Adult Health 2 HESI Test bank
1. A nurse is caring for a client with DI. Which data war- a. Serum sodium of 185
rants the most immediate intervention by the nurse?
a. Serum sodium of 185
b. Dry skin with inelastic turgor
c. Apical rate of 110 beats per minute
d. Polyuria and excessive thirst
2. The nurse is obtaining the admission history for a c. upper mid-abdominal
client with suspected peptic ulcer disease (PUD). Which pain described as gnaw-
subjective data reported by the client supports this ing and burning.
medical diagnosis?
a. Frequent use of chewable and liquid antacids for
indigestion
b. severe abdominal cramps and diarrhea after eating
spicy foods
c. upper mid-abdominal pain described as gnawing
and burning.
d. Marked loss of weight and appetite over the last 3
or 4 months
3. The nurse assess a client who is newly diagnosed with d. Obtain a prescription for
hyperthyroidism and observes that the client's eye- artificial tear drops
balls are protuberant, causing a wide-eyed appearance
and eye discomfort. Based on this finding, which ac-
tion should the nurse include in this client's plan of
care?
a. Assess for signs of increased intracranial pressure
b. Prepare to administer intravenous levothyroxine
c. Review the client's serum electrolyte values
d. Obtain a prescription for artificial tear drops
4.
, Adult Health 2 HESI Test bank
To reduce the risk for pulmonary complication for a a. Perform chest physio-
client with Amyotrophic Lateral Sclerosis (ALS), which therapy
interventions should the nurse implement? (Select all) b. Teach the client breath-
a. Perform chest physiotherapy ing exercises
b. Teach the client breathing exercises e. Encourage use of
c. Initiate passive range of motion exercises incen- tive spriometer
d. Establish a regular bladder routine
e. Encourage use of incentive spriometer
5. A client hospitalized with heart failure (HF). Which in- b. Place the client in high
tervention should the nurse implement to improve fowler position
ventilation and reduce venous return?
a. Perform passive range of motion exercises
b. Place the client in high fowler position
c. Administer oxygen per nasal canula
d. Increase the client's activity level
6. A client who was involved in a motor vehicle collision is a. Verify pedal pulses us-
admitted with a fractured left femur which is immobi- ing a doppler pulse de-
lized using a fracture traction splint in preparation for vice
an open reduction internal fixation (ORIF). The nurse b. Evaluate the application
determines that the client's distal pulses are dimin- of the splint to the left leg
ished in the left foot. Which interventions should the d. Monitor left leg for pain,
nurse implement? (select all) pallor, paresthesia, paraly-
a. Verify pedal pulses using a doppler pulse device sis, pressure
b. Evaluate the application of the splint to the left leg.
c. Offer ice chips and oral clear liquids.
d. Monitor left leg for pain, pallor, paresthesia, paraly-
sis, pressure
3. Administer oral antispasmodics and narcotic anal-
gesics
, Adult Health 2 HESI Test bank
7. The healthcare provider prescribes diagnostic tests for a. Sputum culture and
a client whose chest X-ray indicates pneumonia. Which sensitivity
diagnostic test should the nurse review for implemen-
tation in the most therapeutic treatment of the pneu-
monia?
a. Sputum culture and sensitivity
b. Blood cultures
c. Arterial blood gases (ABG)
d. Computerized tomography (CT) of the chest
8. A client with a history of asthma and bronchitis arrives c. Increase the daily intake
a the clinic with shortness of breath, productive cough of oral fluids to liquefy se-
with thickened, tenacious mucous, and the inability to cretions
walk up a flight of stairs without experiencing breath-
lessness. Which is most important for the nurses to
instruct the client about self-care?
a. Call the clinic if undesirable side effects of medica-
tions occur
b. Avoid crowded enclosed areas to reduce pathogen
exposure
c. Increase the daily intake of oral fluids to liquefy
secretions
d. Teach anxiety reduction methods for feelings of suf-
focation
9. The home health nurse provides teaching about in- b. Continue with the in-
sulin self injection to a client who was recently diag- sulin injection
nosed with diabetes mellitus. When the client begins
to perform a return demonstration of an insulin in-
jection into the abdomen as seen in the video, which
instruction should the nurse provide?
a. select a different injection site
, Adult Health 2 HESI Test bank
b. Continue with the insulin injection
c. keep the skin flat rather than bunched
d. Lie down flat for better skin exposure
10. The nurse observes an increased number of blood c. Increase the flow of the
clots in the drainage tubing of a client with continuous bladder irrigation
bladder irrigation following a trans-urethral resection
of the prostate (TURP). What is the best initial nursing
action?
a. Provide additional oral fluid intake
b. Measure the client's intake and output
c. Increase the flow of the bladder irrigation
d. Administer a PRN dose of an antispasmodic agent
11. Four days following an abdominal aortic aneurysm c. assess pulses with a vas-
repair, the client is exhibiting edema of both lower cular doppler
extremities, and pedal pulses are not palpable. Which
action should the nurse implement first?
a. elevate extremities on pillows
b. evaluate edema for pitting
c. assess pulses with a vascular doppler
d. wrap the feet with warmed blankets
12. A client arrives to the medical surgical unit 4 hours af- a. Monitoring catheter
ter a transurethral resection of the prostate. A triple-lu- drainage
men catheter for continuous bladder irrigation with
normal saline is infusing and the nurse observes dark,
pink- tinged outflow with blood clots in the tubing and
collection bag. Which action should the nurse take?
a. Monitoring catheter drainage
b. decreasing the flow rate
1. A nurse is caring for a client with DI. Which data war- a. Serum sodium of 185
rants the most immediate intervention by the nurse?
a. Serum sodium of 185
b. Dry skin with inelastic turgor
c. Apical rate of 110 beats per minute
d. Polyuria and excessive thirst
2. The nurse is obtaining the admission history for a c. upper mid-abdominal
client with suspected peptic ulcer disease (PUD). Which pain described as gnaw-
subjective data reported by the client supports this ing and burning.
medical diagnosis?
a. Frequent use of chewable and liquid antacids for
indigestion
b. severe abdominal cramps and diarrhea after eating
spicy foods
c. upper mid-abdominal pain described as gnawing
and burning.
d. Marked loss of weight and appetite over the last 3
or 4 months
3. The nurse assess a client who is newly diagnosed with d. Obtain a prescription for
hyperthyroidism and observes that the client's eye- artificial tear drops
balls are protuberant, causing a wide-eyed appearance
and eye discomfort. Based on this finding, which ac-
tion should the nurse include in this client's plan of
care?
a. Assess for signs of increased intracranial pressure
b. Prepare to administer intravenous levothyroxine
c. Review the client's serum electrolyte values
d. Obtain a prescription for artificial tear drops
4.
, Adult Health 2 HESI Test bank
To reduce the risk for pulmonary complication for a a. Perform chest physio-
client with Amyotrophic Lateral Sclerosis (ALS), which therapy
interventions should the nurse implement? (Select all) b. Teach the client breath-
a. Perform chest physiotherapy ing exercises
b. Teach the client breathing exercises e. Encourage use of
c. Initiate passive range of motion exercises incen- tive spriometer
d. Establish a regular bladder routine
e. Encourage use of incentive spriometer
5. A client hospitalized with heart failure (HF). Which in- b. Place the client in high
tervention should the nurse implement to improve fowler position
ventilation and reduce venous return?
a. Perform passive range of motion exercises
b. Place the client in high fowler position
c. Administer oxygen per nasal canula
d. Increase the client's activity level
6. A client who was involved in a motor vehicle collision is a. Verify pedal pulses us-
admitted with a fractured left femur which is immobi- ing a doppler pulse de-
lized using a fracture traction splint in preparation for vice
an open reduction internal fixation (ORIF). The nurse b. Evaluate the application
determines that the client's distal pulses are dimin- of the splint to the left leg
ished in the left foot. Which interventions should the d. Monitor left leg for pain,
nurse implement? (select all) pallor, paresthesia, paraly-
a. Verify pedal pulses using a doppler pulse device sis, pressure
b. Evaluate the application of the splint to the left leg.
c. Offer ice chips and oral clear liquids.
d. Monitor left leg for pain, pallor, paresthesia, paraly-
sis, pressure
3. Administer oral antispasmodics and narcotic anal-
gesics
, Adult Health 2 HESI Test bank
7. The healthcare provider prescribes diagnostic tests for a. Sputum culture and
a client whose chest X-ray indicates pneumonia. Which sensitivity
diagnostic test should the nurse review for implemen-
tation in the most therapeutic treatment of the pneu-
monia?
a. Sputum culture and sensitivity
b. Blood cultures
c. Arterial blood gases (ABG)
d. Computerized tomography (CT) of the chest
8. A client with a history of asthma and bronchitis arrives c. Increase the daily intake
a the clinic with shortness of breath, productive cough of oral fluids to liquefy se-
with thickened, tenacious mucous, and the inability to cretions
walk up a flight of stairs without experiencing breath-
lessness. Which is most important for the nurses to
instruct the client about self-care?
a. Call the clinic if undesirable side effects of medica-
tions occur
b. Avoid crowded enclosed areas to reduce pathogen
exposure
c. Increase the daily intake of oral fluids to liquefy
secretions
d. Teach anxiety reduction methods for feelings of suf-
focation
9. The home health nurse provides teaching about in- b. Continue with the in-
sulin self injection to a client who was recently diag- sulin injection
nosed with diabetes mellitus. When the client begins
to perform a return demonstration of an insulin in-
jection into the abdomen as seen in the video, which
instruction should the nurse provide?
a. select a different injection site
, Adult Health 2 HESI Test bank
b. Continue with the insulin injection
c. keep the skin flat rather than bunched
d. Lie down flat for better skin exposure
10. The nurse observes an increased number of blood c. Increase the flow of the
clots in the drainage tubing of a client with continuous bladder irrigation
bladder irrigation following a trans-urethral resection
of the prostate (TURP). What is the best initial nursing
action?
a. Provide additional oral fluid intake
b. Measure the client's intake and output
c. Increase the flow of the bladder irrigation
d. Administer a PRN dose of an antispasmodic agent
11. Four days following an abdominal aortic aneurysm c. assess pulses with a vas-
repair, the client is exhibiting edema of both lower cular doppler
extremities, and pedal pulses are not palpable. Which
action should the nurse implement first?
a. elevate extremities on pillows
b. evaluate edema for pitting
c. assess pulses with a vascular doppler
d. wrap the feet with warmed blankets
12. A client arrives to the medical surgical unit 4 hours af- a. Monitoring catheter
ter a transurethral resection of the prostate. A triple-lu- drainage
men catheter for continuous bladder irrigation with
normal saline is infusing and the nurse observes dark,
pink- tinged outflow with blood clots in the tubing and
collection bag. Which action should the nurse take?
a. Monitoring catheter drainage
b. decreasing the flow rate
