HESI RN EXIT EXAM
The nurse is giving preop instructions to a 14 yr old scheduled to correct a
spinal curvature. Which statement best demonstrates that learning has taken
place?: I understand I will be in a body cast and I will show you hoy you taught me
to turn
To take the vital signs of a 4 month old child which order will give the most
accurate results?: Respiratory rate, heart rate, rectal temperature
A client with depression remains in bed most of the day, s=and declines activities.
Which nursing problem has the greatest priority for this client: Refusal to address
nutritional needs
The RN is preparing medications for a client with bipolar disorder and notices that
the client discontinued antipsychotic medication for several days.
Which medication should also be discontinued: Benzotropine
A female client requests that her husband be allowed to stay in the room during
the admission assessment. When interviewing the client the RN notes
a discrepancy between the clients verbal and nonverbal communication. What
,action does the RN Take: Pay close attention and document the nonverbal
messages
A male client approaches the RN with an angry expression on his face and raises
his voice saying "My roomate is the most selfish, self centered, angry person I
ahve ever met. If he loses his temper one more time with me I am going to punch
him out!" The RN recognizes that the client is using which defense mechanism:
Projection
A male client with bipolar disorder who began taking lithium carbonate five days
ago is complaining of excessive thirst and the rn finds him attempting to drink
water from the bathroom sink faucet. Which interventions should the RN
Implement: Report the clients serum lithium levels to the HCP
The RN is teaching a client about the initiation of the prescribed abstinence
therapy using disulfiram. What information should the client acknowledge
understanding: Remain alcohol free for 12 hours prior to the first dose
A male client with schizophrenia is admitted to the mental health unit after abruptly
stopping his rx for ziprsidone (Geodon) one month ago. Which question is most
important for the RN to ask the client?: Do you hear sounds or voices that others
do not hear?
,During an annual physical by the occupational RN working in a corporate clinic a
male employee tells the RN that his high stress job is causing trouble in his
personal life. He further explains that he often gets so angry while driving
to and from work that he has considered "getting even" with other drivers. How
should the RN respond?: It sound as if there are many situations that make you
feel angry
A client who has agoraphobia (a fear of crowds) is beginning desensitization with
the therapist, and the RN is reinforcing the process. Which intervention
has the highest priority for this clients plan of care?: Establish trust by providing a
calm safe environment
Which nursing actions are likely to help promote the self esteem of a male client
with modern depression: -Ask the client what his long term goals are
- encourage the client to engage in recreational therapy
- provide opportunities for the client to discuss his concerns
A male client is admitted to the psychiatric unit for recurrent negative symptoms of
chronic schizophrenia and medication adjustment of risperidone. When the client
walks to the nurses station in a laterally contracted position, he
states that something has made his body contort into a monster, What action
should the RN take: Administer the prescribed anticholinergic benzotropine for
dystonia
, A mental health worker is caring for a client with escalating aggressive behavior.
Which action by the MHW warrant immediate intervention by the
RN: Is attempting to physically restrain the patient
A client on the mental health unit is becoming more agitated, shouting at
the staff, and pacing in the hallway. What nursing intervention should the RN
Implement first: Take other clients in the area to the client lounge
A client is admitted to the mental health unit and reports taking extra antianxiety
medication because "I'm so stressed out. I just want to go to sleep" The RN
should plan one on one observation of the client based on which statement: I dont
want to walk nothing matters anymore
A male hospital employee is pushed out of the way by a female employee
because of an oncoming gurney. The pushed employee becomes very angry and
swings at the female employee. Both employees are referred for counseling with
the staff psychiatric RN. Which factor in the pushed employees history is most
related to the reaction that occured: Was physically abused by his mother
The RN documents the mental status of a female client who has been
hospitalized for several days by court order. The client states " I dont need to be
here" and tells the RN that she believes the TV talks to her. The RN should
The nurse is giving preop instructions to a 14 yr old scheduled to correct a
spinal curvature. Which statement best demonstrates that learning has taken
place?: I understand I will be in a body cast and I will show you hoy you taught me
to turn
To take the vital signs of a 4 month old child which order will give the most
accurate results?: Respiratory rate, heart rate, rectal temperature
A client with depression remains in bed most of the day, s=and declines activities.
Which nursing problem has the greatest priority for this client: Refusal to address
nutritional needs
The RN is preparing medications for a client with bipolar disorder and notices that
the client discontinued antipsychotic medication for several days.
Which medication should also be discontinued: Benzotropine
A female client requests that her husband be allowed to stay in the room during
the admission assessment. When interviewing the client the RN notes
a discrepancy between the clients verbal and nonverbal communication. What
,action does the RN Take: Pay close attention and document the nonverbal
messages
A male client approaches the RN with an angry expression on his face and raises
his voice saying "My roomate is the most selfish, self centered, angry person I
ahve ever met. If he loses his temper one more time with me I am going to punch
him out!" The RN recognizes that the client is using which defense mechanism:
Projection
A male client with bipolar disorder who began taking lithium carbonate five days
ago is complaining of excessive thirst and the rn finds him attempting to drink
water from the bathroom sink faucet. Which interventions should the RN
Implement: Report the clients serum lithium levels to the HCP
The RN is teaching a client about the initiation of the prescribed abstinence
therapy using disulfiram. What information should the client acknowledge
understanding: Remain alcohol free for 12 hours prior to the first dose
A male client with schizophrenia is admitted to the mental health unit after abruptly
stopping his rx for ziprsidone (Geodon) one month ago. Which question is most
important for the RN to ask the client?: Do you hear sounds or voices that others
do not hear?
,During an annual physical by the occupational RN working in a corporate clinic a
male employee tells the RN that his high stress job is causing trouble in his
personal life. He further explains that he often gets so angry while driving
to and from work that he has considered "getting even" with other drivers. How
should the RN respond?: It sound as if there are many situations that make you
feel angry
A client who has agoraphobia (a fear of crowds) is beginning desensitization with
the therapist, and the RN is reinforcing the process. Which intervention
has the highest priority for this clients plan of care?: Establish trust by providing a
calm safe environment
Which nursing actions are likely to help promote the self esteem of a male client
with modern depression: -Ask the client what his long term goals are
- encourage the client to engage in recreational therapy
- provide opportunities for the client to discuss his concerns
A male client is admitted to the psychiatric unit for recurrent negative symptoms of
chronic schizophrenia and medication adjustment of risperidone. When the client
walks to the nurses station in a laterally contracted position, he
states that something has made his body contort into a monster, What action
should the RN take: Administer the prescribed anticholinergic benzotropine for
dystonia
, A mental health worker is caring for a client with escalating aggressive behavior.
Which action by the MHW warrant immediate intervention by the
RN: Is attempting to physically restrain the patient
A client on the mental health unit is becoming more agitated, shouting at
the staff, and pacing in the hallway. What nursing intervention should the RN
Implement first: Take other clients in the area to the client lounge
A client is admitted to the mental health unit and reports taking extra antianxiety
medication because "I'm so stressed out. I just want to go to sleep" The RN
should plan one on one observation of the client based on which statement: I dont
want to walk nothing matters anymore
A male hospital employee is pushed out of the way by a female employee
because of an oncoming gurney. The pushed employee becomes very angry and
swings at the female employee. Both employees are referred for counseling with
the staff psychiatric RN. Which factor in the pushed employees history is most
related to the reaction that occured: Was physically abused by his mother
The RN documents the mental status of a female client who has been
hospitalized for several days by court order. The client states " I dont need to be
here" and tells the RN that she believes the TV talks to her. The RN should
