2020 HESI EXIT V1
1. Which information is a priority for the RN to reinforce to an older client after
intravenous pylegraphy Ans: Measure the urine output for the next day and
immediately notify the health care provider if it should decrease.
2. A client has altered renal function and is being treated at home. The nurse
recognizes that the most accurate indicator of fluid balance during the weekly visits is:
weekly weight
3. A client has been diagnosed with Zollinger-Ellison syndrome.Which infor- mation
is most important for the nurse to reinforce with the client Ans: It is critical to report
promptly to your health care provider any findings of peptic ulcers
4. A primigravida in the third trimester is hospitalized for preeclampsia. The nurse
determines that the client's blood pressure is increasing. Which action should the
nurse take first Ans: Have the client turn to the left side
5. The nurse is caring for a client in atrial fibrillation. The atrial heart rate is 250 and
the ventricular rate is controlled at 75. Which of the following findings is cause for
the most concern Ans: A cold, pale lower leg
6. The client with infective endocarditis must be assessed frequently by the home
health nurse. Which finding suggests that antibiotic therapy is not effective, and
must be reported by the nurse immediately to the healthcare provider Ans: Fever
of 103 degrees Fahrenheit (39.5 degrees Celsius)
7. A client who had a vasectomy is in the post recovery unit at an outpatient clinic.
Which of these points is most important to be reinforced by the nurse Ans: Until the
health care provider has determined that your ejaculate doesn't contain
8. A client who is to have antineoplastic chemotherapy tells the nurses of a fear of
,being sick all the time and wishes to try acupuncture. Which of these beliefs stated
by the client would be incorrect about acupuncture Ans: The flow of life is believed
to flow through major pathways or nerve clusters in your body.
9. The nurse is discussing with a group of students the disease Kawasaki. What
statement made by a student about Kawasaki disease is incorrect Ans: Kawasaki
disease occurs most often in boys, children younger than age 5 and children of Hispanic
descent
10. A client has viral pneumonia affecting 2/3 of the right lung. What would be the
best position to teach the client to lie in every other hour during first 12 hours after
admission Ans: Side-lying on the left with the head elevated 10 degrees
11. A client has an indwelling catheter with continuous bladder irrigation after
undergoing a transurethral resection of the prostate (TURP) 12 hours ago. Which
finding at this time should be reported to the health care provider Ans: - minimal
drainage into the urinary collection bag
12. A nurse is performing CPR on an adult who went into cardiopulmonary arrest.
Another nurse enters the room in response to the call. After checking
, the client's pulse and respirations, what should be the function of the second nurse Ans
Participate with the compressions or breathing
13. . The nurse assesses a 72 year-old client who was admitted for right sided
congestive heart failure. Which of the following would the nurse anticipate finding
Ans: Jugular vein distention
14. A client with heart failure has a prescription for digoxin. The nurse is aware that
sufficient potassium should be included in the diet because hypokalemia in
combination with this medication Ans: Can predispose to dysrhythmias
15. A nurse assesses a young adult in the emergency room following a motor vehicle
accident. Which of the following neurological signs is of most con- cern Ans: Pupils
fixed and dilated
16. A 14 year-old with a history of sickle cell disease is admitted to the hospital with a
diagnosis of vaso-occlusive crisis. Which statements by the client would be most
indicative of the etiology of this crisis: "I went to the health care provider last week for a
cold and I have gotten worse."
17. Which these findings would the nurse more closely associate with anemia in a 10
month-old infant Ans: Pale mucosa of the eyelids and lips
18. The nurse is caring for a client in hypertensive crisis in an intensive care unit.
The priority assessment in the first hour of care is: Pupil responses
19. Which of these clients who are all in the terminal stage of cancer is least
appropriate to suggest the use of patient controlled analgesia (PCA) with a pump
Ans: A preschooler with intermittent episodes of alertness
20. The nurse is about to assess a 6 month-old child with nonorganic failure-to thrive
(NOFTT). Upon entering the room, the nurse would expect the baby to be: Pale, thin
arms and legs, uninterested in surroundings
1. Which information is a priority for the RN to reinforce to an older client after
intravenous pylegraphy Ans: Measure the urine output for the next day and
immediately notify the health care provider if it should decrease.
2. A client has altered renal function and is being treated at home. The nurse
recognizes that the most accurate indicator of fluid balance during the weekly visits is:
weekly weight
3. A client has been diagnosed with Zollinger-Ellison syndrome.Which infor- mation
is most important for the nurse to reinforce with the client Ans: It is critical to report
promptly to your health care provider any findings of peptic ulcers
4. A primigravida in the third trimester is hospitalized for preeclampsia. The nurse
determines that the client's blood pressure is increasing. Which action should the
nurse take first Ans: Have the client turn to the left side
5. The nurse is caring for a client in atrial fibrillation. The atrial heart rate is 250 and
the ventricular rate is controlled at 75. Which of the following findings is cause for
the most concern Ans: A cold, pale lower leg
6. The client with infective endocarditis must be assessed frequently by the home
health nurse. Which finding suggests that antibiotic therapy is not effective, and
must be reported by the nurse immediately to the healthcare provider Ans: Fever
of 103 degrees Fahrenheit (39.5 degrees Celsius)
7. A client who had a vasectomy is in the post recovery unit at an outpatient clinic.
Which of these points is most important to be reinforced by the nurse Ans: Until the
health care provider has determined that your ejaculate doesn't contain
8. A client who is to have antineoplastic chemotherapy tells the nurses of a fear of
,being sick all the time and wishes to try acupuncture. Which of these beliefs stated
by the client would be incorrect about acupuncture Ans: The flow of life is believed
to flow through major pathways or nerve clusters in your body.
9. The nurse is discussing with a group of students the disease Kawasaki. What
statement made by a student about Kawasaki disease is incorrect Ans: Kawasaki
disease occurs most often in boys, children younger than age 5 and children of Hispanic
descent
10. A client has viral pneumonia affecting 2/3 of the right lung. What would be the
best position to teach the client to lie in every other hour during first 12 hours after
admission Ans: Side-lying on the left with the head elevated 10 degrees
11. A client has an indwelling catheter with continuous bladder irrigation after
undergoing a transurethral resection of the prostate (TURP) 12 hours ago. Which
finding at this time should be reported to the health care provider Ans: - minimal
drainage into the urinary collection bag
12. A nurse is performing CPR on an adult who went into cardiopulmonary arrest.
Another nurse enters the room in response to the call. After checking
, the client's pulse and respirations, what should be the function of the second nurse Ans
Participate with the compressions or breathing
13. . The nurse assesses a 72 year-old client who was admitted for right sided
congestive heart failure. Which of the following would the nurse anticipate finding
Ans: Jugular vein distention
14. A client with heart failure has a prescription for digoxin. The nurse is aware that
sufficient potassium should be included in the diet because hypokalemia in
combination with this medication Ans: Can predispose to dysrhythmias
15. A nurse assesses a young adult in the emergency room following a motor vehicle
accident. Which of the following neurological signs is of most con- cern Ans: Pupils
fixed and dilated
16. A 14 year-old with a history of sickle cell disease is admitted to the hospital with a
diagnosis of vaso-occlusive crisis. Which statements by the client would be most
indicative of the etiology of this crisis: "I went to the health care provider last week for a
cold and I have gotten worse."
17. Which these findings would the nurse more closely associate with anemia in a 10
month-old infant Ans: Pale mucosa of the eyelids and lips
18. The nurse is caring for a client in hypertensive crisis in an intensive care unit.
The priority assessment in the first hour of care is: Pupil responses
19. Which of these clients who are all in the terminal stage of cancer is least
appropriate to suggest the use of patient controlled analgesia (PCA) with a pump
Ans: A preschooler with intermittent episodes of alertness
20. The nurse is about to assess a 6 month-old child with nonorganic failure-to thrive
(NOFTT). Upon entering the room, the nurse would expect the baby to be: Pale, thin
arms and legs, uninterested in surroundings
