EXIT HESI PRACTICE QUESTIONS WITH
100% CORRECT ANSWERS
A yclient ypresents yto ythe yemergency ydepartment y(ED) ywith ycomplaints yabdominal
ypain. yThe ynurse yobserves ythe yclient's yright ycheek yand yeye ybruised yand ysuspects
ypossible ydomestic yviolence. yWhich yapproach yis ybest ythe ynurse yto yuse ywhen
yinterviewing ythe yclient? y
a. yShare ypersonal yvalues yto yput ythe yat yease y
b. yAsk yquestions yin ya yvague, ynon-specific yformat y
c. yBegin ywith yquestions ythat yare yless ysensitive yin ynature y
d. yGet ythe ymost ydifficult yquestions yover ywith yfist y- yANS--c. yBegin ywith yquestions
ythat yare yless ysensitive yin ynature
A yclient ywho yreceived yan yopen yreduction yand yinternal yfixation y(ORIF) yof ythe yright
yfemur yafter yexperiencing ya yfall yhome yexperiences ya ysudden yonset yof yincreasing
yconfusion yand yagitation. yWhen yreporting yto ythe yhealthcare yusing ySBAR
ycommunication, ywhich yinformation yshould ythe y
nurse yprovide yFIRST
a. yCurrently yprescribed ymedication
b. yClient's yhealthcare ypower yof yattorney
c. yIncreasing yconfusion yof ythe yclient
d. yFall yat yhome yas yreason yfor yadmission y- yANS--c. yIncreasing yconfusion yof ythe
yclient
3. yA yclient ytells ythe ynurse yabout ybeginning yan yexercise yprogram ya ymonth yago yto
ylose yweight yand yimprove ysleep. yThe yclient ystates ythat yit ystill ytakes yat yleast ytwo
yhours yto yfall yasleep yat ynight. yWhich y
action yshould ythe ynurse yimplement?
a. yDetermine ythe yamount yof yweight ythe yclient yhas ylost ysince yincreasing yactivity
b. yEncourage ythe yclient yto yexercise yevery yday yto yeliminate ybedtime ywakefulness
c. yAdvise ythe yclient ythat ylifestyle ychanges yoften ytake yseveral yweeks yto ybe yeffective
d. yAsk ythe yclient yfor ya ydescription yof ythe yexercise yschedule ythat yis ybeing yfollowed
y- yANS--d. yAsk ythe yclient yfor ya ydescription yof ythe yexercise yschedule ythat yis ybeing
yfollowed
4. yWhich yassessment yshould ythe yhome yhealth ynurse yinclude yduring ya yroutine
yhome yvisit yfor ya yclient ywho ywas ydischarged yhome ywith ya ysuprapubic ycatheter? y
,a. yObserve yinsertion ysite y
b. yPalpate yflank yarea y
c. yAssess yperineal yarea y
d. yMeasure yabdominal ygirth y- yANS--a. yObserve yinsertion ysite
5. yAn yolder yadult yclient ywith ya yhistory yof ytype y2 ydiabetes ymellitus yis yseen yin ythe
ycommunity yhealth yclinic yfor yan yannual yphysical yexamination. yWhich ynursing
yactions yshould ybe yincluded yin yassessing yfor ylong-term ycomplication yof ydiabetes?
y(SATA) y
a. yObtain yurine yspecimen yto yassess yfor yalbumin y
b. yTest ylower yextremities yfor ychanges yin ysensation y
c. yObtain yvenous ysample yfor yliver yenzymes y
d. yPalpate ypedal ypulses yand yfoot ytemperature y
e. yAuscultate yfor yadventitious ybreath ysounds y- yANS--b. yTest ylower yextremities yfor
ychanges yin ysensation y
d. yPalpate ypedal ypulses yand yfoot ytemperature
6. yThe yhome yhealth ynurse yis yassessing ya ymale yclient ywho yhas ystarted yperitoneal
ydialysis y(PD) y5 ydays yago. yWhich yassessment yfinding ywarrants yimmediate
yintervention yby ythe ynurse? y
a. yAnorexia yand ypoor yintake yof yadequate ydietary yprotein y
b. yArteriovenous y(AV) ygraft ysurgical ysite ypulsations y
c. yFingerstick yblood yglucose y12o ymg/Dl y(6.66 ymmol/L) ypost yexchange y
d. yCloudy ydialysate youtput yand yrebound yabdominal ypain y- yANS--d. yCloudy
ydialysate youtput yand yrebound yabdominal ypain
7. yWhat yaction yshould ythe yschool ynurse yimplement yto yprovide ysecondary
yprevention yfor yschool yaged ychildren? y
a. yPrepare ya ypresentation yon yhow yto yprevent ythe yspread yof ylice y
b. yCollaborate ywith ya yscience yteacher yto yprepare ya yhealth ylesson y
c. yObserve ya yperson ywith ytype y1 yDiabetes yself-administer ya ydose yof yinsulin y
d. yInitiate ya yhearing yand yvision yscreening yprogram yfor yfirst ygraders y- yANS--d.
yInitiate ya yhearing yand yvision yscreening yprogram yfor yfirst ygraders
8. yThe ynurse yis ydiscussing ymitigation yat ya ydisaster ypreparedness ycommittee
ymeeting. yWhich yactivity yshould ythe ynurse ysuggest yto yenhance ymitigation?
a. yDiscuss ysome yways yto yensure ysafety yin ythe yhome yduring ya ydisaster y
b. yDesign yrequirement yfor yan yincident yCommand yCenter
c. yProvide ya ycommunity ydisaster ypreparedness ymeeting
d. yParticipate yas yan yactive ymember yof ythe ylocal yAmerican yRed yCross y- yANS--c.
yProvide ya ycommunity ydisaster ypreparedness ymeeting
,9. yA yclient yis yadmitted yto ythe yintensive ycare yunit y(ICU) ywith yspinal ycord yinjury
y(SCI) yfollowing ya ymotor y
vehicle ycollision. yWhich ynurse yshould ybe ycontacted yto ycoordinate ythe yprogression
yof ythe yclient's y
care?
a. yNurse yCare ymanager
b. yNeurology yunit ysupervisor
c. yAdult ynurse ypractitioner
d. yRisk ymanagement ynurse y- yANS--b. yNeurology yunit ysupervisor
10. yA yclient ywho yweighs y80 ykg yreceives ya yprescription yfor ydobutamine y2
ymcg/kg/min yintravenously y(IV). yThe yIV ybag yis ycontains ydobutamine y500 ymg yin
ydextrose y5% yin ywater y(D5W) y500 ymL/hour yshould ythe ynurse yprogram ythe yinfusion
ypump? y(Enter ythe ynumerical yvalue yonly. yIf yrounding yis yrequired, yround yto ythe
ynearest ywhole ynumber) y- yANS--
11. yThe ynurse yis ycaring yfor ya yclient yadmitted ya yspontaneous ypneumothorax. yWhich
yactions yshould y
the ynurse yinclude yin ythis yclient's yplan yof ycare?
a. yGive ybronchodilator yby yendotracheal yroute
b. ySchedule yclient yfor yhyperbaric yoxygen ytherapy y(HBOT)
c. yMonitor ybubbling yof ychest yunit ywater-seal ychamber
d. yAdminister yantibiotics yvia ylong-line yIV ycatheter y- yANS--c. yMonitor ybubbling yof
ychest yunit ywater-seal ychamber
12. yThe ynurse yis ycaring yfor ya yclient ywho ydevelops ysigns yand ysymptoms yof yseptic
yshock yfollowing ya y
urinary ytract yinfection yone yweek yago. yThe yhealthcare yprovider yprescribed ya ysepsis
yprotocol yto ybe y
initiated. yWhich yintervention yis yMOST yimportant yfor ythe ynurse yto yinclude yin ythe
yplan yof ycare?
a. yMonitor yblood yglucose ylevel
b. yKeep yhead yof ybed yraised y45, ydegrees
c. yMaintain ystrict yintake yand youtput
d. yAssess ywarmth yof yextremities y- yANS--a. yMonitor yblood yglucose ylevel
13. yA yclient ywith ythe yhistory yof yadrenal yinsufficiency yis yadmitted yto ythe yintensive
ycare yunit ywith yan y
acute yadrenal ycrisis. yThe yclient yis ycomplaining yof ynausea yand yjoint ypain. yVital
ysigns yare: y
temperature y102 yF y(38.9 yC), yheart yrate y138 ybeats/Min, yBP y80/60 ymmHg. yWhich
yintervention y
should ythe ynurse yimplement yFIRST?
a. yCover yclient ywith ycooling yblanket
b. yInfuse yintravenous yfluid ybolus
c. yObtain yan yanalgesic yprescription
, d. yAdminister yPRN yoral yantipyretic y- yANS--b. yInfuse yintravenous yfluid ybolus
14. yA yclient ywho yis yadmitted yto ythe yintensive ycare yunit y(ICU) ywith ysyndrome yof
yinappropriate y
antidiuretic yhormone y(SIADH) yhas ydeveloped yosmotic ydemyelination. yWhich
yIntervention yshould y
the ynurse yimplement yFIRST?
a. yReorient yoften
b. yEvaluate yswallow yor ySwollen yThroat yfor yS/SX
c. yRange yof yMotion
d. yPatch yone yeye y- yANS--b. yEvaluate yswallow yor ySwollen yThroat yfor yS/SX
15. yAfter ysuccessful yresuscitation, ya yclient yis ygiven ypropranolol yand ytransferred yto
yIntensive yCoronary yCare yUnit y(ICCU). yOn yadmission, ymagnesium ysulfate y4 ygrams
yIV yin y250 ymL yD5W yat yone ygram/hour. yWhich yassessment yfindings yrequire
yimmediate yintervention yby ythe ynurse?
a. yDark yamber yurine ydraining yper yindwelling ycatheter ywith y40 ymL yper yhour
b. ySinus yrhythm yat y72 ybeats/minute yand yperipheral yblood ypressure yof y99/62 ymm
yHg
c. ySerum ycalcium yof y9.0 ymg/dL y(2.2 ymmol/L ySI) yand ymagnesium yof y1.8 ymg/dL yor
yEq/L y(0.74 y
mmol/L yS1)
d. yRespiratory yrate yof y10 ybreaths yper yminute yand ypulse yoximetry yof y90% y- yANS--
d. yRespiratory yrate yof y10 ybreaths yper yminute yand ypulse yoximetry yof y90%
The ynurse yusing ya ystraight yurinary ycatheter ykit yto ycollect ya ysterile yurine yspecimen
yfrom ya yfemale yclient. yAfter ypositioning yand yprepping ythe yclient, yrank ythe yaction yin
ythe ysequence ythey yshould ybe yimplemented y(place ythe yfirst yaction yat ythe ytop ywith
ythe ylast yaction yat ythe ybottom) y
Open ythe ysterile ycatheter ykit yclose yto ythe yclient's yperineum y
Place ydistal yend yof ythe ycatheter yin ysterile yspecimen ycup yand yinsert ycatheter yinto
ymeatus
Cleanse ythe yurinary ymeatus yusing ythe ysolution, yswabs, yand yforceps yprovided y
Don ysterile ygloves yand yprepare ythe ysterile yfield y- yANS--Open ythe ysterile ycatheter
ykit yclose yto ythe yclient's yperineum y
Don ysterile ygloves yand yprepare ythe ysterile yfield y
Cleanse ythe yurinary ymeatus yusing ythe ysolution, yswabs, yand yforceps yprovided y
100% CORRECT ANSWERS
A yclient ypresents yto ythe yemergency ydepartment y(ED) ywith ycomplaints yabdominal
ypain. yThe ynurse yobserves ythe yclient's yright ycheek yand yeye ybruised yand ysuspects
ypossible ydomestic yviolence. yWhich yapproach yis ybest ythe ynurse yto yuse ywhen
yinterviewing ythe yclient? y
a. yShare ypersonal yvalues yto yput ythe yat yease y
b. yAsk yquestions yin ya yvague, ynon-specific yformat y
c. yBegin ywith yquestions ythat yare yless ysensitive yin ynature y
d. yGet ythe ymost ydifficult yquestions yover ywith yfist y- yANS--c. yBegin ywith yquestions
ythat yare yless ysensitive yin ynature
A yclient ywho yreceived yan yopen yreduction yand yinternal yfixation y(ORIF) yof ythe yright
yfemur yafter yexperiencing ya yfall yhome yexperiences ya ysudden yonset yof yincreasing
yconfusion yand yagitation. yWhen yreporting yto ythe yhealthcare yusing ySBAR
ycommunication, ywhich yinformation yshould ythe y
nurse yprovide yFIRST
a. yCurrently yprescribed ymedication
b. yClient's yhealthcare ypower yof yattorney
c. yIncreasing yconfusion yof ythe yclient
d. yFall yat yhome yas yreason yfor yadmission y- yANS--c. yIncreasing yconfusion yof ythe
yclient
3. yA yclient ytells ythe ynurse yabout ybeginning yan yexercise yprogram ya ymonth yago yto
ylose yweight yand yimprove ysleep. yThe yclient ystates ythat yit ystill ytakes yat yleast ytwo
yhours yto yfall yasleep yat ynight. yWhich y
action yshould ythe ynurse yimplement?
a. yDetermine ythe yamount yof yweight ythe yclient yhas ylost ysince yincreasing yactivity
b. yEncourage ythe yclient yto yexercise yevery yday yto yeliminate ybedtime ywakefulness
c. yAdvise ythe yclient ythat ylifestyle ychanges yoften ytake yseveral yweeks yto ybe yeffective
d. yAsk ythe yclient yfor ya ydescription yof ythe yexercise yschedule ythat yis ybeing yfollowed
y- yANS--d. yAsk ythe yclient yfor ya ydescription yof ythe yexercise yschedule ythat yis ybeing
yfollowed
4. yWhich yassessment yshould ythe yhome yhealth ynurse yinclude yduring ya yroutine
yhome yvisit yfor ya yclient ywho ywas ydischarged yhome ywith ya ysuprapubic ycatheter? y
,a. yObserve yinsertion ysite y
b. yPalpate yflank yarea y
c. yAssess yperineal yarea y
d. yMeasure yabdominal ygirth y- yANS--a. yObserve yinsertion ysite
5. yAn yolder yadult yclient ywith ya yhistory yof ytype y2 ydiabetes ymellitus yis yseen yin ythe
ycommunity yhealth yclinic yfor yan yannual yphysical yexamination. yWhich ynursing
yactions yshould ybe yincluded yin yassessing yfor ylong-term ycomplication yof ydiabetes?
y(SATA) y
a. yObtain yurine yspecimen yto yassess yfor yalbumin y
b. yTest ylower yextremities yfor ychanges yin ysensation y
c. yObtain yvenous ysample yfor yliver yenzymes y
d. yPalpate ypedal ypulses yand yfoot ytemperature y
e. yAuscultate yfor yadventitious ybreath ysounds y- yANS--b. yTest ylower yextremities yfor
ychanges yin ysensation y
d. yPalpate ypedal ypulses yand yfoot ytemperature
6. yThe yhome yhealth ynurse yis yassessing ya ymale yclient ywho yhas ystarted yperitoneal
ydialysis y(PD) y5 ydays yago. yWhich yassessment yfinding ywarrants yimmediate
yintervention yby ythe ynurse? y
a. yAnorexia yand ypoor yintake yof yadequate ydietary yprotein y
b. yArteriovenous y(AV) ygraft ysurgical ysite ypulsations y
c. yFingerstick yblood yglucose y12o ymg/Dl y(6.66 ymmol/L) ypost yexchange y
d. yCloudy ydialysate youtput yand yrebound yabdominal ypain y- yANS--d. yCloudy
ydialysate youtput yand yrebound yabdominal ypain
7. yWhat yaction yshould ythe yschool ynurse yimplement yto yprovide ysecondary
yprevention yfor yschool yaged ychildren? y
a. yPrepare ya ypresentation yon yhow yto yprevent ythe yspread yof ylice y
b. yCollaborate ywith ya yscience yteacher yto yprepare ya yhealth ylesson y
c. yObserve ya yperson ywith ytype y1 yDiabetes yself-administer ya ydose yof yinsulin y
d. yInitiate ya yhearing yand yvision yscreening yprogram yfor yfirst ygraders y- yANS--d.
yInitiate ya yhearing yand yvision yscreening yprogram yfor yfirst ygraders
8. yThe ynurse yis ydiscussing ymitigation yat ya ydisaster ypreparedness ycommittee
ymeeting. yWhich yactivity yshould ythe ynurse ysuggest yto yenhance ymitigation?
a. yDiscuss ysome yways yto yensure ysafety yin ythe yhome yduring ya ydisaster y
b. yDesign yrequirement yfor yan yincident yCommand yCenter
c. yProvide ya ycommunity ydisaster ypreparedness ymeeting
d. yParticipate yas yan yactive ymember yof ythe ylocal yAmerican yRed yCross y- yANS--c.
yProvide ya ycommunity ydisaster ypreparedness ymeeting
,9. yA yclient yis yadmitted yto ythe yintensive ycare yunit y(ICU) ywith yspinal ycord yinjury
y(SCI) yfollowing ya ymotor y
vehicle ycollision. yWhich ynurse yshould ybe ycontacted yto ycoordinate ythe yprogression
yof ythe yclient's y
care?
a. yNurse yCare ymanager
b. yNeurology yunit ysupervisor
c. yAdult ynurse ypractitioner
d. yRisk ymanagement ynurse y- yANS--b. yNeurology yunit ysupervisor
10. yA yclient ywho yweighs y80 ykg yreceives ya yprescription yfor ydobutamine y2
ymcg/kg/min yintravenously y(IV). yThe yIV ybag yis ycontains ydobutamine y500 ymg yin
ydextrose y5% yin ywater y(D5W) y500 ymL/hour yshould ythe ynurse yprogram ythe yinfusion
ypump? y(Enter ythe ynumerical yvalue yonly. yIf yrounding yis yrequired, yround yto ythe
ynearest ywhole ynumber) y- yANS--
11. yThe ynurse yis ycaring yfor ya yclient yadmitted ya yspontaneous ypneumothorax. yWhich
yactions yshould y
the ynurse yinclude yin ythis yclient's yplan yof ycare?
a. yGive ybronchodilator yby yendotracheal yroute
b. ySchedule yclient yfor yhyperbaric yoxygen ytherapy y(HBOT)
c. yMonitor ybubbling yof ychest yunit ywater-seal ychamber
d. yAdminister yantibiotics yvia ylong-line yIV ycatheter y- yANS--c. yMonitor ybubbling yof
ychest yunit ywater-seal ychamber
12. yThe ynurse yis ycaring yfor ya yclient ywho ydevelops ysigns yand ysymptoms yof yseptic
yshock yfollowing ya y
urinary ytract yinfection yone yweek yago. yThe yhealthcare yprovider yprescribed ya ysepsis
yprotocol yto ybe y
initiated. yWhich yintervention yis yMOST yimportant yfor ythe ynurse yto yinclude yin ythe
yplan yof ycare?
a. yMonitor yblood yglucose ylevel
b. yKeep yhead yof ybed yraised y45, ydegrees
c. yMaintain ystrict yintake yand youtput
d. yAssess ywarmth yof yextremities y- yANS--a. yMonitor yblood yglucose ylevel
13. yA yclient ywith ythe yhistory yof yadrenal yinsufficiency yis yadmitted yto ythe yintensive
ycare yunit ywith yan y
acute yadrenal ycrisis. yThe yclient yis ycomplaining yof ynausea yand yjoint ypain. yVital
ysigns yare: y
temperature y102 yF y(38.9 yC), yheart yrate y138 ybeats/Min, yBP y80/60 ymmHg. yWhich
yintervention y
should ythe ynurse yimplement yFIRST?
a. yCover yclient ywith ycooling yblanket
b. yInfuse yintravenous yfluid ybolus
c. yObtain yan yanalgesic yprescription
, d. yAdminister yPRN yoral yantipyretic y- yANS--b. yInfuse yintravenous yfluid ybolus
14. yA yclient ywho yis yadmitted yto ythe yintensive ycare yunit y(ICU) ywith ysyndrome yof
yinappropriate y
antidiuretic yhormone y(SIADH) yhas ydeveloped yosmotic ydemyelination. yWhich
yIntervention yshould y
the ynurse yimplement yFIRST?
a. yReorient yoften
b. yEvaluate yswallow yor ySwollen yThroat yfor yS/SX
c. yRange yof yMotion
d. yPatch yone yeye y- yANS--b. yEvaluate yswallow yor ySwollen yThroat yfor yS/SX
15. yAfter ysuccessful yresuscitation, ya yclient yis ygiven ypropranolol yand ytransferred yto
yIntensive yCoronary yCare yUnit y(ICCU). yOn yadmission, ymagnesium ysulfate y4 ygrams
yIV yin y250 ymL yD5W yat yone ygram/hour. yWhich yassessment yfindings yrequire
yimmediate yintervention yby ythe ynurse?
a. yDark yamber yurine ydraining yper yindwelling ycatheter ywith y40 ymL yper yhour
b. ySinus yrhythm yat y72 ybeats/minute yand yperipheral yblood ypressure yof y99/62 ymm
yHg
c. ySerum ycalcium yof y9.0 ymg/dL y(2.2 ymmol/L ySI) yand ymagnesium yof y1.8 ymg/dL yor
yEq/L y(0.74 y
mmol/L yS1)
d. yRespiratory yrate yof y10 ybreaths yper yminute yand ypulse yoximetry yof y90% y- yANS--
d. yRespiratory yrate yof y10 ybreaths yper yminute yand ypulse yoximetry yof y90%
The ynurse yusing ya ystraight yurinary ycatheter ykit yto ycollect ya ysterile yurine yspecimen
yfrom ya yfemale yclient. yAfter ypositioning yand yprepping ythe yclient, yrank ythe yaction yin
ythe ysequence ythey yshould ybe yimplemented y(place ythe yfirst yaction yat ythe ytop ywith
ythe ylast yaction yat ythe ybottom) y
Open ythe ysterile ycatheter ykit yclose yto ythe yclient's yperineum y
Place ydistal yend yof ythe ycatheter yin ysterile yspecimen ycup yand yinsert ycatheter yinto
ymeatus
Cleanse ythe yurinary ymeatus yusing ythe ysolution, yswabs, yand yforceps yprovided y
Don ysterile ygloves yand yprepare ythe ysterile yfield y- yANS--Open ythe ysterile ycatheter
ykit yclose yto ythe yclient's yperineum y
Don ysterile ygloves yand yprepare ythe ysterile yfield y
Cleanse ythe yurinary ymeatus yusing ythe ysolution, yswabs, yand yforceps yprovided y
