids ysuch yas ymorphine y(D) yis yrespiratory
ydepression ythat ycauses yan yincrease yin yPco2, ywhich yincreases yICP yand ymasks ythe
yearly ysigns yof yintracranial ybleeding yin yhead yinjury. y(A, yB, yand yC) ydo ynot ysupport
ythe yrisks yassociated ywith yopioid yuse yin ya yclient ywith yincreased yICP.
The ycharge ynurse yof ya ymedical ysurgical yunit yis yalerted yto yan yimpending ydisaster
yrequiring yimplementation yof ythe yhospital's ydisaster yplan. ySpecific yfacts yabout ythe
ynature yof ythis ydisaster yare ynot yyet yknown. yWhich yinstruction yshould ythe ycharge
ynurse ygive yto ythe yother ystaff ymembers yat ythis ytime?
A.Prepare yto yevacuate ythe yunit, ystarting ywith ythe ybedridden yclients.
yB.UAPs yshould yreport yto ythe yemergency ycenter yto yhandle ytransports.
yC.The ylicensed ystaff yshould ybegin ycounting ywheelchairs yand yIV ypoles yon ythe yunit.
yD.Continue ywith ycurrent yassignments yuntil ymore yinstructions yare yreceived. y- yD
When yfaced ywith yan yimpending ydisaster, yhospital ypersonnel ymay ybe yalerted ybut
yshould ycontinue ywith ycurrent yclient ycare yassignments yuntil yfurther yinstructions yare
yreceived y(D). yEvacuation yis ytypically ya yresponse yof ylast yresort ythat ybegins ywith
yclients ywho yare ymost yable yto yambulate y(A). y(B) yis ypremature yand yis ylikely yto
yincrease ythe ychaos yif yincoming ycasualties yare yanticipated. y(C) yis ypoor yutilization
yof ypersonnel.
The ynurse yassesses ya yclient ywhile ythe yUAP ymeasures ythe yclient's yvital ysigns. yThe
yclient's yvital ysigns ychange ysuddenly, yand ythe ynurse ydetermines ythat ythe yclient's
ycondition yis yworsening. yThe ynurse yis yunsure yof ythe yclient's yresuscitative ystatus
yand yneeds yto ycheck ythe yclient's ymedical yrecord yfor yany yadvanced ydirectives.
yWhich yaction yshould ythe ynurse yimplement?
A.Ask ythe yUAP yto ycheck yfor ythe yadvanced ydirective ywhile ythe ynurse ycompletes
ythe yassessment.
B.Assign ythe yUAP yto ycomplete ythe yassessment ywhile ythe ynurse ychecks yfor ythe
yadvanced ydirective.
C.Check ythe ymedical yrecord yfor ythe yadvanced ydirective yand ythen ycomplete ythe
yclient yassessment.
yD.Call yfor ythe ycharge ynurse yto ycheck ythe yadvanced ydirective ywhile ycontinuing yto
yassess ythe yclient. y- yD
Because ythe yclient's ycondition yis yworsening, ythe ynurse yshould yremain ywith ythe
yclient yand ycontinue ythe yassessment ywhile ycalling yfor yhelp yfrom ythe ycharge ynurse
yto ydetermine ythe yclient's yresuscitative ystatus y(D). y(A yand yB) yare ytasks ythat ymust
ybe ycompleted yby ya ynurse yand ycannot ybe ydelegated yto ythe yUAP. y(C) yis
ycontraindicated.
The ynurse yis ypreparing ya yclient yfor ysurgery yscheduled yin y2 yhours. yA yUAP yis
yhelping ythe ynurse. yWhich ytask yis yimportant yfor ythe ynurse yto yperform, yrather ythan
ythe yUAP?
A.Remove ythe yclient's ynail ypolish yand ydentures.
, yB.Assist ythe yclient yto ythe yrestroom yto yvoid.
yC.Obtain ythe yclient's yheight yand yweight.
yD.Offer ythe yclient yemotional ysupport. y- yD
By yusing ytherapeutic ytechniques yto yoffer ysupport y(D), ythe ynurse ycan ydetermine
yany yclient yconcerns ythat yneed yto ybe yaddressed. y(A, yB, yand yC) yare yall yactions
ythat ycan ybe yperformed yby ythe yUAP yunder ythe ysupervision yof ythe ynurse.
Until ythe ycensus yon ythe yobstetrics y(OB) yunit yincreases, yan yunlicensed yassistive
ypersonnel y(UAP) ywho yusually yworks yin ylabor yand ydelivery yand ythe ynewborn
ynursery yis yassigned yto ywork yon ythe ypostoperative yunit. yWhich yclient ywould ybe
ybest yfor ythe ycharge ynurse yto yassign yto ythis yUAP?
yA.An yadolescent ywho ywas yreadmitted yto ythe yhospital ybecause yof ya ypostoperative
yinfection
yB.A ywoman ywith ya ynew ycolostomy ywho yrequires ydischarge yteaching
yC.A ywoman ywho yhad ya yhip yreplacement yand ymay ybe ytransferred yto ythe yhome
ycare yunit
yD.A yman ywho yhad ya ycholecystectomy yand ycurrently yhas ya ynasogastric ytube yset
yto yintermittent ysuction y- yC
The ycharge ynurse ywill ybe yresponsible yfor yproviding ya yreport yto ythe yhome ycare yunit
yif ythe ytransfer yoccurs y(A). yThe yclient yis yinfected yand yan yemployee ywho yworks yon
yan yOB yunit yshould ybe yassigned yto yclean ycases yin ycase ythe yemployee yis yrequired
yto yreturn yto ythe yOB yunit y(B). yThis yrequires ythe yskills yof ya yregistered ynurse y(RN)
yto ydo ydischarge yteaching yand yprovide yemotional ysupport y(D). yThis ymay yrequire
yskills ybeyond ythe ylevel yof ythis yUAP.
A ymale yclient yis yadmitted yfor yobservation yafter ybeing yhit yon ythe yhead ywith ya
ybaseball ybat. ySix yhours yafter yadmission, ythe yclient yattempts yto ycrawl yout yof ybed
yand yasks ythe ynurse ywhy ythere yare yso ymany ybugs yin yhis ybed. yHis yvital ysigns yare
ystable, yand ythe ypulse yoximeter yreading yis y98% yon yroom yair. yWhich yintervention
yshould ythe ynurse yperform yfirst?
A.Administer yoxygen yper ynasal ycannula yat y2 yL/min.
B.Plan yto ycheck yhis yvital ysigns yagain yin y30 yminutes.
C.Notify ythe yhealth ycare yprovider yof ythe ychange yin ymental ystatus.
D.Ask ythe yclient ywhy yhe ythinks ythere yare ybugs yin ythe ybed. y- yC
One yof ythe yearliest ysigns yof yincreased yintracranial ypressure y(ICP) yis ya ychange yin
ymental ystatus y(C). yIt yis yimportant yto yact yearly yand yquickly ywhen ysymptoms yof
yincreased yICP yoccur. yBecause yhis yoxygen ysaturation yis ynormal, ythe yadministration
yof yoxygen y(A) yis ynot ythe ytop ypriority. yVital ysigns yshould ybe ymonitored yfrequently
y(B), ybut ythe yclient's yconfusion yshould ybe yreported yimmediately. y(D) yis ynot ya yuseful
yintervention.
The ynurse yis ymonitoring ya yclient ywho yis yreceiving ybedside yconscious ysedation ywith
ymidazolam yhydrochloride y(Versed). yIn yassessing ythe yclient, ythe ynurse ydetermines
A PRACTICE QUESTIONS PERFECTLY
SOLVED
A ynurse ywho yhas yrecently ycompleted yorientation yis ybeginning ywork yin ythe ylabor
yand ydelivery yunit yfor ythe yfirst ytime. yWhen ymaking yassignments, ywhich yclient
yshould ythe ycharge ynurse yassign yto ythis ynew ynurse? y- yA ymultiparous yclient ywho yis
ydilated y5 ycm yand y50% yeffaced
A yclient ywith yhuman yimmunodeficiency yvirus y(HIV) yinfection yhas ywhite ylesions yin
ythe yoral ycavity ythat yresemble ymilk ycurds. yNystatin y(Mycostatin) ypreparation yis
yprescribed yas ya yswish yand yswallow. yWhich yinformation yis ymost yimportant yfor ythe
ynurse yto yprovide ythe yclient? y- yOral yhygiene yshould ybe yperformed ybefore ythe
ymedication.
A yclient ywho yis yadmitted ywith yemphysema yis yhaving ydifficulty ybreathing. yIn ywhich
yposition yshould ythe ynurse yplace ythe yclient? y- ySitting yupright yand yforward ywith yboth
yarms ysupported yon yan yover ythe ybed ytable
A yclient ywith ychronic yrenal yinsufficiency y(CRI) yis ytaking y25 ymg yof
yhydrochlorothiazide y(HCTZ) yPO yand y40 ymg yof yfurosemide y(Lasix) yPO ydaily.
yToday, yat ya yroutine yclinic yvisit, ythe yclient's yserum ypotassium ylevel yis y4 ymEq/L.
yWhat yis ythe ymost ylikely ycause yof ythis yclient's ypotassium ylevel? y- yThe yclient's
yrenal yfunction yhas yaffected yhis ypotassium ylevel.
A yregistered ynurse y(RN) ydelivers ytelehealth yservices yto yclients yvia yelectronic
ycommunication. yWhich ynursing yaction ycreates ythe ygreatest yrisk yfor yprofessional
yliability yand yhas ythe ypotential yfor ya ymalpractice ylawsuit? y- ySending ymedical
yrecords yto yhealth ycare yproviders yvia ythe yInternet
Which ypathophysiologic yresponse ysupports ythe ycontraindication yfor yopioids, ysuch
yas ymorphine, yin yclients ywith yincreased yintracranial ypressure y(ICP)?
A.Sedation yproduced yby yopioids yis ya yresult yof ya yprolonged yhalf-life ywhen ythe yICP
yis yelevated.
yB.Higher ydoses yof yopioids yare yrequired ywhen ycerebral yblood yflow yis yreduced yby
yan yelevated yICP.
yC.Dysphoria yfrom yopioids ycontributes yto yaltered ylevels yof yconsciousness ywith yan
yelevated yICP.
D.Opioids ysuppress yrespirations, ywhich yincreases yPco2 yand ycontributes yto yan
yelevated yICP. y- yD
,The ygreatest yrisk yassociated ywith yopioids ysuch yas ymorphine y(D) yis yrespiratory
ydepression ythat ycauses yan yincrease yin yPco2, ywhich yincreases yICP yand ymasks ythe
yearly ysigns yof yintracranial ybleeding yin yhead yinjury. y(A, yB, yand yC) ydo ynot ysupport
ythe yrisks yassociated ywith yopioid yuse yin ya yclient ywith yincreased yICP.
The ycharge ynurse yof ya ymedical ysurgical yunit yis yalerted yto yan yimpending ydisaster
yrequiring yimplementation yof ythe yhospital's ydisaster yplan. ySpecific yfacts yabout ythe
ynature yof ythis ydisaster yare ynot yyet yknown. yWhich yinstruction yshould ythe ycharge
ynurse ygive yto ythe yother ystaff ymembers yat ythis ytime?
A.Prepare yto yevacuate ythe yunit, ystarting ywith ythe ybedridden yclients.
yB.UAPs yshould yreport yto ythe yemergency ycenter yto yhandle ytransports.
yC.The ylicensed ystaff yshould ybegin ycounting ywheelchairs yand yIV ypoles yon ythe yunit.
yD.Continue ywith ycurrent yassignments yuntil ymore yinstructions yare yreceived. y- yD
When yfaced ywith yan yimpending ydisaster, yhospital ypersonnel ymay ybe yalerted ybut
yshould ycontinue ywith ycurrent yclient ycare yassignments yuntil yfurther yinstructions yare
yreceived y(D). yEvacuation yis ytypically ya yresponse yof ylast yresort ythat ybegins ywith
yclients ywho yare ymost yable yto yambulate y(A). y(B) yis ypremature yand yis ylikely yto
yincrease ythe ychaos yif yincoming ycasualties yare yanticipated. y(C) yis ypoor yutilization
yof ypersonnel.
The ynurse yassesses ya yclient ywhile ythe yUAP ymeasures ythe yclient's yvital ysigns. yThe
yclient's yvital ysigns ychange ysuddenly, yand ythe ynurse ydetermines ythat ythe yclient's
ycondition yis yworsening. yThe ynurse yis yunsure yof ythe yclient's yresuscitative ystatus
yand yneeds yto ycheck ythe yclient's ymedical yrecord yfor yany yadvanced ydirectives.
yWhich yaction yshould ythe ynurse yimplement?
A.Ask ythe yUAP yto ycheck yfor ythe yadvanced ydirective ywhile ythe ynurse ycompletes
ythe yassessment.
B.Assign ythe yUAP yto ycomplete ythe yassessment ywhile ythe ynurse ychecks yfor ythe
yadvanced ydirective.
C.Check ythe ymedical yrecord yfor ythe yadvanced ydirective yand ythen ycomplete ythe
yclient yassessment.
yD.Call yfor ythe ycharge ynurse yto ycheck ythe yadvanced ydirective ywhile ycontinuing yto
yassess ythe yclient. y- yD
Because ythe yclient's ycondition yis yworsening, ythe ynurse yshould yremain ywith ythe
yclient yand ycontinue ythe yassessment ywhile ycalling yfor yhelp yfrom ythe ycharge ynurse
yto ydetermine ythe yclient's yresuscitative ystatus y(D). y(A yand yB) yare ytasks ythat ymust
ybe ycompleted yby ya ynurse yand ycannot ybe ydelegated yto ythe yUAP. y(C) yis
ycontraindicated.
The ynurse yis ypreparing ya yclient yfor ysurgery yscheduled yin y2 yhours. yA yUAP yis
yhelping ythe ynurse. yWhich ytask yis yimportant yfor ythe ynurse yto yperform, yrather ythan
ythe yUAP?
A.Remove ythe yclient's ynail ypolish yand ydentures.
, yB.Assist ythe yclient yto ythe yrestroom yto yvoid.
yC.Obtain ythe yclient's yheight yand yweight.
yD.Offer ythe yclient yemotional ysupport. y- yD
By yusing ytherapeutic ytechniques yto yoffer ysupport y(D), ythe ynurse ycan ydetermine
yany yclient yconcerns ythat yneed yto ybe yaddressed. y(A, yB, yand yC) yare yall yactions
ythat ycan ybe yperformed yby ythe yUAP yunder ythe ysupervision yof ythe ynurse.
Until ythe ycensus yon ythe yobstetrics y(OB) yunit yincreases, yan yunlicensed yassistive
ypersonnel y(UAP) ywho yusually yworks yin ylabor yand ydelivery yand ythe ynewborn
ynursery yis yassigned yto ywork yon ythe ypostoperative yunit. yWhich yclient ywould ybe
ybest yfor ythe ycharge ynurse yto yassign yto ythis yUAP?
yA.An yadolescent ywho ywas yreadmitted yto ythe yhospital ybecause yof ya ypostoperative
yinfection
yB.A ywoman ywith ya ynew ycolostomy ywho yrequires ydischarge yteaching
yC.A ywoman ywho yhad ya yhip yreplacement yand ymay ybe ytransferred yto ythe yhome
ycare yunit
yD.A yman ywho yhad ya ycholecystectomy yand ycurrently yhas ya ynasogastric ytube yset
yto yintermittent ysuction y- yC
The ycharge ynurse ywill ybe yresponsible yfor yproviding ya yreport yto ythe yhome ycare yunit
yif ythe ytransfer yoccurs y(A). yThe yclient yis yinfected yand yan yemployee ywho yworks yon
yan yOB yunit yshould ybe yassigned yto yclean ycases yin ycase ythe yemployee yis yrequired
yto yreturn yto ythe yOB yunit y(B). yThis yrequires ythe yskills yof ya yregistered ynurse y(RN)
yto ydo ydischarge yteaching yand yprovide yemotional ysupport y(D). yThis ymay yrequire
yskills ybeyond ythe ylevel yof ythis yUAP.
A ymale yclient yis yadmitted yfor yobservation yafter ybeing yhit yon ythe yhead ywith ya
ybaseball ybat. ySix yhours yafter yadmission, ythe yclient yattempts yto ycrawl yout yof ybed
yand yasks ythe ynurse ywhy ythere yare yso ymany ybugs yin yhis ybed. yHis yvital ysigns yare
ystable, yand ythe ypulse yoximeter yreading yis y98% yon yroom yair. yWhich yintervention
yshould ythe ynurse yperform yfirst?
A.Administer yoxygen yper ynasal ycannula yat y2 yL/min.
B.Plan yto ycheck yhis yvital ysigns yagain yin y30 yminutes.
C.Notify ythe yhealth ycare yprovider yof ythe ychange yin ymental ystatus.
D.Ask ythe yclient ywhy yhe ythinks ythere yare ybugs yin ythe ybed. y- yC
One yof ythe yearliest ysigns yof yincreased yintracranial ypressure y(ICP) yis ya ychange yin
ymental ystatus y(C). yIt yis yimportant yto yact yearly yand yquickly ywhen ysymptoms yof
yincreased yICP yoccur. yBecause yhis yoxygen ysaturation yis ynormal, ythe yadministration
yof yoxygen y(A) yis ynot ythe ytop ypriority. yVital ysigns yshould ybe ymonitored yfrequently
y(B), ybut ythe yclient's yconfusion yshould ybe yreported yimmediately. y(D) yis ynot ya yuseful
yintervention.
The ynurse yis ymonitoring ya yclient ywho yis yreceiving ybedside yconscious ysedation ywith
ymidazolam yhydrochloride y(Versed). yIn yassessing ythe yclient, ythe ynurse ydetermines
