SOLVED PROBLEMS FOR EXIT
HESI EXAM QUESTIONS AND
ANSWERS
After receiving IV fluids in the ER, an elderly patient is admitted to the acute care unit with a medical
diagnosis of dehydration. The patient is receiving 0.9% normal saline 125 mL/hr via saline lock and has a
bounding pulse, tachycardia, and pedal edema. When contacting the dr, the nurse anticipates a
prescription with what intervention?
a. Remove the saline lock from the arm
b. Increase rate of normal saline
c. Decrease rate of normal saline infusion
d. Change IV solution to 0.45% saline solution - CORRECT ANSWER -a. Remove the saline lock from the
arm
A patient who is admitted to the care unit with syndrome of inappropriate 9antidiuretic 9hormone
9(SIADH) 9has 9developed 9osmotic 9demyelination. 9Which 9intervention 9should 9the 9nurse 9implement
9first?
a. Patch 9one 9eye
b. Evaluate 9swallow
c. Reorient 9often
d. Range 9of 9motion 9- 9CORRECT 9ANSWER 9-b. 9Evaluate 9swallow
The 9nurse 9is 9preparing 9a 9client 9who 9had 9a 9below-the-knee 9(BKA) 9amputation 9for 9discharge
9home. 9Which 9recommendations 9should 9the 9nurse 9provide 9this 9patient? 9(SATA)
,a. Wash 9stump 9with 9soap 9and 9water
b. Avoid 9range 9of 9motion 9exercise
c. Apply 9alcohol 9to 9the 9stump 9after 9bathing
d. Inspect 9skin 9for 9redness
e. Use 9a 9residual 9limb 9shrinker 9- 9CORRECT 9ANSWER 9-a. 9Wash 9stump 9with 9soap 9and 9water
d. 9Inspect 9skin 9for 9redness
e. 9Use 9a 9residual 9limb 9shrinker
After 92 9days 9treatment 9of 9dehydration, 9a 9child 9continues 9to 9vomit 9and 9have 9diarrhea. 9Normal
9saline 9is 9infusing 9and 9the 9child's 9urine 9output 9is 950 9mL/hr. 9During 9morning 9assessment, 9the
9nurse 9determines 9that 9the 9child 9is 9lethargic 9and 9difficult 9to 9arouse. 9Which 9should 9the 9nurse
9implement?
a. Increase 9IV 9fluid 9flow 9rate
b. Review 924 9hr 9intake 9and 9output
c. Obtain 9ABGs
d. Perform 9a 9finger 9stick 9glucose 9test 9- 9CORRECT 9ANSWER 9-d. 9Perform 9a 9finger 9stick 9glucose 9test
A 9patient 9with 9bleeding 9esophageal 9varices 9receives 9vasopressin 9IV. 9What 9should 9the 9nurse
9monitor 9for 9during 9the 9IV 9infusion 9of 9this 9medication?
a. Vasodilation 9of 9the 9extremities
b. Chest 9pain 9and 9dysrhythmia
c. Hypotension 9and 9tachycardia
d. Decreasing 9GI 9cramping 9and 9nausea 9- 9CORRECT 9ANSWER 9-b. 9Chest 9pain 9and 9dysrhythmia
,A 9male 9patient 9with 9an 9antisocial 9personality 9disorder 9is 9admitted 9to 9an 9inpatient 9mental 9health
9unit 9for 9multiple 9substance 9dependency. 9When 9providing 9a 9history, 9the 9patient 9justifies 9to 9the
9nurse 9his 9use 9of 9drugs. 9Based 9on 9this 9pattern 9of 9behavior, 9this 9patient's 9history 9if 9most 9likely
9to 9include 9which 9finding?
a. Multiple 9convictions 9for 9misdemeanors 9and 9Class 9B 9felonies
b. Delusions 9of 9grandiosity 9and 9persecution
c. Suicidal 9ideations 9and 9multiple 9attempts
d. Photos 9and 9panic 9attacks 9when 9confronted 9by 9authority 9- 9CORRECT 9ANSWER 9-a. 9Multiple
9convictions 9for 9misdemeanors 9and 9Class 9B 9felonies
An 9older 9patient 9is 9admitted 9for 9repair 9of 9a 9broken 9hip. 9To 9reduce 9the 9risk 9of 9infection
9postoperative 9period, 9which 9nursing 9care 9intervention 9should 9the 9nurse 9include 9in 9the 9patient's
9plan 9of 9care? 9(SATA)
a. Administer 9low 9molecular 9weight 9heparin
b. Teach 9patient 9to 9use 9incentive 9spirometer 9every 92 9hours 9while 9awake
c. Remove 9urinary 9catheter 9as 9soon 9as 9possible 9and 9encourage 9voiding
d. Maintain 9sequential 9compression 9devices 9while 9in 9bed
e. Assess 9pain 9level 9and 9medicate 9PRN 9as 9prescribed 9- 9CORRECT 9ANSWER 9-b. 9Teach
9patient 9to 9use 9incentive 9spirometer 9every 92 9hours 9while 9awake
c. 9Remove 9urinary 9catheter 9as 9soon 9possible 9and 9encourage 9voiding
The 9nurse 9is 9preparing 9a 950 9mL 9dose 9of 950% 9dextrose 9IV 9for 9a 9patient 9with 9insulin 9shock. 9How
9should 9the 9nurse 9administer 9the 9medication?
a. Dilute 9dextrose 9in 91 9liter 9of 90.9% 9normal 9saline 9solution
b. Push 9undiluted 9slowly 9through 9the 9currently 9infusing 9IV
, c. Mix 9dextrose 9in 9a 950 9mL 9piggyback 9for 9a 9total 9volume 9of 9100 9mL
d. Ask 9the 9pharmacist 9to 9add 9the 9dextrose 9to 9a 9TPN 9solution 9- 9CORRECT 9ANSWER 9-b.
9Push 9undiluted 9slowly 9through 9the 9currently 9infusing 9IV
A 9patient 9with 9arthritis 9has 9been 9receiving 9treatment 9with 9naproxen 9and 9now 9reports 9stomach
9pain, 9increasing 9weakness, 9and 9fatigue. 9Which 9lab 9test 9should 9the 9nurse 9monitor?
a. Calcium
b. Erythrocyte 9sedimentation 9rate
c. Osmolaltiy
d. Hemoglobin 9- 9CORRECT 9ANSWER 9-d. 9Hemoglobin
A 9patient 9with 9bacterial 9meningitis 9is 9receiving 9phenytoin. 9Which 9assessment 9finding 9indication 9to
9the 9nurse 9that 9the 9client 9is 9experiencing 9a 9therapeutic 9response 9to 9the 9phenytoin?
a. Increased 9time 9of 9ambulation 9between 9periods 9of 9rest
b. Decrease 9in 9intracranial 9pressure 9and 9cerebral 9edema
c. Absence 9of 9seizure 9activity 9for 9the 9duration 9of 9treatment
d. Normal 9electroencephalogram 9after 9drug 9administration 9- 9CORRECT 9ANSWER 9-c. 9Absence 9of
9seizure 9activity 9for 9the 9duration 9of 9treatment
A 9patient 9with 9peptic 9ulcer 9disease 9receives 9a 9prescription 9for 9intermittent 9suction 9via 9a 9salem
9sump 9nasogastric 9tube. 9After 9inserting 9the 9NGT 9and 9obtaining 9coffee 9ground 9gastric 9contents,
9the 9nurse 9clamps 9the 9NGT 9because 9the 9patient 9must 9leave 9the 9room 9for 9diagnostic 9studies.
9Upon 9return 9to 9the 9unit, 9the 9patient 9complains 9of 9nausea. 9What 9action 9should 9the 9nurse
9implement 9first?
a. Administering 9a 9prescribed 9antiemetic 9agent
b. Provide 9oral 9suction 9using 9a 9Yankauer 9tip
HESI EXAM QUESTIONS AND
ANSWERS
After receiving IV fluids in the ER, an elderly patient is admitted to the acute care unit with a medical
diagnosis of dehydration. The patient is receiving 0.9% normal saline 125 mL/hr via saline lock and has a
bounding pulse, tachycardia, and pedal edema. When contacting the dr, the nurse anticipates a
prescription with what intervention?
a. Remove the saline lock from the arm
b. Increase rate of normal saline
c. Decrease rate of normal saline infusion
d. Change IV solution to 0.45% saline solution - CORRECT ANSWER -a. Remove the saline lock from the
arm
A patient who is admitted to the care unit with syndrome of inappropriate 9antidiuretic 9hormone
9(SIADH) 9has 9developed 9osmotic 9demyelination. 9Which 9intervention 9should 9the 9nurse 9implement
9first?
a. Patch 9one 9eye
b. Evaluate 9swallow
c. Reorient 9often
d. Range 9of 9motion 9- 9CORRECT 9ANSWER 9-b. 9Evaluate 9swallow
The 9nurse 9is 9preparing 9a 9client 9who 9had 9a 9below-the-knee 9(BKA) 9amputation 9for 9discharge
9home. 9Which 9recommendations 9should 9the 9nurse 9provide 9this 9patient? 9(SATA)
,a. Wash 9stump 9with 9soap 9and 9water
b. Avoid 9range 9of 9motion 9exercise
c. Apply 9alcohol 9to 9the 9stump 9after 9bathing
d. Inspect 9skin 9for 9redness
e. Use 9a 9residual 9limb 9shrinker 9- 9CORRECT 9ANSWER 9-a. 9Wash 9stump 9with 9soap 9and 9water
d. 9Inspect 9skin 9for 9redness
e. 9Use 9a 9residual 9limb 9shrinker
After 92 9days 9treatment 9of 9dehydration, 9a 9child 9continues 9to 9vomit 9and 9have 9diarrhea. 9Normal
9saline 9is 9infusing 9and 9the 9child's 9urine 9output 9is 950 9mL/hr. 9During 9morning 9assessment, 9the
9nurse 9determines 9that 9the 9child 9is 9lethargic 9and 9difficult 9to 9arouse. 9Which 9should 9the 9nurse
9implement?
a. Increase 9IV 9fluid 9flow 9rate
b. Review 924 9hr 9intake 9and 9output
c. Obtain 9ABGs
d. Perform 9a 9finger 9stick 9glucose 9test 9- 9CORRECT 9ANSWER 9-d. 9Perform 9a 9finger 9stick 9glucose 9test
A 9patient 9with 9bleeding 9esophageal 9varices 9receives 9vasopressin 9IV. 9What 9should 9the 9nurse
9monitor 9for 9during 9the 9IV 9infusion 9of 9this 9medication?
a. Vasodilation 9of 9the 9extremities
b. Chest 9pain 9and 9dysrhythmia
c. Hypotension 9and 9tachycardia
d. Decreasing 9GI 9cramping 9and 9nausea 9- 9CORRECT 9ANSWER 9-b. 9Chest 9pain 9and 9dysrhythmia
,A 9male 9patient 9with 9an 9antisocial 9personality 9disorder 9is 9admitted 9to 9an 9inpatient 9mental 9health
9unit 9for 9multiple 9substance 9dependency. 9When 9providing 9a 9history, 9the 9patient 9justifies 9to 9the
9nurse 9his 9use 9of 9drugs. 9Based 9on 9this 9pattern 9of 9behavior, 9this 9patient's 9history 9if 9most 9likely
9to 9include 9which 9finding?
a. Multiple 9convictions 9for 9misdemeanors 9and 9Class 9B 9felonies
b. Delusions 9of 9grandiosity 9and 9persecution
c. Suicidal 9ideations 9and 9multiple 9attempts
d. Photos 9and 9panic 9attacks 9when 9confronted 9by 9authority 9- 9CORRECT 9ANSWER 9-a. 9Multiple
9convictions 9for 9misdemeanors 9and 9Class 9B 9felonies
An 9older 9patient 9is 9admitted 9for 9repair 9of 9a 9broken 9hip. 9To 9reduce 9the 9risk 9of 9infection
9postoperative 9period, 9which 9nursing 9care 9intervention 9should 9the 9nurse 9include 9in 9the 9patient's
9plan 9of 9care? 9(SATA)
a. Administer 9low 9molecular 9weight 9heparin
b. Teach 9patient 9to 9use 9incentive 9spirometer 9every 92 9hours 9while 9awake
c. Remove 9urinary 9catheter 9as 9soon 9as 9possible 9and 9encourage 9voiding
d. Maintain 9sequential 9compression 9devices 9while 9in 9bed
e. Assess 9pain 9level 9and 9medicate 9PRN 9as 9prescribed 9- 9CORRECT 9ANSWER 9-b. 9Teach
9patient 9to 9use 9incentive 9spirometer 9every 92 9hours 9while 9awake
c. 9Remove 9urinary 9catheter 9as 9soon 9possible 9and 9encourage 9voiding
The 9nurse 9is 9preparing 9a 950 9mL 9dose 9of 950% 9dextrose 9IV 9for 9a 9patient 9with 9insulin 9shock. 9How
9should 9the 9nurse 9administer 9the 9medication?
a. Dilute 9dextrose 9in 91 9liter 9of 90.9% 9normal 9saline 9solution
b. Push 9undiluted 9slowly 9through 9the 9currently 9infusing 9IV
, c. Mix 9dextrose 9in 9a 950 9mL 9piggyback 9for 9a 9total 9volume 9of 9100 9mL
d. Ask 9the 9pharmacist 9to 9add 9the 9dextrose 9to 9a 9TPN 9solution 9- 9CORRECT 9ANSWER 9-b.
9Push 9undiluted 9slowly 9through 9the 9currently 9infusing 9IV
A 9patient 9with 9arthritis 9has 9been 9receiving 9treatment 9with 9naproxen 9and 9now 9reports 9stomach
9pain, 9increasing 9weakness, 9and 9fatigue. 9Which 9lab 9test 9should 9the 9nurse 9monitor?
a. Calcium
b. Erythrocyte 9sedimentation 9rate
c. Osmolaltiy
d. Hemoglobin 9- 9CORRECT 9ANSWER 9-d. 9Hemoglobin
A 9patient 9with 9bacterial 9meningitis 9is 9receiving 9phenytoin. 9Which 9assessment 9finding 9indication 9to
9the 9nurse 9that 9the 9client 9is 9experiencing 9a 9therapeutic 9response 9to 9the 9phenytoin?
a. Increased 9time 9of 9ambulation 9between 9periods 9of 9rest
b. Decrease 9in 9intracranial 9pressure 9and 9cerebral 9edema
c. Absence 9of 9seizure 9activity 9for 9the 9duration 9of 9treatment
d. Normal 9electroencephalogram 9after 9drug 9administration 9- 9CORRECT 9ANSWER 9-c. 9Absence 9of
9seizure 9activity 9for 9the 9duration 9of 9treatment
A 9patient 9with 9peptic 9ulcer 9disease 9receives 9a 9prescription 9for 9intermittent 9suction 9via 9a 9salem
9sump 9nasogastric 9tube. 9After 9inserting 9the 9NGT 9and 9obtaining 9coffee 9ground 9gastric 9contents,
9the 9nurse 9clamps 9the 9NGT 9because 9the 9patient 9must 9leave 9the 9room 9for 9diagnostic 9studies.
9Upon 9return 9to 9the 9unit, 9the 9patient 9complains 9of 9nausea. 9What 9action 9should 9the 9nurse
9implement 9first?
a. Administering 9a 9prescribed 9antiemetic 9agent
b. Provide 9oral 9suction 9using 9a 9Yankauer 9tip
