HESI Comprehensive Exit Exam 1 (And
Rationale) Questions and Answers A+
Guide
The nurse is monitoring neurological vital signs for a male client
who lost consciousness after falling and hitting his head. Which
assessment finding is the earliest and most sensitive indication of
altered cerebral function?
a. Unequal pupils.
b. Loss of central reflexes.
c. Inability to open the eyes.
d. Change in level of consciousness. - correct answers✅✅D
(Neurological vital signs include serial assessments of TPR, blood
pressure, and components of the Glasgow coma scale (GCS),
which includes verbal, musculoskeletal, and pupillary responses. A
change in the client's level of consciousness, as indicated by
responses to commands during the GCS, is the first and the most
sensitive sign of change in cerebral function. The other
assessment data choices are late signs of altered cerebral
function.)
A nurse is planning to teach self-care measures to a female client
about prevention of yeast infections. Which instructions should
the nurse provide?
a. Use a douche preparation no more than once a month.
b. Increase daily intake of fiber and leafy green vegetables.
c. Select nylon underwear that is loose-fitting, white, and
comfortable.
,HESI Comprehensive Exit Exam 1 (And
Rationale) Questions and Answers A+
Guide
d. Avoid tight-fitting clothing and do not use bubble-bath or bath
salts. - correct answers✅✅D
(A common genital tract infection in females is candidiasis, which
is an overgrowth of the normal vaginal flora of Candida albicans
that thrives in an environment that is warm and moist and is
perpetuated by tight-fitting clothing, underwear, or pantyhose
made of nonabsorbent materials. The client should wear clothing
that is loose fitting and absorbent, such as cotton underwear, and
avoid using bubble-bath or bath salts which further irritate
sensitive genital tissue. Douching is not recommended because it
can irritate vaginal tissue, alter pH, and contribute to fungal
growth. While increasing dietary fiber intake encourages healthy,
nutritional guidelines, it is not the focus of the teaching. Cotton,
not nylon undergarments, provide absorbancy and reduce
moisture in the perineal area.)
A client who has active tuberculosis (TB) is admitted to the
medical unit. What action is most important for the nurse to
implement?
a. Place an isolation cart in the hallway.
b. Fit the client with a respirator mask.
c. Don a clean gown for client care.
d. Assign the client to a negative air-flow room. - correct
answers✅✅D
,HESI Comprehensive Exit Exam 1 (And
Rationale) Questions and Answers A+
Guide
(Active tuberculosis requires implementation of airborne
precautions, so the client should be assigned to a negative
pressure air-flow room. Although isolation gowns and isolation
carts should be implemented for clients in isolation with contact
precautions, it is most important that air flow from the room is
minimized when the client has TB. The respirator mask should be
implemented when the client leaves the isolation environment.)
The nurse is planning to conduct nutritional assessments and diet
teaching to clients at a family health clinic. Which individual has
the greatest nutritional and energy demands?
a. A pregnant woman.
b. A teenager beginning puberty.
c. A 3-month-old infant.
d. A school-aged child. - correct answers✅✅A
A pregnant woman's metabolic demands are 20 to 24% more than
the basic metabolic rate. The other clients require only 15 to 20%
more than the basic metabolic rate.
What nursing delivery of care provides the nurse to plan and
direct care of a group of clients over a 24-hour period?
a. Team nursing.
b. Primary nursing.
c. Case management.
, HESI Comprehensive Exit Exam 1 (And
Rationale) Questions and Answers A+
Guide
d. Functional nursing. - correct answers✅✅B
(Primary nursing is a model of delivery of care where a nurse is
accountable for planning care for clients around the clock.
Functional nursing is a care delivery model that provides client
care by assignment of functions or tasks. Team nursing is a care
delivery model where assignments to a group of clients are
provided by a mixed-staff team. Case management is the delivery
of care that uses a collaborative process of assessment, planning,
facilitation, and advocacy for options and services to meet an
individual's health needs and promote quality cost-effective
outcomes.)
Which approach should the nurse use when preparing a toddler
for a procedure?
a. Demonstrate the procedure using a doll.
b. Avoid asking the child to make choices.
c. Plan a teaching session to last about 20 minutes.
d. Show equipment but prevent child from handling it. - correct
answers✅✅A
(Imitation is one of the most distinguishing characteristics of
toddler play, so demonstration of a procedure on a doll enables a
non-threatening, dramatic experience that can help prepare the
toddler for the actual procedure. The primary developmental task
Rationale) Questions and Answers A+
Guide
The nurse is monitoring neurological vital signs for a male client
who lost consciousness after falling and hitting his head. Which
assessment finding is the earliest and most sensitive indication of
altered cerebral function?
a. Unequal pupils.
b. Loss of central reflexes.
c. Inability to open the eyes.
d. Change in level of consciousness. - correct answers✅✅D
(Neurological vital signs include serial assessments of TPR, blood
pressure, and components of the Glasgow coma scale (GCS),
which includes verbal, musculoskeletal, and pupillary responses. A
change in the client's level of consciousness, as indicated by
responses to commands during the GCS, is the first and the most
sensitive sign of change in cerebral function. The other
assessment data choices are late signs of altered cerebral
function.)
A nurse is planning to teach self-care measures to a female client
about prevention of yeast infections. Which instructions should
the nurse provide?
a. Use a douche preparation no more than once a month.
b. Increase daily intake of fiber and leafy green vegetables.
c. Select nylon underwear that is loose-fitting, white, and
comfortable.
,HESI Comprehensive Exit Exam 1 (And
Rationale) Questions and Answers A+
Guide
d. Avoid tight-fitting clothing and do not use bubble-bath or bath
salts. - correct answers✅✅D
(A common genital tract infection in females is candidiasis, which
is an overgrowth of the normal vaginal flora of Candida albicans
that thrives in an environment that is warm and moist and is
perpetuated by tight-fitting clothing, underwear, or pantyhose
made of nonabsorbent materials. The client should wear clothing
that is loose fitting and absorbent, such as cotton underwear, and
avoid using bubble-bath or bath salts which further irritate
sensitive genital tissue. Douching is not recommended because it
can irritate vaginal tissue, alter pH, and contribute to fungal
growth. While increasing dietary fiber intake encourages healthy,
nutritional guidelines, it is not the focus of the teaching. Cotton,
not nylon undergarments, provide absorbancy and reduce
moisture in the perineal area.)
A client who has active tuberculosis (TB) is admitted to the
medical unit. What action is most important for the nurse to
implement?
a. Place an isolation cart in the hallway.
b. Fit the client with a respirator mask.
c. Don a clean gown for client care.
d. Assign the client to a negative air-flow room. - correct
answers✅✅D
,HESI Comprehensive Exit Exam 1 (And
Rationale) Questions and Answers A+
Guide
(Active tuberculosis requires implementation of airborne
precautions, so the client should be assigned to a negative
pressure air-flow room. Although isolation gowns and isolation
carts should be implemented for clients in isolation with contact
precautions, it is most important that air flow from the room is
minimized when the client has TB. The respirator mask should be
implemented when the client leaves the isolation environment.)
The nurse is planning to conduct nutritional assessments and diet
teaching to clients at a family health clinic. Which individual has
the greatest nutritional and energy demands?
a. A pregnant woman.
b. A teenager beginning puberty.
c. A 3-month-old infant.
d. A school-aged child. - correct answers✅✅A
A pregnant woman's metabolic demands are 20 to 24% more than
the basic metabolic rate. The other clients require only 15 to 20%
more than the basic metabolic rate.
What nursing delivery of care provides the nurse to plan and
direct care of a group of clients over a 24-hour period?
a. Team nursing.
b. Primary nursing.
c. Case management.
, HESI Comprehensive Exit Exam 1 (And
Rationale) Questions and Answers A+
Guide
d. Functional nursing. - correct answers✅✅B
(Primary nursing is a model of delivery of care where a nurse is
accountable for planning care for clients around the clock.
Functional nursing is a care delivery model that provides client
care by assignment of functions or tasks. Team nursing is a care
delivery model where assignments to a group of clients are
provided by a mixed-staff team. Case management is the delivery
of care that uses a collaborative process of assessment, planning,
facilitation, and advocacy for options and services to meet an
individual's health needs and promote quality cost-effective
outcomes.)
Which approach should the nurse use when preparing a toddler
for a procedure?
a. Demonstrate the procedure using a doll.
b. Avoid asking the child to make choices.
c. Plan a teaching session to last about 20 minutes.
d. Show equipment but prevent child from handling it. - correct
answers✅✅A
(Imitation is one of the most distinguishing characteristics of
toddler play, so demonstration of a procedure on a doll enables a
non-threatening, dramatic experience that can help prepare the
toddler for the actual procedure. The primary developmental task
