HESI PN EXIT EXAM QUESTIONS AND VERIFIED
RATIONALIZED ANSWERS, 100% GUARANTEED.
The nurse enters the room of a client with Parkinson's disease who is taking carbidopa levodopa.
The client is a rising slowly from the chair while the unlicensed assistive personnel stands next to
the chair. Which action should the nurse take?
A) Offer a PRN analgesic to reduce painful movement.
B) Tell the UAP to assess the quiet and moving more quickly.
C) Affirm that the client should arise slowly from the chair.
D) Demonstrate how to help the client move more efficiently.
C) Affirm that the client should arise slowly from the chair.
The healthcare provider prescribes 500 mL IV bolus of 0.9% normal saline to be infused over 30
minutes. How many milliliters per hour should the nurse at the infusion pump? (Enter numerical
value only.)
1000
NGN: (Nurses Notes)
1800: The client is a female neonate born at 37 weeks of gestation to a G 2 P 1 mother, who was
diagnosed with gestational diabetes. Following a spontaneous vaginal birth, she received Apgar
scores of seven at one minute and eight at five minutes. The client weighs 4036.97g (8lbs 9oz)
and appears pink with acrocyanosis and a moderate amount of subcutaneous fat. She is noted to
be slightly jittery at 30min of age. Axillary temperature 96F, pulse 140, RR 80. Blood glucose
35, Billy Rubin seven, fontanelles soft, mongolian spot noted on lower back, Ballard maturity
rating 37 weeks. (For each assessment finding, click to indicate whether the findings are
associated with an infant of a diabetic mother or normal presentation.)
Soft Fontanelles
Blood Glucose 35
Axillary temp. 96F
Acrocyanosis
Ballard score maturity rating 37
Diabetic Findings:
BG 35
Axillary temp 96
Ballard score maturity rating 37
Normal Presentation:
Soft Fontanelles
Acrocyanosis
(normal findings include acrocyanosis, soft fontanelles, mongolian spots, and Apgar scores 7 to
10)
NGN: (Nurses Notes)
1800: The client is a female neonate born at 37 weeks of gestation to a G 2 P 1 mother, who was
diagnosed with gestational diabetes. Following a spontaneous vaginal birth, she received Apgar
scores of seven at one minute and eight at five minutes. The client weighs 4036.97g (8lbs 9oz)
and appears pink with acrocyanosis and a moderate amount of subcutaneous fat. She is noted to
be slightly jittery at 30min of age. Axillary temperature 96F, pulse 140, RR 80. Blood glucose
,35, Billy Rubin seven, fontanelles soft, mongolian spot noted on lower back, Ballard maturity
rating 37 weeks.
The nurse recognizes that the infant of a diabetic mother is at risk for _________ ,
_____________ , and _________________
Hyperbilirubinemia , Resppiratory Distress Syndrome , and Cardiomyopathy
NGN: Orders
Breast-feed immediately once stable then on demand. If unstable, may feed breastmilk via
orogastric tube. If two feeding attempts failed to increase the glucose levels or if symptoms of
hypoglycemia develop, apply dextrose gel inside the babies cheek. If the above are ineffective,
IV glucose should be administered to maintain glucose levels above 45. Bolus of 2mL/kg
glucose 10% IV, hello by a continuous glucose perfusion of 6 to 8mg/kg/min, maintain glycemic
levels over 40.
Which 6 orders take priority?
A) Feed Immediately
B) Monitor for respiratory distress
C) Apply dextrose gell inside the baby's cheek
D) Keep in warmer with bilirubin lights
E) Monitor temp every 30 min
F) Bolus 2 mL/kg glucose 10% IV
G) Contact RT for ABG and oxygen therapy
H) Echo
I) Transfer to NICU
J) Blood glucose level
A) Feed Immedicately
B) Monitor for Respiratory Distress
D) Keep in warmer with bili lights
E) Monitor temp q30min
G) Contact RT for ABG and O2 therapy
J) Blood glucose level
NGN Laboratory Results (same case of patient who just gave birth)
Which actions are appropriate for the nurse to take at this time? SATA
A) Keep infant in warmer with bili lights to maintain temp of 97.6F
B) Monitor Temp
C) Continue to monitor glucose level
D) Tell the mother that she will need to discuss this with the neonatologist
E) Explain to the mother that the babys RR needs to be below 60
F) Inform the mother that the baby is stable enought to take out of the warmer
G) Observe for signs of respiratory distress and monitor O2 with pulse ox
A) Keep infant in warmer with bili lights to maintain temp of 97F
E) Explain to the mother that the babys RR need to be below 60
F) Inform the mother that the baby is stable enough to take out of the warmer
G) Observe for signs of respiratory distress and monitor oxygenation by pulse ox
,NGN: 1800: The client is a female neonate born at 37 weeks of gestation to a G 2 P 1 mother,
who was diagnosed with gestational diabetes. Following a spontaneous vaginal birth, she
received Apgar scores of seven at one minute and eight at five minutes. The client weighs
4036.97g (8lbs 9oz) and appears pink with acrocyanosis and a moderate amount of subcutaneous
fat. She is noted to be slightly jittery at 30min of age. Axillary temperature 96F, pulse 140, RR
80. Blood glucose 35, Billy Rubin seven, fontanelles soft, mongolian spot noted on lower back,
Ballard maturity rating 37 weeks.
(The day shift nurse reviews the nurses notes, labs, and flow sheet from the night before. The
nurse plans on providing health teaching for the client and her family in preparation for
discharge.)
For each teaching point, click to indicate whether it is indicated or contraindicated. Only one
right option per row.
A) You will need to se
A)
B)
C)
D) Indicated
E)
NGN: 1800: The client is a female neonate born at 37 weeks of gestation to a G 2 P 1 mother,
who was diagnosed with gestational diabetes. Following a spontaneous vaginal birth, she
received Apgar scores of seven at one minute and eight at five minutes. The client weighs
4036.97g (8lbs 9oz) and appears pink with acrocyanosis and a moderate amount of subcutaneous
fat. She is noted to be slightly jittery at 30min of age. Axillary temperature 96F, pulse 140, RR
80. Blood glucose 35, Billy Rubin seven, fontanelles soft, mongolian spot noted on lower back,
Ballard maturity rating 37 weeks.
(Click to highlight notes that demonstrate a positive outcome)
Day 2, 0630: Vitals have remained stable throughout the night. Oxygen 98% on nasal canal.
Mother to breastfeed in the nursery on demand. Able to tolerate breastmilk. Glucose after
feeding was 60, temp 97.8F, when returned to warmer and bili light. CXR and echo results were
Glucose after feeding was 60
Direct bili 5
Temp 97.8
Oxygen 98%
Able to tolerate breastmilk
While caring for a toddler receiving oxygen via facemask, the nurse observes that the child's lips
and nares are dry and cracked. Which intervention should the nurse implement?
A) Use a water-soluble lubricant on affected oral and nasal mucosa.
B) Use a topical lidocaine analgesic for cracked lips.
C) Ask the mother what she usually uses on the child's lips and nose.
D) Apply a petroleum jelly to the child's nose and lips.
A) use a water-soluble lubricant on affected oral and nasal mucosa
When assessing a multigravida on the first postpartum day, the nurse finds a moderate amount of
lochia rubra, with the uterus firm, and three finger breaths above the umbilicus. What action
, should the nurse implement first?
A) Increase IV infusion.
B) Massage the uterus to decrease attorney.
C) Review the hemoglobin to determine hemorrhage.
D)Check for a distended bladder.
D) Check for a distended bladder
The psychiatric nurse is caring for clients in an adolescent unit. Which client requires the nurse's
immediate attention?
A) An 18-year-old client with antisocial behavior who is being yelled at by other clients.
B) A 17-year-old client diagnosed with bipolar disorder who is pacing around the lobby.
C) A 16-year-old client diagnosed with major depression who refuses to participate in a room.
D) A 14-year-old client with anorexia nervosa who is refusing to eat the evening snack
A) An 18-year-old client with antisocial behavior who is being yelled at by other clients.
A client recovering from pneumonia who has a history of severe chronic obstructive pulmonary
disease and peripheral vascular disease is being discharged from the skilled nursing facility.
Which action is most important for the nurse to implement?
A) Explain exercise daily regimen.
B) Demonstrate specific strengthening exercises.
C) Provide typed instructions for healthy diet selection.
D) Reinforce need for adequate hydration.
C) Provide typed instructions for healthy diet selection.
A six week old infant with pyloric stenosis is scheduled for a pyloromyotomy which pre-
operative nursing action has the highest priority?
A) Instruct Parents regarding care of the incisional area.
B) Mark and outline of the olive shaped mass in the right epigastric area.
C) Initiate a continuous infusion of IV fluids per prescription.
D) Monitor the amount of intake and infant's response to feedings.
C) Initiate a continuous infusion of IV fluids per prescription.
NGN: the client has returned to work at an accounting firm and has started going to a grief
support group. She states she is seeking care from a healthcare professional because her father is
worried about her. The client states she only gets 2 to 3 hours of sleep due to nightmares about
the crash. She states that exercising right after work helps her get better sleep and to relax. She
feels that she is jumpy after the accident, especially when she is in the car. She also stated, "I feel
so sad that I can't seem to feel anything...
(highlight the areas that the nurse should....)
NGN: the client is a 26 year-old female who was in a car accident six months ago that killed her
mother, husband, and two-year-old son. She and her father were the only survivors of the crash.
She is seeking care for depression.
The client is exhibiting symptoms of __________ related to _____________ and __________
Post-traumatic stress disorder , experiencing a life-threatening event , losing a loved one
RATIONALIZED ANSWERS, 100% GUARANTEED.
The nurse enters the room of a client with Parkinson's disease who is taking carbidopa levodopa.
The client is a rising slowly from the chair while the unlicensed assistive personnel stands next to
the chair. Which action should the nurse take?
A) Offer a PRN analgesic to reduce painful movement.
B) Tell the UAP to assess the quiet and moving more quickly.
C) Affirm that the client should arise slowly from the chair.
D) Demonstrate how to help the client move more efficiently.
C) Affirm that the client should arise slowly from the chair.
The healthcare provider prescribes 500 mL IV bolus of 0.9% normal saline to be infused over 30
minutes. How many milliliters per hour should the nurse at the infusion pump? (Enter numerical
value only.)
1000
NGN: (Nurses Notes)
1800: The client is a female neonate born at 37 weeks of gestation to a G 2 P 1 mother, who was
diagnosed with gestational diabetes. Following a spontaneous vaginal birth, she received Apgar
scores of seven at one minute and eight at five minutes. The client weighs 4036.97g (8lbs 9oz)
and appears pink with acrocyanosis and a moderate amount of subcutaneous fat. She is noted to
be slightly jittery at 30min of age. Axillary temperature 96F, pulse 140, RR 80. Blood glucose
35, Billy Rubin seven, fontanelles soft, mongolian spot noted on lower back, Ballard maturity
rating 37 weeks. (For each assessment finding, click to indicate whether the findings are
associated with an infant of a diabetic mother or normal presentation.)
Soft Fontanelles
Blood Glucose 35
Axillary temp. 96F
Acrocyanosis
Ballard score maturity rating 37
Diabetic Findings:
BG 35
Axillary temp 96
Ballard score maturity rating 37
Normal Presentation:
Soft Fontanelles
Acrocyanosis
(normal findings include acrocyanosis, soft fontanelles, mongolian spots, and Apgar scores 7 to
10)
NGN: (Nurses Notes)
1800: The client is a female neonate born at 37 weeks of gestation to a G 2 P 1 mother, who was
diagnosed with gestational diabetes. Following a spontaneous vaginal birth, she received Apgar
scores of seven at one minute and eight at five minutes. The client weighs 4036.97g (8lbs 9oz)
and appears pink with acrocyanosis and a moderate amount of subcutaneous fat. She is noted to
be slightly jittery at 30min of age. Axillary temperature 96F, pulse 140, RR 80. Blood glucose
,35, Billy Rubin seven, fontanelles soft, mongolian spot noted on lower back, Ballard maturity
rating 37 weeks.
The nurse recognizes that the infant of a diabetic mother is at risk for _________ ,
_____________ , and _________________
Hyperbilirubinemia , Resppiratory Distress Syndrome , and Cardiomyopathy
NGN: Orders
Breast-feed immediately once stable then on demand. If unstable, may feed breastmilk via
orogastric tube. If two feeding attempts failed to increase the glucose levels or if symptoms of
hypoglycemia develop, apply dextrose gel inside the babies cheek. If the above are ineffective,
IV glucose should be administered to maintain glucose levels above 45. Bolus of 2mL/kg
glucose 10% IV, hello by a continuous glucose perfusion of 6 to 8mg/kg/min, maintain glycemic
levels over 40.
Which 6 orders take priority?
A) Feed Immediately
B) Monitor for respiratory distress
C) Apply dextrose gell inside the baby's cheek
D) Keep in warmer with bilirubin lights
E) Monitor temp every 30 min
F) Bolus 2 mL/kg glucose 10% IV
G) Contact RT for ABG and oxygen therapy
H) Echo
I) Transfer to NICU
J) Blood glucose level
A) Feed Immedicately
B) Monitor for Respiratory Distress
D) Keep in warmer with bili lights
E) Monitor temp q30min
G) Contact RT for ABG and O2 therapy
J) Blood glucose level
NGN Laboratory Results (same case of patient who just gave birth)
Which actions are appropriate for the nurse to take at this time? SATA
A) Keep infant in warmer with bili lights to maintain temp of 97.6F
B) Monitor Temp
C) Continue to monitor glucose level
D) Tell the mother that she will need to discuss this with the neonatologist
E) Explain to the mother that the babys RR needs to be below 60
F) Inform the mother that the baby is stable enought to take out of the warmer
G) Observe for signs of respiratory distress and monitor O2 with pulse ox
A) Keep infant in warmer with bili lights to maintain temp of 97F
E) Explain to the mother that the babys RR need to be below 60
F) Inform the mother that the baby is stable enough to take out of the warmer
G) Observe for signs of respiratory distress and monitor oxygenation by pulse ox
,NGN: 1800: The client is a female neonate born at 37 weeks of gestation to a G 2 P 1 mother,
who was diagnosed with gestational diabetes. Following a spontaneous vaginal birth, she
received Apgar scores of seven at one minute and eight at five minutes. The client weighs
4036.97g (8lbs 9oz) and appears pink with acrocyanosis and a moderate amount of subcutaneous
fat. She is noted to be slightly jittery at 30min of age. Axillary temperature 96F, pulse 140, RR
80. Blood glucose 35, Billy Rubin seven, fontanelles soft, mongolian spot noted on lower back,
Ballard maturity rating 37 weeks.
(The day shift nurse reviews the nurses notes, labs, and flow sheet from the night before. The
nurse plans on providing health teaching for the client and her family in preparation for
discharge.)
For each teaching point, click to indicate whether it is indicated or contraindicated. Only one
right option per row.
A) You will need to se
A)
B)
C)
D) Indicated
E)
NGN: 1800: The client is a female neonate born at 37 weeks of gestation to a G 2 P 1 mother,
who was diagnosed with gestational diabetes. Following a spontaneous vaginal birth, she
received Apgar scores of seven at one minute and eight at five minutes. The client weighs
4036.97g (8lbs 9oz) and appears pink with acrocyanosis and a moderate amount of subcutaneous
fat. She is noted to be slightly jittery at 30min of age. Axillary temperature 96F, pulse 140, RR
80. Blood glucose 35, Billy Rubin seven, fontanelles soft, mongolian spot noted on lower back,
Ballard maturity rating 37 weeks.
(Click to highlight notes that demonstrate a positive outcome)
Day 2, 0630: Vitals have remained stable throughout the night. Oxygen 98% on nasal canal.
Mother to breastfeed in the nursery on demand. Able to tolerate breastmilk. Glucose after
feeding was 60, temp 97.8F, when returned to warmer and bili light. CXR and echo results were
Glucose after feeding was 60
Direct bili 5
Temp 97.8
Oxygen 98%
Able to tolerate breastmilk
While caring for a toddler receiving oxygen via facemask, the nurse observes that the child's lips
and nares are dry and cracked. Which intervention should the nurse implement?
A) Use a water-soluble lubricant on affected oral and nasal mucosa.
B) Use a topical lidocaine analgesic for cracked lips.
C) Ask the mother what she usually uses on the child's lips and nose.
D) Apply a petroleum jelly to the child's nose and lips.
A) use a water-soluble lubricant on affected oral and nasal mucosa
When assessing a multigravida on the first postpartum day, the nurse finds a moderate amount of
lochia rubra, with the uterus firm, and three finger breaths above the umbilicus. What action
, should the nurse implement first?
A) Increase IV infusion.
B) Massage the uterus to decrease attorney.
C) Review the hemoglobin to determine hemorrhage.
D)Check for a distended bladder.
D) Check for a distended bladder
The psychiatric nurse is caring for clients in an adolescent unit. Which client requires the nurse's
immediate attention?
A) An 18-year-old client with antisocial behavior who is being yelled at by other clients.
B) A 17-year-old client diagnosed with bipolar disorder who is pacing around the lobby.
C) A 16-year-old client diagnosed with major depression who refuses to participate in a room.
D) A 14-year-old client with anorexia nervosa who is refusing to eat the evening snack
A) An 18-year-old client with antisocial behavior who is being yelled at by other clients.
A client recovering from pneumonia who has a history of severe chronic obstructive pulmonary
disease and peripheral vascular disease is being discharged from the skilled nursing facility.
Which action is most important for the nurse to implement?
A) Explain exercise daily regimen.
B) Demonstrate specific strengthening exercises.
C) Provide typed instructions for healthy diet selection.
D) Reinforce need for adequate hydration.
C) Provide typed instructions for healthy diet selection.
A six week old infant with pyloric stenosis is scheduled for a pyloromyotomy which pre-
operative nursing action has the highest priority?
A) Instruct Parents regarding care of the incisional area.
B) Mark and outline of the olive shaped mass in the right epigastric area.
C) Initiate a continuous infusion of IV fluids per prescription.
D) Monitor the amount of intake and infant's response to feedings.
C) Initiate a continuous infusion of IV fluids per prescription.
NGN: the client has returned to work at an accounting firm and has started going to a grief
support group. She states she is seeking care from a healthcare professional because her father is
worried about her. The client states she only gets 2 to 3 hours of sleep due to nightmares about
the crash. She states that exercising right after work helps her get better sleep and to relax. She
feels that she is jumpy after the accident, especially when she is in the car. She also stated, "I feel
so sad that I can't seem to feel anything...
(highlight the areas that the nurse should....)
NGN: the client is a 26 year-old female who was in a car accident six months ago that killed her
mother, husband, and two-year-old son. She and her father were the only survivors of the crash.
She is seeking care for depression.
The client is exhibiting symptoms of __________ related to _____________ and __________
Post-traumatic stress disorder , experiencing a life-threatening event , losing a loved one
