ESI RN EXIT EXAM V2 2025/2026 INET PROCTORED 160
QUESTIONS COMPLETE STUDY GUIDE WITH DETAILED,
VERIFIED SOLUTIONS & RATIONALES
SECTION 1: CARDIOVASCULAR SYSTEM
Question 1
A client with heart failure is prescribed furosemide (Lasix) 40
mg IV. Which laboratory value should the nurse assess FIRST
before administering this medication?
• A) Sodium level
• B) Potassium level
• C) Creatinine level
• D) Magnesium level
Correct 100%Correct VERIFid Answer:: B
Rationale: Furosemide is a loop diuretic that causes significant
potassium loss through the kidneys. Hypokalemia is a serious
and common side effect that can lead to life-threatening cardiac
dysrhythmias . If potassium is below 3.5 mEq/L, the nurse
should hold the medication and notify the healthcare provider.
Question 2
,A nurse is caring for a client who is 2 hours post-myocardial
infarction (MI). Which finding requires IMMEDIATE
intervention?
• A) Blood pressure of 130/80 mmHg
• B) Heart rate of 58 beats per minute
• C) Chest pain rated 8/10 on pain scale
• D) Temperature of 99.2°F (37.3°C)
Correct 100%Correct VERIFid Answer:: C
Rationale: Chest pain post-MI indicates ongoing myocardial
ischemia and possible extension of the infarction. This is a
medical emergency requiring immediate intervention including
oxygen administration, nitroglycerin, morphine, and
notification of the healthcare provider .
Question 3
A client is receiving a continuous heparin infusion for deep vein
thrombosis (DVT). The aPTT result is 120 seconds (therapeutic
range 60–100 seconds). What action should the nurse take?
• A) Increase the infusion rate by 2 units/kg/hr
• B) Decrease the infusion rate and notify the healthcare
provider
• C) Discontinue the infusion immediately
• D) Continue the infusion at the current rate
,Correct 100%Correct VERIFid Answer:: B
Rationale: An aPTT of 120 seconds is above the therapeutic
range, indicating the client is over-anticoagulated and at
increased risk for bleeding. The nurse should decrease the
infusion rate and notify the provider .
Question 4
A client has just returned from cardiac catheterization via
the right femoral artery. Which assessment finding requires
IMMEDIATE nursing intervention?
• A) Blood pressure of 118/76 mmHg
• B) Small amount of bloody drainage at puncture site
• C) Right foot that is cool, pale, and pulseless
• D) Client reports mild soreness at the insertion site
Correct 100%Correct VERIFid Answer:: C
Rationale: A cool, pale, and pulseless foot following femoral
artery catheterization indicates arterial occlusion, which is a
vascular emergency. This requires immediate notification of the
healthcare provider and vascular surgery consultation .
Question 5
, A client with hypertension is prescribed lisinopril. The nurse
should instruct the client to report which side effect
IMMEDIATELY?
• A) Persistent dry cough
• B) Mild dizziness upon standing
• C) Facial swelling and difficulty breathing
• D) Mild headache
Correct 100%Correct VERIFid Answer:: C
Rationale: ACE inhibitors such as lisinopril can cause
angioedema, a life-threatening allergic reaction characterized
by swelling of the face, lips, tongue, and throat, which can
cause airway obstruction. This is a medical emergency requiring
immediate discontinuation of the drug and emergency
treatment .
Question 6
A nurse is preparing to administer digoxin to a client with heart
failure. Which assessment finding should cause the nurse to
WITHHOLD the medication?
• A) Heart rate of 56 beats per minute
• B) Blood pressure of 138/88 mmHg
• C) Respiratory rate of 18 breaths per minute
• D) Serum potassium of 4.0 mEq/L
QUESTIONS COMPLETE STUDY GUIDE WITH DETAILED,
VERIFIED SOLUTIONS & RATIONALES
SECTION 1: CARDIOVASCULAR SYSTEM
Question 1
A client with heart failure is prescribed furosemide (Lasix) 40
mg IV. Which laboratory value should the nurse assess FIRST
before administering this medication?
• A) Sodium level
• B) Potassium level
• C) Creatinine level
• D) Magnesium level
Correct 100%Correct VERIFid Answer:: B
Rationale: Furosemide is a loop diuretic that causes significant
potassium loss through the kidneys. Hypokalemia is a serious
and common side effect that can lead to life-threatening cardiac
dysrhythmias . If potassium is below 3.5 mEq/L, the nurse
should hold the medication and notify the healthcare provider.
Question 2
,A nurse is caring for a client who is 2 hours post-myocardial
infarction (MI). Which finding requires IMMEDIATE
intervention?
• A) Blood pressure of 130/80 mmHg
• B) Heart rate of 58 beats per minute
• C) Chest pain rated 8/10 on pain scale
• D) Temperature of 99.2°F (37.3°C)
Correct 100%Correct VERIFid Answer:: C
Rationale: Chest pain post-MI indicates ongoing myocardial
ischemia and possible extension of the infarction. This is a
medical emergency requiring immediate intervention including
oxygen administration, nitroglycerin, morphine, and
notification of the healthcare provider .
Question 3
A client is receiving a continuous heparin infusion for deep vein
thrombosis (DVT). The aPTT result is 120 seconds (therapeutic
range 60–100 seconds). What action should the nurse take?
• A) Increase the infusion rate by 2 units/kg/hr
• B) Decrease the infusion rate and notify the healthcare
provider
• C) Discontinue the infusion immediately
• D) Continue the infusion at the current rate
,Correct 100%Correct VERIFid Answer:: B
Rationale: An aPTT of 120 seconds is above the therapeutic
range, indicating the client is over-anticoagulated and at
increased risk for bleeding. The nurse should decrease the
infusion rate and notify the provider .
Question 4
A client has just returned from cardiac catheterization via
the right femoral artery. Which assessment finding requires
IMMEDIATE nursing intervention?
• A) Blood pressure of 118/76 mmHg
• B) Small amount of bloody drainage at puncture site
• C) Right foot that is cool, pale, and pulseless
• D) Client reports mild soreness at the insertion site
Correct 100%Correct VERIFid Answer:: C
Rationale: A cool, pale, and pulseless foot following femoral
artery catheterization indicates arterial occlusion, which is a
vascular emergency. This requires immediate notification of the
healthcare provider and vascular surgery consultation .
Question 5
, A client with hypertension is prescribed lisinopril. The nurse
should instruct the client to report which side effect
IMMEDIATELY?
• A) Persistent dry cough
• B) Mild dizziness upon standing
• C) Facial swelling and difficulty breathing
• D) Mild headache
Correct 100%Correct VERIFid Answer:: C
Rationale: ACE inhibitors such as lisinopril can cause
angioedema, a life-threatening allergic reaction characterized
by swelling of the face, lips, tongue, and throat, which can
cause airway obstruction. This is a medical emergency requiring
immediate discontinuation of the drug and emergency
treatment .
Question 6
A nurse is preparing to administer digoxin to a client with heart
failure. Which assessment finding should cause the nurse to
WITHHOLD the medication?
• A) Heart rate of 56 beats per minute
• B) Blood pressure of 138/88 mmHg
• C) Respiratory rate of 18 breaths per minute
• D) Serum potassium of 4.0 mEq/L
