2025 HESI Exit Exam | Nightingale College | Featuring
Comprehensive Nursing Concepts, Clinical Judgment,
NCLEX Readiness, and Patient Care Management
An adult client is admitted to the emergency department after falling from the
ladder. While waiting to have a computed tomography (CT) scan, the client
requests something for a severe headache. When the nurse offers a prescribed
dose of acetaminophen, the client asks for something stronger. Which
intervention should the nurse implement?
A. Review client's history for use of illicit drugs
B. Explain the reason for using only non-narcotics
C. Assess client's pupils for their reaction to light
D. Request that the CT scan be done immediately ---------CORRECT ANSWER---------
--------B. Explain the reason for using only non-narcotics
The nurse is caring for a client who has chronic obstructive pulmonary disease
(COPD) and chest pain related to a recent fall. What nursing intervention requires
the greatest caution when caring for a client with COPD?
A. Monitoring telemetry and cardiac rhythm
B. Assisting client to cough and deep breath
C. Administering narcotics for pain relief
D. Increasing the client's fluid intake ---------CORRECT ANSWER-----------------C.
Administering narcotics for pain relief
,The nurse is providing care for a client with schizophrenia who receives
haloperidol decanoate 75mg IM every 4 weeks. The client begins developing a
puckering and smacking of the lips and facial grimacing. Which intervention
should the nurse implement?
A. Monitor lying, sitting, and standing blood pressures
B. Provide coaching in relaxation techniques
C. Complete abnormal involuntary movement scale (AIMS)
D. Discontinue all medications immediately ---------CORRECT ANSWER-----------------
C. Complete abnormal involuntary movement scale (AIMS)
Prolonged exposure to high concentrations of supplemental oxygen over several
days can cause which pathophysiological effect?
A. Disrupted surfactant production
B. Metabolic acidosis
C. Aphasia and memory loss
D. Deep sleep or coma ---------CORRECT ANSWER-----------------A. Disrupted
surfactant production
A client who recently received a prescription for ramelteon to treat sleep
deprivation reports experiencing several side effects since taking the drug. Which
side effect should the nurse report to the healthcare provider?
A. A change in the sleep-wake cycle
B. Mild sedation
C. Dizziness reported after initial dose
D. Somnambulism ---------CORRECT ANSWER-----------------D. Somnambulism
,The nurse instructs a client in use of a incentive spirometer. The client performs a
return demonstration as seen in the video. Which action should the nurse take in
response to the return demonstration?
A. Auscultate the client's lungs for adventitious sounds
B. Encourage the client to practice until successful
C. Emphasize the need to inhale slowly into the spirometer
D. Remind the client to cough after using the spirometer ---------CORRECT
ANSWER-----------------D. Remind the client to cough after using the spirometer
A client tells the nurse about working out with a personal trainer and swimming
three times a week in an effort to lose weight and sleep better. The client states
that it still is taking hours to fall asleep at night. Which action should the nurse
implement?
A. Advise the client that lifestyle changes often take several weeks to be effective
B. Encourage the client to exercise everyday to eliminate bedtime wakefulness
C. Ask the client for a description of the exercise schedule that is being followed
D. Determine the amount of weight the client has lost since increasing activity ----
-----CORRECT ANSWER-----------------C. Ask the client for a description of the
exercise schedule that is being followed
The nurse is developing an educational program for older clients who are being
discharged with new antihypertensive medications. The nurse should ensure that
the education materials include which characteristics? (Select all that apply)
, A. Uses common words with few syllables
B. Printed using a 12-point type font
C. Uses pictures to help illustrate complex ideas
D. Contains a list with definitions of unfamiliar terms
E. Written at a twelfth-grade reading level ---------CORRECT ANSWER-----------------
A. Uses common words with few syllables
C. Uses pictures to help illustrate complex ideas
D. Contains a list with definitions of unfamiliar terms
The nurse is providing care for a client with severe peripheral arterial disease
(PAD). The client reports a history of rest ischemia, with leg pain that occurs
during the night. Which action should the nurse take in response to this finding?
A. Elevate the legs to assess for color changes
B. Provide a heating pad for PRN use
C. Offer cold packs when the pain occurs
D. Suggest dangling the legs when pain occurs ---------CORRECT ANSWER-------------
----C. Offer cold packs when the pain occurs
The nurse assess a client being treated for Herpes zoster (shingles). Which
assessments should the nurse include when evaluating the effectiveness of the
the treatment? (Select all that apply)
A. Functional ability
B. Skin integrity
C. Pain scale
Comprehensive Nursing Concepts, Clinical Judgment,
NCLEX Readiness, and Patient Care Management
An adult client is admitted to the emergency department after falling from the
ladder. While waiting to have a computed tomography (CT) scan, the client
requests something for a severe headache. When the nurse offers a prescribed
dose of acetaminophen, the client asks for something stronger. Which
intervention should the nurse implement?
A. Review client's history for use of illicit drugs
B. Explain the reason for using only non-narcotics
C. Assess client's pupils for their reaction to light
D. Request that the CT scan be done immediately ---------CORRECT ANSWER---------
--------B. Explain the reason for using only non-narcotics
The nurse is caring for a client who has chronic obstructive pulmonary disease
(COPD) and chest pain related to a recent fall. What nursing intervention requires
the greatest caution when caring for a client with COPD?
A. Monitoring telemetry and cardiac rhythm
B. Assisting client to cough and deep breath
C. Administering narcotics for pain relief
D. Increasing the client's fluid intake ---------CORRECT ANSWER-----------------C.
Administering narcotics for pain relief
,The nurse is providing care for a client with schizophrenia who receives
haloperidol decanoate 75mg IM every 4 weeks. The client begins developing a
puckering and smacking of the lips and facial grimacing. Which intervention
should the nurse implement?
A. Monitor lying, sitting, and standing blood pressures
B. Provide coaching in relaxation techniques
C. Complete abnormal involuntary movement scale (AIMS)
D. Discontinue all medications immediately ---------CORRECT ANSWER-----------------
C. Complete abnormal involuntary movement scale (AIMS)
Prolonged exposure to high concentrations of supplemental oxygen over several
days can cause which pathophysiological effect?
A. Disrupted surfactant production
B. Metabolic acidosis
C. Aphasia and memory loss
D. Deep sleep or coma ---------CORRECT ANSWER-----------------A. Disrupted
surfactant production
A client who recently received a prescription for ramelteon to treat sleep
deprivation reports experiencing several side effects since taking the drug. Which
side effect should the nurse report to the healthcare provider?
A. A change in the sleep-wake cycle
B. Mild sedation
C. Dizziness reported after initial dose
D. Somnambulism ---------CORRECT ANSWER-----------------D. Somnambulism
,The nurse instructs a client in use of a incentive spirometer. The client performs a
return demonstration as seen in the video. Which action should the nurse take in
response to the return demonstration?
A. Auscultate the client's lungs for adventitious sounds
B. Encourage the client to practice until successful
C. Emphasize the need to inhale slowly into the spirometer
D. Remind the client to cough after using the spirometer ---------CORRECT
ANSWER-----------------D. Remind the client to cough after using the spirometer
A client tells the nurse about working out with a personal trainer and swimming
three times a week in an effort to lose weight and sleep better. The client states
that it still is taking hours to fall asleep at night. Which action should the nurse
implement?
A. Advise the client that lifestyle changes often take several weeks to be effective
B. Encourage the client to exercise everyday to eliminate bedtime wakefulness
C. Ask the client for a description of the exercise schedule that is being followed
D. Determine the amount of weight the client has lost since increasing activity ----
-----CORRECT ANSWER-----------------C. Ask the client for a description of the
exercise schedule that is being followed
The nurse is developing an educational program for older clients who are being
discharged with new antihypertensive medications. The nurse should ensure that
the education materials include which characteristics? (Select all that apply)
, A. Uses common words with few syllables
B. Printed using a 12-point type font
C. Uses pictures to help illustrate complex ideas
D. Contains a list with definitions of unfamiliar terms
E. Written at a twelfth-grade reading level ---------CORRECT ANSWER-----------------
A. Uses common words with few syllables
C. Uses pictures to help illustrate complex ideas
D. Contains a list with definitions of unfamiliar terms
The nurse is providing care for a client with severe peripheral arterial disease
(PAD). The client reports a history of rest ischemia, with leg pain that occurs
during the night. Which action should the nurse take in response to this finding?
A. Elevate the legs to assess for color changes
B. Provide a heating pad for PRN use
C. Offer cold packs when the pain occurs
D. Suggest dangling the legs when pain occurs ---------CORRECT ANSWER-------------
----C. Offer cold packs when the pain occurs
The nurse assess a client being treated for Herpes zoster (shingles). Which
assessments should the nurse include when evaluating the effectiveness of the
the treatment? (Select all that apply)
A. Functional ability
B. Skin integrity
C. Pain scale
