HESI RN EXIT EXAM V1-V7 (UPDATED 2024/2025) / RN EXIT HESI EXAM (V1,V2,V3,V4,V5,V6,V7)
1. Following discharge teaching, a male client with duodenal ulcer tells the nurse the he will drink plenty of
dairy products, such as milk, to help coat and protect his ulcer. What is the best follow-up action by the
nurse?
Review with the client the need to avoid foods that are rich in milk and cream
Page |
2. A male client with hypertension, who received new antihypertensive prescriptions at his last visit returns 1
to the clinic two weeks later to evaluate his blood pressure (BP). His BPis 158/106 and he admits that he
has not been taking the prescribed medication because the drugs1
the need for hypertension control, the nurseshould stress that an elevated BP places the client at risk for
which pathophysiological condition?
Stroke secondary to hemorrhage
3. The nurse observes an unlicensed assistive personnel (UAP) positioning a newly admitted client who has
a seizure disorder. The client is supine and the UAP is placing soft pillows along the side rails. What
action should the nurse implement?
Instruct the UAP to obtain soft blankets to secure to the side rails instead ofpillows.
4. An adolescent with major depressive disorder has been taking duloxetine (Cymbalta) forthe past 12
days. Which assessment finding requires immediate follow-up?
Describes life without purpose
5. A 60-year-old female client with a positive family history of ovarian cancer has developed an abdominal
mass and is being evaluated for possible ovarian cancer. Her Papanicolau (Pap) smear results are negative.
teaching plan?
Further evaluation involving surgery may be needed
6. A client who recently underwear a tracheostomy is being prepared for discharge to home.Which
instructions is most important for the nurse to include in the discharge plan?
Teach tracheal suctioning techniques
7. In assessing an adult client with a partial rebreather mask, the nurse notes that the oxygenreservoir bag
rate is 14 breaths / minute.
What action should the nurse implement?
Document the assessment data
respiratory
rate is within normal limits.
8. During shift report, the central electrocardiogram (EKG) monitoring system alarms.Which client
alarm should the nurse investigate firs?
STUDYGUIDESOLUTIONS
,HESI RN EXIT EXAM V1-V7 (UPDATED 2024/2025) / RN EXIT HESI EXAM (V1,V2,V3,V4,V5,V6,V7)
Respiratory apnea of 30 seconds
9. During a home visit, the nurse observed an elderly client with diabetes slip and fall. What action should
the nurse take first?
Check the client for lacerations or fractures
10. At 0600 while admitting a woman for a schedule repeat cesarean section (C-Section), the client tells the
nurse that she drank a cup a coffee at 0400 because she wanted to avoid getting a headache. Which Page |
action should the nurse take first? 2
Inform the anesthesia care provider
11. After placing a stethoscope as seen in the picture, the nurse auscultates S1 and S2 heart sounds. To
determine if an S3 heart sound is present, what action should the nurse takefirst?
Listen with the bell at the same location
12. A 66-year-old woman is retiring and will no longer have a health insurance through her place of
employment. Which agency should the client be referred to by the employee health nurse for health
insurance needs?
Medicare
13. A client who is taking an oral dose of a tetracycline complains of gastrointestinal upset. What snack
should the nurse instruct the client to take with the tetracycline?
Toasted wheat bread and jelly
14. Following a lumbar puncture, a client voices several complaints. What complaint indicated to
the nurse that the client is experiencing a complication?
• have a headache that gets worse when I
• am having pain in my lower back when I move my
• throat hurts when I
• feel sick to my stomach and am going to
15. An elderly client seems confused and reports the onset of nausea, dysuria, and urgency with
incontinence. Which action should the nurse implement? Obtain a clean catchmid-stream specimen
16. The nurse is assisting the mother of a child with phenylketonuria (PKU) to select foodsthat are in
keeping dietary restrictions. Which foods are contraindicated for this child?
Foods sweetened with aspartame
17. Before preparing a client for the first surgical case of the day, a part-time scrub nurse asks the
circulating nurse if a 3 minute surgical hand scrub is adequate preparation forthis client. Which
response should the circulating nurse provide?
Direct the nurse to continue the surgical hand scrub for a 5 minute duration
18. about the
dietary management of osteoporosis?
STUDYGUIDESOLUTIONS
, HESI RN EXIT EXAM V1-V7 (UPDATED 2024/2025) / RN EXIT HESI EXAM (V1,V2,V3,V4,V5,V6,V7)
Bagel with jelly and skim milk
19. The charge nurse of a critical care unit is informed at the beginning of the shift that less than the optimal number of
registered nurses will be working that shift. In planning assignments, which clientshould receive the most care hours
by a registered nurse (RN)?
• An 82-year- -fractures femur who has a Foley catheter and soft Page |
wrist restrains applied 3
STUDYGUIDESOLUTIONS
,HESI RN EXIT EXAM V1-V7 (UPDATED 2024/2025) / RN EXIT HESI EXAM (V1,V2,V3,V4,V5,V6,V7)
20. A mother brings her 6-year-old child, who has just stepped on a rusty nail, to the
Upon inspection, the nurse notes that the nail went through the shoeand pierced the bottom of the
first?
• Cleanse the foot with soap and water and apply an antibiotic ointment
Provide teaching about the need for a tetanus booster within the next 72 hours.
• have the mother check the child's temperature q4h for the next 24 hours
• transfer the child to the emergency department to receive a gamma globulininjection
21. The mother of an adolescent tells the clinic nurse, son has foot, I have beenapplying triple
What instruction should the
nurse provide?
• Stop using the ointment and encourage complete drying of the feet and wearingclean socks.
22. A 26-year-old female client is admitted to the hospital for treatment of a simple goiter,and
levothyroxine sodium (Synthroid) is prescribed. Which symptoms indicate to the nurse that the
prescribed dosage is too high for this client? The client experiences
• Bradycardia and constipation
• Lethargy and lack of appetite
• Muscle cramping and dry, flushed skin
• Palpitations and shortness of breath
23. A client with a history of heart failure presents to the clinic with a nausea, vomiting, yellow vision and
palpitations. Which finding is most important for the nurse to assess tothe client?
Obtain a list of medications taken for cardiac history
24. The healthcare provider prescribes an IV solution of isoproterenol (Isuprel) 1 mg in 250 ml of D5W at
300 mcg/hour. The nurse should program the infusion pump to deliver how many ml/hour? (Enter
numeric value only.)
75
Rationale: Convert mg to mcg and use the formula D/H x Q. 300 mcg/hour /1,000 mcg x
250 ml = 3/1 x 25 = 75 ml/hour
25. The pathophysiological mechanism are responsible for ascites related to liver failure? (Select all that
apply)
Fluid shifts from intravascular to interstitial area due to decreased serum protein
Increased hydrostatic pressure in portal circulation increases fluid shifts intoabdomen
Increased circulating aldosterone levels that increase sodium and water retention
26. to document
this sound? (Please listen to the audio first to select the option that applies)
STUDYGUIDESOLUTIONS
,HESI RN EXIT EXAM V1-V7 (UPDATED 2024/2025) / RN EXIT HESI EXAM (V1,V2,V3,V4,V5,V6,V7)
Murmur
Rationale: A murmur is auscultated as a swishing sound that is associated with theblood
turbulence created by the heart or valvular defect.
27. The healthcare provider prescribes celtazidime (Fortax) 35 mg every 8 hours IM for an infant. The 500
mg vial is labeled with the instruction to add 5.3 ml diluent to provide a concentration of 100 mg/ml.
How many ml should the nurse administered for each dose?(Enter numeric value only. If rounding is
required, round to the nearest tenth)
0.4
rationale: 35mg/100mg x 1 = 0.35 = 0.4 ml
28. The nurse notes that a client has been receiving hydromorphone (Dilaudid) every sixhours for four
days. What assessment is most important for the nurse to complete?
• Auscultate the client's bowel sounds
• Observe for edema around the ankles
• Measure the capillary glucose level
• Count the apical and radial pulses simultaneously
• Rationale: hydromorphone is a potent opioid analgesic that slows peristalsis andfrequently
causes constipation, so it is most important to Auscultate the client's bowel sounds
29. A female client is admitted with end stage pulmonary disease is alert, oriented, and complaining of
breathing, and she asks the nurse to document this in her medical record. What action should the
nurse implement?
Ask the client to discuss not with her healthcare provider
30. A client is receiving a full strength continuous enteral tube feeding at 50 ml/hour and hasdeveloped
diarrhea. The client has a new prescription to change the feeding to half strength. What intervention
should the nurse implement?
Add equal amounts of water and feeding to a feeding bag and infuse at 50ml/hour
31. A female client reports that her hair is becoming coarse and breaking off, that the outer part of her
eyebrows have disappeared, and that her eyes are all puffy. Which follow-upquestion is best for the
nurse to ask?
• Have you noticed any changes in your fingernails?
• Rationale: The pattern of reported manifestations is suggestive of hypothyroidism
32. After a third hospitalization 6 months ago, a client is admitted to the hospital withascites and
malnutrition. The client is drowsy but responding to verbal stimuli andreports recently spitting
up blood. What assessment finding warrants immediate intervention by the nurse?
• Capillary refill of 8 seconds
• bruises on arms and legs
STUDYGUIDESOLUTIONS
,HESI RN EXIT EXAM V1-V7 (UPDATED 2024/2025) / RN EXIT HESI EXAM (V1,V2,V3,V4,V5,V6,V7)
• round and tight abdomen pitting
• edema in lower legs
33. After the nurse witnesses a preoperative client sign the surgical consent form, the nurse signs the form
the consent
form? (Select all that apply)
• The client voluntarily grants permission for the procedure to be done
• The client is competent to sign the consent without impairment of judgment
• The client understands the risks and benefits associated with the procedure
34. Following surgery, a male client with antisocial personality disorder frequently requests that a specific
nurse be assigned to his care and is belligerent when another nurse is assigned. What action should the
charge nurse implement?
Advise the client that assignments are not based on clients requests
35. A client with cervical cancer is hospitalized for insertion of a sealed internal cervical radiation implant.
While providing care, the nurse finds the radiation implant in the bed.What action should the nurse
take?
Place the implant in a lead container using long-handled forceps
36. The client with which type of wound is most likely to need immediate intervention by the nurse?
• Laceration
• Abrasion
• Contusion
• Ulceration
• Rationale: A laceration is a wound that is produced by the tearing of soft body tissue. This type
of wound is often irregular and jagged. A laceration wound is often contaminated with bacteria
and debris from whatever object caused the cut.
37. The nurse is planning care for a client admitted with a diagnosis of pheochromocytoma.Which
intervention has the highest priority for inclusion in plan of care?
Monitor blood pressure frequently
Rationale: A pheochromocytoma is a rare, catecholamine-secreting tumor that mayprecipitate
life-threatening hypertension. The tumor is malignant in 10% of casesbut may be cured
completely by surgical removal. Although pheochromocytomahas classically been associated
with 3 syndromes von Hippel-Lindau (VHL) syndrome, multiple endocrine neoplasia type 2
(MEN 2), and neurofibromatosis type 1 (NF1) there are now 10 genes that have been
identified as sites of mutations leading to pheochromocytoma.
38. When caring for a client who has acute respiratory distress syndrome (ARDS), the nurse elevates the
head of the bed 30 degrees. What is the reason for this intervention?
• To reduce abdominal pressure on the diaphragm
• to promote retraction of the intercostal accessory muscle of respiration
• to promote bronchodilation and effective airway clearance
• to decrease pressure on the medullary center which stimulates breathing
STUDYGUIDESOLUTIONS
, HESI RN EXIT EXAM V1-V7 (UPDATED 2024/2025) / RN EXIT HESI EXAM (V1,V2,V3,V4,V5,V6,V7)
• Rationale: a semi-sitting position is the best position for matching ventilation andperfusion and
for decreasing abdominal pressure on the diaphragm, so that the client can maximize
breathing.
39. When assessing a mildly obese 35-year-old female client, the nurse is unable to locate thegallbladder
when palpating below the liver margin at the lateral border of the rectus abdominal muscle. What is the
most likely explanation for failure to locate the gallbladder by palpation?
• The client is too obese
• Palpating in the wrong abdominal quadrant
• Deeper palpation technique is needed
• The gallbladder is normal
• Rationale: a normal healthy gallbladder is not palpable
40. increased anxiety
since the normal vaginal delivery of her son three weeks ago. Since sheis breastfeeding, she stopped
taking her antianxiety medications, but thinks she may needto start taking them again because of her
increased anxiety. What response is best for the nurse to provide this woman?
• describe the transmission of drugs to the infant through breast milk
• encourage her to use stress relieving alternatives, such as deep breathing exercisesInform her
that some antianxiety medications are safe to take while breastfeeding
• Explain that anxiety is a normal response for the mother of a 3-week-old.
• Rationale: there are several antianxiety medications that are not contraindicatedfor
breastfeeding mothers.
41. An older male client with a history of type 1 diabetes has not felt well the past few days and arrives at
the clinic with abdominal cramping and vomiting. He is lethargic, moderately, confused, and cannot
remember when he took his last dose of insulin or atelast. What action should the nurse implement
first?
• Start an intravenous (IV) infusion of normal saline
• obtain a serum potassium level
• administer the client's usual dose of insulin
• assess pupillary response to light
• Rationale: the nurse should first start an intravenous infusion of normal saline toreplace the
fluids and electrolytes because the client has been vomiting, and it isunclear when he last ate
or took insulin. The symptoms of confusion, lethargy, vomiting, and abdominal cramping are
all suggestive of hyperglycemia, which also contributes to diuresis and fluid electrolyte
imbalance.
42. A client who received multiple antihypertensive medications experiences syncope due to a drop in blood
the
antihypertensive medication?
increased urinary clearance of the multiple medications has produced diuresis andlowered the
blood pressure
STUDYGUIDESOLUTIONS
1. Following discharge teaching, a male client with duodenal ulcer tells the nurse the he will drink plenty of
dairy products, such as milk, to help coat and protect his ulcer. What is the best follow-up action by the
nurse?
Review with the client the need to avoid foods that are rich in milk and cream
Page |
2. A male client with hypertension, who received new antihypertensive prescriptions at his last visit returns 1
to the clinic two weeks later to evaluate his blood pressure (BP). His BPis 158/106 and he admits that he
has not been taking the prescribed medication because the drugs1
the need for hypertension control, the nurseshould stress that an elevated BP places the client at risk for
which pathophysiological condition?
Stroke secondary to hemorrhage
3. The nurse observes an unlicensed assistive personnel (UAP) positioning a newly admitted client who has
a seizure disorder. The client is supine and the UAP is placing soft pillows along the side rails. What
action should the nurse implement?
Instruct the UAP to obtain soft blankets to secure to the side rails instead ofpillows.
4. An adolescent with major depressive disorder has been taking duloxetine (Cymbalta) forthe past 12
days. Which assessment finding requires immediate follow-up?
Describes life without purpose
5. A 60-year-old female client with a positive family history of ovarian cancer has developed an abdominal
mass and is being evaluated for possible ovarian cancer. Her Papanicolau (Pap) smear results are negative.
teaching plan?
Further evaluation involving surgery may be needed
6. A client who recently underwear a tracheostomy is being prepared for discharge to home.Which
instructions is most important for the nurse to include in the discharge plan?
Teach tracheal suctioning techniques
7. In assessing an adult client with a partial rebreather mask, the nurse notes that the oxygenreservoir bag
rate is 14 breaths / minute.
What action should the nurse implement?
Document the assessment data
respiratory
rate is within normal limits.
8. During shift report, the central electrocardiogram (EKG) monitoring system alarms.Which client
alarm should the nurse investigate firs?
STUDYGUIDESOLUTIONS
,HESI RN EXIT EXAM V1-V7 (UPDATED 2024/2025) / RN EXIT HESI EXAM (V1,V2,V3,V4,V5,V6,V7)
Respiratory apnea of 30 seconds
9. During a home visit, the nurse observed an elderly client with diabetes slip and fall. What action should
the nurse take first?
Check the client for lacerations or fractures
10. At 0600 while admitting a woman for a schedule repeat cesarean section (C-Section), the client tells the
nurse that she drank a cup a coffee at 0400 because she wanted to avoid getting a headache. Which Page |
action should the nurse take first? 2
Inform the anesthesia care provider
11. After placing a stethoscope as seen in the picture, the nurse auscultates S1 and S2 heart sounds. To
determine if an S3 heart sound is present, what action should the nurse takefirst?
Listen with the bell at the same location
12. A 66-year-old woman is retiring and will no longer have a health insurance through her place of
employment. Which agency should the client be referred to by the employee health nurse for health
insurance needs?
Medicare
13. A client who is taking an oral dose of a tetracycline complains of gastrointestinal upset. What snack
should the nurse instruct the client to take with the tetracycline?
Toasted wheat bread and jelly
14. Following a lumbar puncture, a client voices several complaints. What complaint indicated to
the nurse that the client is experiencing a complication?
• have a headache that gets worse when I
• am having pain in my lower back when I move my
• throat hurts when I
• feel sick to my stomach and am going to
15. An elderly client seems confused and reports the onset of nausea, dysuria, and urgency with
incontinence. Which action should the nurse implement? Obtain a clean catchmid-stream specimen
16. The nurse is assisting the mother of a child with phenylketonuria (PKU) to select foodsthat are in
keeping dietary restrictions. Which foods are contraindicated for this child?
Foods sweetened with aspartame
17. Before preparing a client for the first surgical case of the day, a part-time scrub nurse asks the
circulating nurse if a 3 minute surgical hand scrub is adequate preparation forthis client. Which
response should the circulating nurse provide?
Direct the nurse to continue the surgical hand scrub for a 5 minute duration
18. about the
dietary management of osteoporosis?
STUDYGUIDESOLUTIONS
, HESI RN EXIT EXAM V1-V7 (UPDATED 2024/2025) / RN EXIT HESI EXAM (V1,V2,V3,V4,V5,V6,V7)
Bagel with jelly and skim milk
19. The charge nurse of a critical care unit is informed at the beginning of the shift that less than the optimal number of
registered nurses will be working that shift. In planning assignments, which clientshould receive the most care hours
by a registered nurse (RN)?
• An 82-year- -fractures femur who has a Foley catheter and soft Page |
wrist restrains applied 3
STUDYGUIDESOLUTIONS
,HESI RN EXIT EXAM V1-V7 (UPDATED 2024/2025) / RN EXIT HESI EXAM (V1,V2,V3,V4,V5,V6,V7)
20. A mother brings her 6-year-old child, who has just stepped on a rusty nail, to the
Upon inspection, the nurse notes that the nail went through the shoeand pierced the bottom of the
first?
• Cleanse the foot with soap and water and apply an antibiotic ointment
Provide teaching about the need for a tetanus booster within the next 72 hours.
• have the mother check the child's temperature q4h for the next 24 hours
• transfer the child to the emergency department to receive a gamma globulininjection
21. The mother of an adolescent tells the clinic nurse, son has foot, I have beenapplying triple
What instruction should the
nurse provide?
• Stop using the ointment and encourage complete drying of the feet and wearingclean socks.
22. A 26-year-old female client is admitted to the hospital for treatment of a simple goiter,and
levothyroxine sodium (Synthroid) is prescribed. Which symptoms indicate to the nurse that the
prescribed dosage is too high for this client? The client experiences
• Bradycardia and constipation
• Lethargy and lack of appetite
• Muscle cramping and dry, flushed skin
• Palpitations and shortness of breath
23. A client with a history of heart failure presents to the clinic with a nausea, vomiting, yellow vision and
palpitations. Which finding is most important for the nurse to assess tothe client?
Obtain a list of medications taken for cardiac history
24. The healthcare provider prescribes an IV solution of isoproterenol (Isuprel) 1 mg in 250 ml of D5W at
300 mcg/hour. The nurse should program the infusion pump to deliver how many ml/hour? (Enter
numeric value only.)
75
Rationale: Convert mg to mcg and use the formula D/H x Q. 300 mcg/hour /1,000 mcg x
250 ml = 3/1 x 25 = 75 ml/hour
25. The pathophysiological mechanism are responsible for ascites related to liver failure? (Select all that
apply)
Fluid shifts from intravascular to interstitial area due to decreased serum protein
Increased hydrostatic pressure in portal circulation increases fluid shifts intoabdomen
Increased circulating aldosterone levels that increase sodium and water retention
26. to document
this sound? (Please listen to the audio first to select the option that applies)
STUDYGUIDESOLUTIONS
,HESI RN EXIT EXAM V1-V7 (UPDATED 2024/2025) / RN EXIT HESI EXAM (V1,V2,V3,V4,V5,V6,V7)
Murmur
Rationale: A murmur is auscultated as a swishing sound that is associated with theblood
turbulence created by the heart or valvular defect.
27. The healthcare provider prescribes celtazidime (Fortax) 35 mg every 8 hours IM for an infant. The 500
mg vial is labeled with the instruction to add 5.3 ml diluent to provide a concentration of 100 mg/ml.
How many ml should the nurse administered for each dose?(Enter numeric value only. If rounding is
required, round to the nearest tenth)
0.4
rationale: 35mg/100mg x 1 = 0.35 = 0.4 ml
28. The nurse notes that a client has been receiving hydromorphone (Dilaudid) every sixhours for four
days. What assessment is most important for the nurse to complete?
• Auscultate the client's bowel sounds
• Observe for edema around the ankles
• Measure the capillary glucose level
• Count the apical and radial pulses simultaneously
• Rationale: hydromorphone is a potent opioid analgesic that slows peristalsis andfrequently
causes constipation, so it is most important to Auscultate the client's bowel sounds
29. A female client is admitted with end stage pulmonary disease is alert, oriented, and complaining of
breathing, and she asks the nurse to document this in her medical record. What action should the
nurse implement?
Ask the client to discuss not with her healthcare provider
30. A client is receiving a full strength continuous enteral tube feeding at 50 ml/hour and hasdeveloped
diarrhea. The client has a new prescription to change the feeding to half strength. What intervention
should the nurse implement?
Add equal amounts of water and feeding to a feeding bag and infuse at 50ml/hour
31. A female client reports that her hair is becoming coarse and breaking off, that the outer part of her
eyebrows have disappeared, and that her eyes are all puffy. Which follow-upquestion is best for the
nurse to ask?
• Have you noticed any changes in your fingernails?
• Rationale: The pattern of reported manifestations is suggestive of hypothyroidism
32. After a third hospitalization 6 months ago, a client is admitted to the hospital withascites and
malnutrition. The client is drowsy but responding to verbal stimuli andreports recently spitting
up blood. What assessment finding warrants immediate intervention by the nurse?
• Capillary refill of 8 seconds
• bruises on arms and legs
STUDYGUIDESOLUTIONS
,HESI RN EXIT EXAM V1-V7 (UPDATED 2024/2025) / RN EXIT HESI EXAM (V1,V2,V3,V4,V5,V6,V7)
• round and tight abdomen pitting
• edema in lower legs
33. After the nurse witnesses a preoperative client sign the surgical consent form, the nurse signs the form
the consent
form? (Select all that apply)
• The client voluntarily grants permission for the procedure to be done
• The client is competent to sign the consent without impairment of judgment
• The client understands the risks and benefits associated with the procedure
34. Following surgery, a male client with antisocial personality disorder frequently requests that a specific
nurse be assigned to his care and is belligerent when another nurse is assigned. What action should the
charge nurse implement?
Advise the client that assignments are not based on clients requests
35. A client with cervical cancer is hospitalized for insertion of a sealed internal cervical radiation implant.
While providing care, the nurse finds the radiation implant in the bed.What action should the nurse
take?
Place the implant in a lead container using long-handled forceps
36. The client with which type of wound is most likely to need immediate intervention by the nurse?
• Laceration
• Abrasion
• Contusion
• Ulceration
• Rationale: A laceration is a wound that is produced by the tearing of soft body tissue. This type
of wound is often irregular and jagged. A laceration wound is often contaminated with bacteria
and debris from whatever object caused the cut.
37. The nurse is planning care for a client admitted with a diagnosis of pheochromocytoma.Which
intervention has the highest priority for inclusion in plan of care?
Monitor blood pressure frequently
Rationale: A pheochromocytoma is a rare, catecholamine-secreting tumor that mayprecipitate
life-threatening hypertension. The tumor is malignant in 10% of casesbut may be cured
completely by surgical removal. Although pheochromocytomahas classically been associated
with 3 syndromes von Hippel-Lindau (VHL) syndrome, multiple endocrine neoplasia type 2
(MEN 2), and neurofibromatosis type 1 (NF1) there are now 10 genes that have been
identified as sites of mutations leading to pheochromocytoma.
38. When caring for a client who has acute respiratory distress syndrome (ARDS), the nurse elevates the
head of the bed 30 degrees. What is the reason for this intervention?
• To reduce abdominal pressure on the diaphragm
• to promote retraction of the intercostal accessory muscle of respiration
• to promote bronchodilation and effective airway clearance
• to decrease pressure on the medullary center which stimulates breathing
STUDYGUIDESOLUTIONS
, HESI RN EXIT EXAM V1-V7 (UPDATED 2024/2025) / RN EXIT HESI EXAM (V1,V2,V3,V4,V5,V6,V7)
• Rationale: a semi-sitting position is the best position for matching ventilation andperfusion and
for decreasing abdominal pressure on the diaphragm, so that the client can maximize
breathing.
39. When assessing a mildly obese 35-year-old female client, the nurse is unable to locate thegallbladder
when palpating below the liver margin at the lateral border of the rectus abdominal muscle. What is the
most likely explanation for failure to locate the gallbladder by palpation?
• The client is too obese
• Palpating in the wrong abdominal quadrant
• Deeper palpation technique is needed
• The gallbladder is normal
• Rationale: a normal healthy gallbladder is not palpable
40. increased anxiety
since the normal vaginal delivery of her son three weeks ago. Since sheis breastfeeding, she stopped
taking her antianxiety medications, but thinks she may needto start taking them again because of her
increased anxiety. What response is best for the nurse to provide this woman?
• describe the transmission of drugs to the infant through breast milk
• encourage her to use stress relieving alternatives, such as deep breathing exercisesInform her
that some antianxiety medications are safe to take while breastfeeding
• Explain that anxiety is a normal response for the mother of a 3-week-old.
• Rationale: there are several antianxiety medications that are not contraindicatedfor
breastfeeding mothers.
41. An older male client with a history of type 1 diabetes has not felt well the past few days and arrives at
the clinic with abdominal cramping and vomiting. He is lethargic, moderately, confused, and cannot
remember when he took his last dose of insulin or atelast. What action should the nurse implement
first?
• Start an intravenous (IV) infusion of normal saline
• obtain a serum potassium level
• administer the client's usual dose of insulin
• assess pupillary response to light
• Rationale: the nurse should first start an intravenous infusion of normal saline toreplace the
fluids and electrolytes because the client has been vomiting, and it isunclear when he last ate
or took insulin. The symptoms of confusion, lethargy, vomiting, and abdominal cramping are
all suggestive of hyperglycemia, which also contributes to diuresis and fluid electrolyte
imbalance.
42. A client who received multiple antihypertensive medications experiences syncope due to a drop in blood
the
antihypertensive medication?
increased urinary clearance of the multiple medications has produced diuresis andlowered the
blood pressure
STUDYGUIDESOLUTIONS
