HESI EXIT COMPREHENSIVE EXAM
2023-2024 260+ QUESTIONS AND
DETAILED ANSWERS WITH
RATIONALES (NIGHTINGALE
COLLEGE NURSING) |A+ GRADED|
The nurse is obtaining a medication history for a client with a new prescription for
paroxetine (Paxil). The client reports current use of the MAO inhibitor isocarboxazid
, (Marplan). What intervention is most important for the nurse to implement? - ANSWER-
Notify the healthcare provider that the client is currently taking Marplan.
After administering a medication through a nasogastric tube connected to suction, what
action should the nurse take first? - ANSWER-Clamp the tube
What action should the nurse implement first when delegating nursing activities to an
unlicensed assistive personnel (UAP)? - ANSWER-Evaluate the experience of the UAP.
The nurse is caring for four clients: Client A 94% o2 saturation, Client B, hemoglobin of
8.;
Client C, potassium level of 3.8 and Client D appendectomy who has a white blood cell
count of 15,000. What
should the nurse implement? - ANSWER-Determine if Client B has two units of packed
cells available in the blood bank.
A 40-year-old client with type 1 diabetes developed chronic kidney (CKD) disease 6
months ago. Because of secondary complications often associated with this illness the
nurse plans to carefully assess for signs of what condition? - ANSWER-Anemia
A client diagnosed with acute epididymitis secondary to a sexually transmitted disease
receives a prescription for ceftriaxone (Rocephin). Prior to administering the
prescription, which question should the nurse ask the client? - ANSWER-"Have you
ever had an allergic reaction to any other antibiotics?"
A client at 38 weeks gestation is in active labor, and a vaginal birth after Cesarean
section (VBAC) is planned. Vaginal exam indicates that the client is 6cm dilated, 90%
effaced, and the station 0 with intact membranes. As the client's contraction become
stronger, the fetal heart rate decelerates during the contraction but returns to baseline.
What action should be taken? - ANSWER-Continue to monitor the client's labor
progress.
An elderly client with limited mobility reports frequent episodes of nocturia. To reduce
the risk for urinary incontinence, what action should the nurse implement? - ANSWER-
Keep the call bell button within the client's reach.
Which diagnosis tests are most important for the nurse to monitor when providing care
for a client with a bowel movement? - ANSWER-Serum electrolytes.
While assessing a client with wrist restraints the nurse first slides two fingers under the
restraints and then notes that the ties are secured to the side rail using a quick-release
tie. What action should the nurse implement? - ANSWER-Reposition the restraints ties,
securing them to the bed frame
After administering the first dose of newly prescribed medications to four clients within a
thirty minute time frame, the nurse evaluates each client for therapeutic responses or
2023-2024 260+ QUESTIONS AND
DETAILED ANSWERS WITH
RATIONALES (NIGHTINGALE
COLLEGE NURSING) |A+ GRADED|
The nurse is obtaining a medication history for a client with a new prescription for
paroxetine (Paxil). The client reports current use of the MAO inhibitor isocarboxazid
, (Marplan). What intervention is most important for the nurse to implement? - ANSWER-
Notify the healthcare provider that the client is currently taking Marplan.
After administering a medication through a nasogastric tube connected to suction, what
action should the nurse take first? - ANSWER-Clamp the tube
What action should the nurse implement first when delegating nursing activities to an
unlicensed assistive personnel (UAP)? - ANSWER-Evaluate the experience of the UAP.
The nurse is caring for four clients: Client A 94% o2 saturation, Client B, hemoglobin of
8.;
Client C, potassium level of 3.8 and Client D appendectomy who has a white blood cell
count of 15,000. What
should the nurse implement? - ANSWER-Determine if Client B has two units of packed
cells available in the blood bank.
A 40-year-old client with type 1 diabetes developed chronic kidney (CKD) disease 6
months ago. Because of secondary complications often associated with this illness the
nurse plans to carefully assess for signs of what condition? - ANSWER-Anemia
A client diagnosed with acute epididymitis secondary to a sexually transmitted disease
receives a prescription for ceftriaxone (Rocephin). Prior to administering the
prescription, which question should the nurse ask the client? - ANSWER-"Have you
ever had an allergic reaction to any other antibiotics?"
A client at 38 weeks gestation is in active labor, and a vaginal birth after Cesarean
section (VBAC) is planned. Vaginal exam indicates that the client is 6cm dilated, 90%
effaced, and the station 0 with intact membranes. As the client's contraction become
stronger, the fetal heart rate decelerates during the contraction but returns to baseline.
What action should be taken? - ANSWER-Continue to monitor the client's labor
progress.
An elderly client with limited mobility reports frequent episodes of nocturia. To reduce
the risk for urinary incontinence, what action should the nurse implement? - ANSWER-
Keep the call bell button within the client's reach.
Which diagnosis tests are most important for the nurse to monitor when providing care
for a client with a bowel movement? - ANSWER-Serum electrolytes.
While assessing a client with wrist restraints the nurse first slides two fingers under the
restraints and then notes that the ties are secured to the side rail using a quick-release
tie. What action should the nurse implement? - ANSWER-Reposition the restraints ties,
securing them to the bed frame
After administering the first dose of newly prescribed medications to four clients within a
thirty minute time frame, the nurse evaluates each client for therapeutic responses or
