SCRUTINIZED HESI EXIT EXAM
PRACTICE QUESTIONS AND
ANSWERS
A52client52presents52at52the 52ED52complaining52of52a52raspy52voice,52cold52intolerance,52and52fatigue.52
Lab52 tests52indicate52an52elevated52 TSH52 and52low52T352and52T452levels.52After52the 52 client52is52admitt
ed52 to52the52telemetry52unit,52which52intervention52is52most52important52for52the52nurse52 to52implem
ent?
A) Assess52for52presence 52of52non-pitting52edema.
B) Administer52the52prescribed52dose52of52levothyroxine.
C) Offer52additional52blankets52and52a52warm52 drink.
D) Note 52 client's52most52recent52hemoglobin52levels.52-52CORRECT52ANSWER52-
B) 52Administer52the52prescribed52dose52of52levothyroxine.
Rationale:52In52the52negative52feedback52mechanism52of52hypothyroidism,52a52low52level52of52thyroid5
2 hormone 52stimulates52 TSH52 production52by52 the 52hypothalamus52and52results52in52an52 elevated52TSH
52 level,52but52the52thyroid52gland52 does52 not52respond52 with52 adequate52production52of 52T352and52T4
52 to52 regulate52 basal 52metabolic52 rate.52These52serum52 hormone 52 levels52indicate 52 the52need52to52 ad
minister52supplementary52thyroid52hormone52 as52soon52as52possible52to52avert52possible52 myxedema5
2 coma.52 Non-
pitting52edema52is52seen52in52chronic52hypothyroidism52and52assessment52of 52the52presence 52and52loc
ation52of 52the52edema52(A)52is52not52a52top52priority.52 Providing52warmth52(C)52is52beneficial 52but52of5
2 less52priority52than52(B).52Anemia52 is52common52in52 hypothyroidism,52 but52(D)52is52of52lower52priority
52 than52 initiating52treatment52to52 prevent52myxedema52 coma.
The 52 nurse52suspects52that52a52client52might52be52hemorrhaging52internally.52Which52findings52 of52an52
orthostatic52tilt52test52are52a52most52likely52indication52 of52a52major52bleed52(>52100052 ml)?
A) A52 decrease 52in52the52systolic52BP52of521052mm52Hg52with52a52corresponding52increase52in52the52HR5
2 of 52 20.
,B) A52 decrease 52in52the 52systolic52BP52of521052mm52Hg52with52a52corresponding52decrease52in52the 52HR
52 of 5220.
C) A52 decrease 52in52the 52systolic52BP52of522052 mm52Hg52with52a52 corresponding52decrease52 in52the 52HR
52 of 5210.
D) A52 decrease52in52the52systolic52BP52of52 2052 mm52Hg52with52a52 corresponding52increase52in52the52
HR52 of5210.52- 52CORRECT52ANSWER52-
Ans:52 A)52A52decrease52in52the52 systolic52BP52 of521052mm52Hg52with52 a52corresponding52increase52in5
2 the 52 HR52of52 20.
Rationale:52The52loss52 of52circulatory52volume52results52in52a521052mm52 Hg52drop52in52the52systolic52
pressure,52while52the52HR52increases52by522052%52 above52normal 52as52a52 compensatory52response 52t
o52the 52low52 pressure.
When52conducting52diet52teaching52for52a52client52who52is52on52a52postoperative 52full52 liquid52diet,52w
hich52foods52should52the52nurse 52encourage52the52client52to52eat?52SATA.
A) Canned52fruit52cocktail
B) Creamy52peanut52butter
C) Vegetable52juice
D) Vanilla52frozen52yogurt
E) Clear52beef52broth52-52CORRECT52ANSWER52-Ans:52C,52D,52E
A52full52liquid52diet52includes52all52liquids52that52are52not52 clear52such52as52vegetable 52juice52and52fro
zen52 yogurt,52as52well52 as52clear52liquids.52Pieces52of52fruit52as52found52in52fruit52cocktail52 and52pean
ut52butter52are52not52considered52liquids.
A52client52is52receiving52ophthalmic52drops52preoperatively52for52a52cataract52extraction52and52asks52th
e 52nurse52why52he52is52prescribed52all 52these 52medications?52SATA.
A) One 52of52the52medications52is52used52to52anesthetize 52the52corneal 52surface.
B) The 52iris52must52be52paralyzed52during52the52surgery52to52prevent52it52from52reacting52to52light.
C) Medication52is52used52to52induce 52sleep52during52the52procedure.
D) Pupillary52dilation52is52necessary52to52access52the52eye52chamber52for52lens52removal.
,E) These 52 meds52assist52in52obstructing52the 52client's52vision52during52 the 52surgery.52-
52 CORRECT52 ANSWER52-Ans:52A,52B,52D
Cataract52 surgery52is52accessed52through52the 52cornea52using52 eyelid52retractors52while52the52client52i
s52awake.52It52is52necessary52to52anesthetize52the52corneal52surface 52(A),52paralyze52the52ciliary52body
52 (B),52and52provide52 pupil 52 dilation52 (D)(mydriasis) 52to52 facilitate 52access52to52the52 lens52which52ties52
behind52the52iris52(posterior52chamber52of52the52anterior52cavity).52A52sedative52may52be52 administere
d52to52reduce52anxiety52but52it52 is52not52used52to52induce52sleep.52(C) 52Cloudy52vision52may52be52a52si
de 52 effect52of 52these52agents,52but52the52client52will52still52be 52 able52to52see 52during52 the 52 surgery52(
E).
When52assessing52an52IV52site 52that52is52sued52for52fluid52replacement52and52medication52administrati
on,52 the52client52complains52of52 the 52tenderness52 when52the 52arm52is52touched52above 52the52site.52W
hich52additional 52 assessment52warrants52immediate 52intervention52by52the52nurse?
A) Sluggish52blood52return
B) Client52uses52the 52arm52cautiously
C) Spot52 of52dried52blood52at52the52insertion52site
D) Red52streak52tracking52the 52vein52-52CORRECT52ANSWER52 -Ans:52D
A52red52streak52(D) 52indicates52vein52irritation52and52necessitates52discontinuing52the52 IV 52at52the52pr
esent52site.52A,52B,52and52C52are 52indications52for52 relocating52the52IV52site52or52other52immediate52i
ntervention.
A52client52with52a52liver52abscess52develops52 septic52shock.52A52sepsis52resuscitation52bundle52protoco
l 52is52initiated52and52the 52client52receives52a52 bolus52of52IV52fluids.52 Which52parameter52should52the52
nurse 52monitor52to52assess52effectiveness52of 52the52fluid52 bolus?
A) Blood52 cultures.
B) Oxygen52saturation.
C) White 52 blood52count.
D) Mean52 arterial52pressure52(MAP).52-52CORRECT52ANSWER52-D)52Mean52arterial 52pressure 52(MAP)
The 52 cornerstone52of52initial 52sepsis52resuscitation52is52fluid52volume52administration52to52restore 52an
d52then52maintain52MAP52of 52at52least52 6552mmHg.
, When52attempting52to52establish52risk52reduction52strategies52in52a52community,52the52nurse 52notes52t
hat52 regional 52 studies52 indicate52a52high52number52of52persons52with52growth52stunting52and52 irrever
sible 52mental52deficiencies52(cretinism)52caused52 by52hypothyroidism.52The52nurse 52should52seek52fun
ding52to52implement52which52screening52measure?
A ) T452 levels52in52newborns.
B) TSH52 levels52in52women52 over5245.
C) T352 levels52in52school-aged52children
D) Iodine 52levels52in52all 52persons52 over52 60.52-52CORRECT52 ANSWER52-A)52T452levels52in52newborns.
Screening52for52low52T452levels52in52newborns52with52follow-
up52 treatment52can52reduce 52the52risk52for52irreversible 52growth52stunting52and52mental52deficiencies5
2 caused52 by52congenital52hypothyroidism.
For52 the 52past522452hours,52an52antidiarrheal52 agent,52 diphenoxylate,52has52been52administered52to52
a52bedridden, 52older52 client52with52 infectious52gastroenteritis.52 Which52finding52requires52 the52 nurse
52 to52 take52further52action?
A) Loss52of 52appetite
B) Serum52K+524.052mEq/L52or52mmol/L52(SI)
C) Loose,52runny52stools.
D) Tented52skin52turgor.52-52CORRECT52ANSWER52-D)52Tented52skin52turgor.
Indicates52dehydration,52a52serious52complication52following52prolonged52diarrhea52that52requires52furt
her52 intervention52 by52the 52nurse.
A52male 52client52with52ulcerative52colitis52received52an52Rx52for52a52corticosteroid52last52month52but52
because 52of52the52 S/E,52he 52stopped52taking52the52medications52652days52ago.52Which52finding52warra
nts52 immediate 52intervention52by52the52nurse?
A) Fluid52retention
PRACTICE QUESTIONS AND
ANSWERS
A52client52presents52at52the 52ED52complaining52of52a52raspy52voice,52cold52intolerance,52and52fatigue.52
Lab52 tests52indicate52an52elevated52 TSH52 and52low52T352and52T452levels.52After52the 52 client52is52admitt
ed52 to52the52telemetry52unit,52which52intervention52is52most52important52for52the52nurse52 to52implem
ent?
A) Assess52for52presence 52of52non-pitting52edema.
B) Administer52the52prescribed52dose52of52levothyroxine.
C) Offer52additional52blankets52and52a52warm52 drink.
D) Note 52 client's52most52recent52hemoglobin52levels.52-52CORRECT52ANSWER52-
B) 52Administer52the52prescribed52dose52of52levothyroxine.
Rationale:52In52the52negative52feedback52mechanism52of52hypothyroidism,52a52low52level52of52thyroid5
2 hormone 52stimulates52 TSH52 production52by52 the 52hypothalamus52and52results52in52an52 elevated52TSH
52 level,52but52the52thyroid52gland52 does52 not52respond52 with52 adequate52production52of 52T352and52T4
52 to52 regulate52 basal 52metabolic52 rate.52These52serum52 hormone 52 levels52indicate 52 the52need52to52 ad
minister52supplementary52thyroid52hormone52 as52soon52as52possible52to52avert52possible52 myxedema5
2 coma.52 Non-
pitting52edema52is52seen52in52chronic52hypothyroidism52and52assessment52of 52the52presence 52and52loc
ation52of 52the52edema52(A)52is52not52a52top52priority.52 Providing52warmth52(C)52is52beneficial 52but52of5
2 less52priority52than52(B).52Anemia52 is52common52in52 hypothyroidism,52 but52(D)52is52of52lower52priority
52 than52 initiating52treatment52to52 prevent52myxedema52 coma.
The 52 nurse52suspects52that52a52client52might52be52hemorrhaging52internally.52Which52findings52 of52an52
orthostatic52tilt52test52are52a52most52likely52indication52 of52a52major52bleed52(>52100052 ml)?
A) A52 decrease 52in52the52systolic52BP52of521052mm52Hg52with52a52corresponding52increase52in52the52HR5
2 of 52 20.
,B) A52 decrease 52in52the 52systolic52BP52of521052mm52Hg52with52a52corresponding52decrease52in52the 52HR
52 of 5220.
C) A52 decrease 52in52the 52systolic52BP52of522052 mm52Hg52with52a52 corresponding52decrease52 in52the 52HR
52 of 5210.
D) A52 decrease52in52the52systolic52BP52of52 2052 mm52Hg52with52a52 corresponding52increase52in52the52
HR52 of5210.52- 52CORRECT52ANSWER52-
Ans:52 A)52A52decrease52in52the52 systolic52BP52 of521052mm52Hg52with52 a52corresponding52increase52in5
2 the 52 HR52of52 20.
Rationale:52The52loss52 of52circulatory52volume52results52in52a521052mm52 Hg52drop52in52the52systolic52
pressure,52while52the52HR52increases52by522052%52 above52normal 52as52a52 compensatory52response 52t
o52the 52low52 pressure.
When52conducting52diet52teaching52for52a52client52who52is52on52a52postoperative 52full52 liquid52diet,52w
hich52foods52should52the52nurse 52encourage52the52client52to52eat?52SATA.
A) Canned52fruit52cocktail
B) Creamy52peanut52butter
C) Vegetable52juice
D) Vanilla52frozen52yogurt
E) Clear52beef52broth52-52CORRECT52ANSWER52-Ans:52C,52D,52E
A52full52liquid52diet52includes52all52liquids52that52are52not52 clear52such52as52vegetable 52juice52and52fro
zen52 yogurt,52as52well52 as52clear52liquids.52Pieces52of52fruit52as52found52in52fruit52cocktail52 and52pean
ut52butter52are52not52considered52liquids.
A52client52is52receiving52ophthalmic52drops52preoperatively52for52a52cataract52extraction52and52asks52th
e 52nurse52why52he52is52prescribed52all 52these 52medications?52SATA.
A) One 52of52the52medications52is52used52to52anesthetize 52the52corneal 52surface.
B) The 52iris52must52be52paralyzed52during52the52surgery52to52prevent52it52from52reacting52to52light.
C) Medication52is52used52to52induce 52sleep52during52the52procedure.
D) Pupillary52dilation52is52necessary52to52access52the52eye52chamber52for52lens52removal.
,E) These 52 meds52assist52in52obstructing52the 52client's52vision52during52 the 52surgery.52-
52 CORRECT52 ANSWER52-Ans:52A,52B,52D
Cataract52 surgery52is52accessed52through52the 52cornea52using52 eyelid52retractors52while52the52client52i
s52awake.52It52is52necessary52to52anesthetize52the52corneal52surface 52(A),52paralyze52the52ciliary52body
52 (B),52and52provide52 pupil 52 dilation52 (D)(mydriasis) 52to52 facilitate 52access52to52the52 lens52which52ties52
behind52the52iris52(posterior52chamber52of52the52anterior52cavity).52A52sedative52may52be52 administere
d52to52reduce52anxiety52but52it52 is52not52used52to52induce52sleep.52(C) 52Cloudy52vision52may52be52a52si
de 52 effect52of 52these52agents,52but52the52client52will52still52be 52 able52to52see 52during52 the 52 surgery52(
E).
When52assessing52an52IV52site 52that52is52sued52for52fluid52replacement52and52medication52administrati
on,52 the52client52complains52of52 the 52tenderness52 when52the 52arm52is52touched52above 52the52site.52W
hich52additional 52 assessment52warrants52immediate 52intervention52by52the52nurse?
A) Sluggish52blood52return
B) Client52uses52the 52arm52cautiously
C) Spot52 of52dried52blood52at52the52insertion52site
D) Red52streak52tracking52the 52vein52-52CORRECT52ANSWER52 -Ans:52D
A52red52streak52(D) 52indicates52vein52irritation52and52necessitates52discontinuing52the52 IV 52at52the52pr
esent52site.52A,52B,52and52C52are 52indications52for52 relocating52the52IV52site52or52other52immediate52i
ntervention.
A52client52with52a52liver52abscess52develops52 septic52shock.52A52sepsis52resuscitation52bundle52protoco
l 52is52initiated52and52the 52client52receives52a52 bolus52of52IV52fluids.52 Which52parameter52should52the52
nurse 52monitor52to52assess52effectiveness52of 52the52fluid52 bolus?
A) Blood52 cultures.
B) Oxygen52saturation.
C) White 52 blood52count.
D) Mean52 arterial52pressure52(MAP).52-52CORRECT52ANSWER52-D)52Mean52arterial 52pressure 52(MAP)
The 52 cornerstone52of52initial 52sepsis52resuscitation52is52fluid52volume52administration52to52restore 52an
d52then52maintain52MAP52of 52at52least52 6552mmHg.
, When52attempting52to52establish52risk52reduction52strategies52in52a52community,52the52nurse 52notes52t
hat52 regional 52 studies52 indicate52a52high52number52of52persons52with52growth52stunting52and52 irrever
sible 52mental52deficiencies52(cretinism)52caused52 by52hypothyroidism.52The52nurse 52should52seek52fun
ding52to52implement52which52screening52measure?
A ) T452 levels52in52newborns.
B) TSH52 levels52in52women52 over5245.
C) T352 levels52in52school-aged52children
D) Iodine 52levels52in52all 52persons52 over52 60.52-52CORRECT52 ANSWER52-A)52T452levels52in52newborns.
Screening52for52low52T452levels52in52newborns52with52follow-
up52 treatment52can52reduce 52the52risk52for52irreversible 52growth52stunting52and52mental52deficiencies5
2 caused52 by52congenital52hypothyroidism.
For52 the 52past522452hours,52an52antidiarrheal52 agent,52 diphenoxylate,52has52been52administered52to52
a52bedridden, 52older52 client52with52 infectious52gastroenteritis.52 Which52finding52requires52 the52 nurse
52 to52 take52further52action?
A) Loss52of 52appetite
B) Serum52K+524.052mEq/L52or52mmol/L52(SI)
C) Loose,52runny52stools.
D) Tented52skin52turgor.52-52CORRECT52ANSWER52-D)52Tented52skin52turgor.
Indicates52dehydration,52a52serious52complication52following52prolonged52diarrhea52that52requires52furt
her52 intervention52 by52the 52nurse.
A52male 52client52with52ulcerative52colitis52received52an52Rx52for52a52corticosteroid52last52month52but52
because 52of52the52 S/E,52he 52stopped52taking52the52medications52652days52ago.52Which52finding52warra
nts52 immediate 52intervention52by52the52nurse?
A) Fluid52retention
