CAT EXAM 1-HESI EXIT
1. A client is comatose upon arrival to the emergency department after falling a
roof. The client flexes with painful stimuli, and the nurse determines the client's
Glasgow Coma Scale (GCS) is 6. Which intervention should the nurse prepare
to implement to maintain the client's airway?
Answer A nasopharyngeal tube
2. A client is receiving a continuous half strength tube feeding at 50 ml/hr. To
prepare enough of the solution for eight hours, how many ml of full strength
feeding will the nurse need?
Answer Answer
200
25 ml x 8hrs = 200
3. The alarm of a client's pulse oximeter sounds and the nurse notes that the
oxygen saturation rate is indicated at 85%. What action should the nurse take
,first?
Answer Check the probe position
4. A client is known to have an irregular respiratory rate with periods of apnea
lasting 10 to 15 seconds. Currently, the nurse counts 22 respiratory cycles in a
30-second interval followed by an apneic period. What intervention should the
nurse implement?
Answer Reassess the respiratory rate, counting for one full minute
5. A retiree with depression complains of feeling "lonely and having no purpose"
in life.Based on Erikson's developmental theory, which questions suggest that
the nurse understands the client's most important emotional need?
Answer "What about your life makes you proud?"
6. Following a precipitous labor, a client has a continuous trickling of bright red
blood from her vagina. Her uterus is firm and her vital signs are within normal
limits. The
nurse determines that the client's symptoms may indicate which condition?
,Answer A cervical laceration
7. In preparing assignments for the shift, which client is best for the charge
nurse to assign to a practical nurse?
Answer An elderly client with Alzheimer's disease complicated by dysphagia
8. The healthcare provider prescribes oxygen per nasal cannula at 2 L/min.
Which action has the highest priority when the nurse implements this prescrip-
tion?
Answer Set the flow meter
, 9. 9. A nurse who is new to the pediatric unit is positioning a 6-month-old for an
injection of penicillin V (Pen V) in the dorsogluteal muscle. Which action should
the nurse-manager who is supervising this nurse take first?
Answer C. Instruct the nurse to select another injection site
10. 10. After diagnosis and initial treatment of a 3-year-old child with cystic fibro-
sis, the nurse provides home care instructions to the mother. Which statement
by the child's mother indicates that she understands home care treatment to
promote pulmonary function?
Answer "Chest physiotherapy should be performed at least twice a day"
11. The nurse is preparing a community education program on osteoporosis.
Which instruction is helpful in preventing bone loss and promoting bone for-
mation?
Answer Encourage physical activity
12. The nurse reviews the signs of hypoglycemia with the parents of a child
with Type 1 diabetes mellitus. The parents correctly understands signs of
1. A client is comatose upon arrival to the emergency department after falling a
roof. The client flexes with painful stimuli, and the nurse determines the client's
Glasgow Coma Scale (GCS) is 6. Which intervention should the nurse prepare
to implement to maintain the client's airway?
Answer A nasopharyngeal tube
2. A client is receiving a continuous half strength tube feeding at 50 ml/hr. To
prepare enough of the solution for eight hours, how many ml of full strength
feeding will the nurse need?
Answer Answer
200
25 ml x 8hrs = 200
3. The alarm of a client's pulse oximeter sounds and the nurse notes that the
oxygen saturation rate is indicated at 85%. What action should the nurse take
,first?
Answer Check the probe position
4. A client is known to have an irregular respiratory rate with periods of apnea
lasting 10 to 15 seconds. Currently, the nurse counts 22 respiratory cycles in a
30-second interval followed by an apneic period. What intervention should the
nurse implement?
Answer Reassess the respiratory rate, counting for one full minute
5. A retiree with depression complains of feeling "lonely and having no purpose"
in life.Based on Erikson's developmental theory, which questions suggest that
the nurse understands the client's most important emotional need?
Answer "What about your life makes you proud?"
6. Following a precipitous labor, a client has a continuous trickling of bright red
blood from her vagina. Her uterus is firm and her vital signs are within normal
limits. The
nurse determines that the client's symptoms may indicate which condition?
,Answer A cervical laceration
7. In preparing assignments for the shift, which client is best for the charge
nurse to assign to a practical nurse?
Answer An elderly client with Alzheimer's disease complicated by dysphagia
8. The healthcare provider prescribes oxygen per nasal cannula at 2 L/min.
Which action has the highest priority when the nurse implements this prescrip-
tion?
Answer Set the flow meter
, 9. 9. A nurse who is new to the pediatric unit is positioning a 6-month-old for an
injection of penicillin V (Pen V) in the dorsogluteal muscle. Which action should
the nurse-manager who is supervising this nurse take first?
Answer C. Instruct the nurse to select another injection site
10. 10. After diagnosis and initial treatment of a 3-year-old child with cystic fibro-
sis, the nurse provides home care instructions to the mother. Which statement
by the child's mother indicates that she understands home care treatment to
promote pulmonary function?
Answer "Chest physiotherapy should be performed at least twice a day"
11. The nurse is preparing a community education program on osteoporosis.
Which instruction is helpful in preventing bone loss and promoting bone for-
mation?
Answer Encourage physical activity
12. The nurse reviews the signs of hypoglycemia with the parents of a child
with Type 1 diabetes mellitus. The parents correctly understands signs of
