D AND HESI PN COMPREHENSIVE EXAM SCRIPT COMPLETE QUESTIONS VERIFIED
SOLUTIONS
Question:
● While the PN assists a postoperative client with an incentive spirometer, the client experiences
wound evisceration. WHAT ACTION SHOULD THE PN TAKE?
Answer:
Call for immediate assistance.
Question:
● The PN finds a postoperative client lying in bed with a unsecured surgical dressing. After
reinforcing the dressing, WHAT FOLLOW UP ASSESSMENT IS MOST IMPORTANT FOR THE
PN TO IMPLEMENT?
Answer:
Vital signs measurement.
Question:
● The scope of practice for the PN includes which CLIENT ASSESSMENT?
Answer:
An agitated client with b/l wrist restraints.
Question:
● Which intervention is within the scope of practice for a PN?
Answer:
Demonstrating deep breathing and coughing to a postoperative client.
,Question:
● Which nursing activity is within the scope of practice for a PN?
Answer:
Observe client rotate the SQ site for an insulin pump.
Question:
● The nurse is assessing care for residents on 12-bed unit in an extended care facility. The staff
consists of 1 unlicensed UAP and 1 certified medication aide. WHICH TASK SHOULD THE
NURSE PERFORM?
Answer:
Change a hydrocolloid dressing for a client with a stage II pressure ulcer.
Question:
● A PN who works on a 16-bed of an extended care facility with an additional P and a UAP is told
that the other PN will not be in because of illness. The facility manager agrees to obtain another
UAP for the day. WHICH ACTION SHOULD THE PN TAKE?
Answer:
Prioritize assessment of safety issues in addition to administration of daily medication.
Question:
● In working with UAP to provide care for an immobile client, WHICH TASK SHOULD THE
NURSE PERFORM, RATHER THAN THE UAP?
Answer:
Cover a skin tear with a transparent dressing.
Question:
● A nurse sees a college taking drugs from the hospital unit. WHAT ACTION SHOULD THE
NURSE TAKE?
Answer:
,Report the incident to the person in charge of the unit or nursing supervisor.
Question:
● The PN finds a client who is assigned to another nurse bleeding from an IV site and the IV tubing
and fluid are on the floor. The PN immediately applies a dressing to stop the bleeding. WHAT
ACTION SHOULD THE PN TAKE NEXT?
Answer:
Enter computer documentation of the findings and the application of a dressing.
Question:
● During report, the PN is told that a client has 4+ pitting edema of both feet and ankles. The PN
observes the client's lower extremities and finds 2+ pitting edema b/l. WHAT ACTION SHOULD
THE PN TAKE?
Answer:
Enter computer documentation of the finding.
Question:
● The UAP working in a small community hospital obtains 0800 V/S measurements of clients on
the unit. In reviewing these vital signs, WHICH MEASUREMENT WARRANTS IMMEDIATE
INTERVENTION BY THE NURSE?
Answer:
A one-month old infant with a HR of 80 bpm.
Question:
● The nurse is assigned to care for four children. WHICH CHILD SHOULD BE ASSESSED
FIRST?
Answer:
18 month old who has cystic fibrosis and is wheezing.
, Question:
● On a short-staffed unit of a long-term are facility, it is most important that the nurse assign the
UAP to complete this morning care for the resident with which problem first?
Answer:
Frequent episodes of fecal incontinence.
Question:
● Which client should the nurse assess first?
Answer:
A client who is ambulating with partial weight-bearing after a total hip replacement.
Question:
● After report, the nurse receives the laboratory values for 4 clients. Which client requires the
nurse's immediate intervention? The client who is:
Answer:
Trembling and has a glucose level of a 50 mg/dL.
Question:
● The PN who is working as the charge nurse at an extended care facility is making assignments for
the UAP working a 12-hour shift. WHICH RESOURCE IS MOST IMPORTANT IN GUIDING
THE PN's assignments of the UAPs?
Answer:
The state's Nurse Practice Act regarding delegation to unlicensed personnel.
Question:
● In caring for a client following a BKA, WHICH TASK IS BEST FOR THE NURSE TO
DELEGATE TO THE UAP who is assisting with the care of this client?
Answer:
SOLUTIONS
Question:
● While the PN assists a postoperative client with an incentive spirometer, the client experiences
wound evisceration. WHAT ACTION SHOULD THE PN TAKE?
Answer:
Call for immediate assistance.
Question:
● The PN finds a postoperative client lying in bed with a unsecured surgical dressing. After
reinforcing the dressing, WHAT FOLLOW UP ASSESSMENT IS MOST IMPORTANT FOR THE
PN TO IMPLEMENT?
Answer:
Vital signs measurement.
Question:
● The scope of practice for the PN includes which CLIENT ASSESSMENT?
Answer:
An agitated client with b/l wrist restraints.
Question:
● Which intervention is within the scope of practice for a PN?
Answer:
Demonstrating deep breathing and coughing to a postoperative client.
,Question:
● Which nursing activity is within the scope of practice for a PN?
Answer:
Observe client rotate the SQ site for an insulin pump.
Question:
● The nurse is assessing care for residents on 12-bed unit in an extended care facility. The staff
consists of 1 unlicensed UAP and 1 certified medication aide. WHICH TASK SHOULD THE
NURSE PERFORM?
Answer:
Change a hydrocolloid dressing for a client with a stage II pressure ulcer.
Question:
● A PN who works on a 16-bed of an extended care facility with an additional P and a UAP is told
that the other PN will not be in because of illness. The facility manager agrees to obtain another
UAP for the day. WHICH ACTION SHOULD THE PN TAKE?
Answer:
Prioritize assessment of safety issues in addition to administration of daily medication.
Question:
● In working with UAP to provide care for an immobile client, WHICH TASK SHOULD THE
NURSE PERFORM, RATHER THAN THE UAP?
Answer:
Cover a skin tear with a transparent dressing.
Question:
● A nurse sees a college taking drugs from the hospital unit. WHAT ACTION SHOULD THE
NURSE TAKE?
Answer:
,Report the incident to the person in charge of the unit or nursing supervisor.
Question:
● The PN finds a client who is assigned to another nurse bleeding from an IV site and the IV tubing
and fluid are on the floor. The PN immediately applies a dressing to stop the bleeding. WHAT
ACTION SHOULD THE PN TAKE NEXT?
Answer:
Enter computer documentation of the findings and the application of a dressing.
Question:
● During report, the PN is told that a client has 4+ pitting edema of both feet and ankles. The PN
observes the client's lower extremities and finds 2+ pitting edema b/l. WHAT ACTION SHOULD
THE PN TAKE?
Answer:
Enter computer documentation of the finding.
Question:
● The UAP working in a small community hospital obtains 0800 V/S measurements of clients on
the unit. In reviewing these vital signs, WHICH MEASUREMENT WARRANTS IMMEDIATE
INTERVENTION BY THE NURSE?
Answer:
A one-month old infant with a HR of 80 bpm.
Question:
● The nurse is assigned to care for four children. WHICH CHILD SHOULD BE ASSESSED
FIRST?
Answer:
18 month old who has cystic fibrosis and is wheezing.
, Question:
● On a short-staffed unit of a long-term are facility, it is most important that the nurse assign the
UAP to complete this morning care for the resident with which problem first?
Answer:
Frequent episodes of fecal incontinence.
Question:
● Which client should the nurse assess first?
Answer:
A client who is ambulating with partial weight-bearing after a total hip replacement.
Question:
● After report, the nurse receives the laboratory values for 4 clients. Which client requires the
nurse's immediate intervention? The client who is:
Answer:
Trembling and has a glucose level of a 50 mg/dL.
Question:
● The PN who is working as the charge nurse at an extended care facility is making assignments for
the UAP working a 12-hour shift. WHICH RESOURCE IS MOST IMPORTANT IN GUIDING
THE PN's assignments of the UAPs?
Answer:
The state's Nurse Practice Act regarding delegation to unlicensed personnel.
Question:
● In caring for a client following a BKA, WHICH TASK IS BEST FOR THE NURSE TO
DELEGATE TO THE UAP who is assisting with the care of this client?
Answer:
