hesi_pn_exit_exam_v3_110_questions_and_answers_202

HESI PN EXIT EXAM V3 LATEST VERSION 2022-
2024ALL 110QUESTIONSANDVERIFIED
ANSWERS PLUS RATIONALES/PN HESI EXIT
EXAMV3

1. AnKadultKclientKexperiencesKaKgasolineKtankKfireKwhenKridingKaKmotorcycleKandKisKadmittedK
toKtheKemergencyKdepartmentK(ED)KwithKfullKthicknessKburnsKtoKallKsurfacesKofKbothKlowerK
extremities.KWhatKpercentageKofKbodyKsurfaceKareaKshouldKtheKnurseKdocumentKinKtheKelect
ronicKmedicalKrecordK(EMR)?

• 9K%
• 18K%
• 36K%

• 45K%
• Rational:KaccordingKtoKtheKruleKofKnines,KtheKanteriorKandKposteriorKsurfacesKofKo
neKlowerKextremityKisKdesignatedKasK18K%ofKtotalKbodyKsurfaceKareaK(TBSA),KsoK
bothKextremitiesKequalsK36%KTBSA,KotherKoptionsKareKincorrect.
2. AKclientKwithKhyperthyroidismKisKreceivingKpropranololK(Inderal).KWhichKfindingKindicatesKth
atKtheKmedicationKisKhavingKtheKdesiredKeffect?

• DecreaseKinKserumKT4Klevels
• IncreaseKinKbloodKpressure
• DecreaseKinKpulseKrate
• GoiterKnoKlongerKpalpable
3. AnKolderKmaleKclientKwithKtypeK2KdiabetesKmellitusKreportsKthatKhasKexperiencesKlegsKpai
nKwhenKwalkingKshortKdistances,KandKthatKtheKpainKisKrelievedKbyKrest.KWhichKclientKbeha
viorKindicatesKanKunderstandingKofKhealthcareKteachingKtoKpromoteKmoreKeffectiveKarteri
alKcirculation?

• ConsistentlyKappliesKTEDKhoseKbeforeKgettingKdressedKinKtheKmorning.
• FrequentlyKelevatedKlegsKthoroughKtheKday.
• InspectKtheKlegKfrequentlyKforKanyKirritationKorKskinKbreakdown
• CompletelyKstopKcigarette/KcigarKsmoking.
• Rationale:KStoppingKcigaretteKsmokingKhelpsKtoKdecreaseKvasoconstrictionKan
dKimproveKarterialKcirculationKtoKtheKextremity.

4. AKcommunityKhealthKnurseKisKconcernedKaboutKtheKspreadKofKcommunicableKdiseasesKamong
KmigrantKfarmKworkersKinKaKruralKcommunity.KWhatKactionKshouldKtheKnurseKtakeKtoKpromoteKt

heKsuccessKofKaKhealthcareKprogramKdesignedKtoKaddressKthisKproblem?
• EstablishKtrustKwithKcommunityKleadersKandKrespectKculturalKandKfamil
yKvalues

,5. TheKnurseKperformsKaKprescribedKneurologicalKcheckKatKtheKbeginningKofKtheKshiftKonKaKclie
ntKwhoKwasKadmittedKtoKtheKhospitalKwithKaKsubarachnoidKbrainKattackK(stroke).KTheKclient’
sKGlasgowKComaKScaleK(GCS)KscoreKisK9.KWhatKinformationKisKmostKimportantKforKtheKnurs
eKtoKdetermine?
• TheKclient’sKpreviousKGCSKscore

• WhenKtheKclient’sKstrokeKsymptomsKstarted
• IfKtheKclientKisKorientedKtoKtime
• TheKclient’sKbloodKpressureKandKrespirationKrate
• Rationale:KTheKnormalKGCSKisK15,KandKitKisKmostKimportantKforKtheKnurseKtoK
determineKifKitKabnormalKscoreKaKsignKofKimprovementKorKaKdeteriorationKinKt
heKclient’sKcondition
6. TheKchargeKnurseKinKaKcriticalKcareKunitKisKreviewingKclients’KconditionsKtoKdetermineKwhoK
isKstableKenoughKtoKbeKtransferred.KWhichKclientKstatusKreportKindicatesKreadinessKforKtran
sferKfromKtheKcriticalKcareKunitKtoKaKmedicalKunit?
• ChronicKliverKfailureKwithKaKhemoglobinKofK10.1KandKslightKbilirubinKelevatio
n
7. BasedKonKprinciplesKofKasepsis,KtheKnurseKshouldKconsiderKwhichKcircumstanceKtoKbeKsterile?

• OneKinch-KborderKaroundKtheKedgeKofKtheKsterileKfieldKsetKupKinKtheKoperatingKroom
• AKwrappedKunopened,KsterileK4x4KgauzeKplacedKonKaKdampKtableKtop.
• AnKopenKsterileKFoleyKcatheterKkitKsetKupKonKaKtableKatKtheKnurseKwaistKlevel

• SterileKsyringeKisKplacedKonKsterileKareaKasKtheKnurseKrichesKoverKtheKsterileKfield.
• Rationale:KAKsterileKpackageKatKorKaboveKtheKwaistKlevelKisKconsideredKsterile.KT
heKedgeKofKsterileKfieldKisKcontaminatedKwhichKincludeKaK1-
inchKborderK(A).KAKsterile
objectsKbecomeKcontaminatedKbyKcapillaryKactionKwhenKsterileKobjectsKbecomeKinK
contactKwithKaKwetKcontaminatedKsurface.
8. AnKunlicensedKassistiveKpersonnelK(UAP)KreportsKthatKaKclient’sKrightKhandKandKfingersKspas
msKwhenKtakingKtheKbloodKpressureKusingKtheKsameKarm.KAfterKconfirmingKtheKpresenceKofKs
pamsKwhatKactionKshouldKtheKnurseKtake?

• AskKtheKUAPKtoKtakeKtheKbloodKpressureKinKtheKotherKarm

• TellKtheKUAPKtoKuseKaKdifferentKsphygmomanometer.
• ReviewKtheKclient’sKserumKcalciumKlevel

• AdministerKPRNKantianxietyKmedication.
• Rationale:KTrousseau’sKsignKisKindicatedKbyKspasmsKinKtheKdistalKportionKofKa
nKextremityKthatKisKbeingKusedKtoKmeasureKbloodKpressureKandKisKcausedKby

, hypocalcemiaK(normalKlevelK9.0-10.5Kmg/dl,KsoKCKshouldKbeKimplemented.
9. AK56-years-
oldKmanKsharesKwithKtheKnurseKthatKheKisKhavingKdifficultyKmakingKdecisionKaboutKterminati
ngKlifeKsupportKforKhisKwife.KWhatKisKtheKbestKinitialKactionKbyKtheKnurse?
• ProvideKanKopportunityKforKhimKtoKclarifyKhisKvaluesKrelatedKtoKtheKdecision
• EncourageKhimKtoKshareKmemoriesKaboutKhisKlifeKwithKhisKwifeKandKfamily
• AdviseKhimKtoKseekKseveralKopinionsKbeforeKmakingKdecision
• OfferKtoKcontactKtheKhospitalKchaplainKorKsocialKworkerKtoKofferKsupport.
• Rationale:KWhenKaKclientKisKfacedKwithKaKdecisionalKconflict,KtheKnurseKshouldKfir
stKprovideKopportunitiesKforKtheKclientKtoKclarifyKvaluesKimportantKinKtheKdecision.K
The
restKmayKalsoKbeKbeneficialKonceKtheKclientKasKclarifiedKtheKvaluesKthatKareKimport
antKtoKhimKinKtheKdecision-makingKprocess.
10. AKclientKisKbeingKdischargedKhomeKafterKbeingKtreatedKforKheartKfailureK(HF).KWhatKinstructi
onKshouldKtheKnurseKincludeKinKthisKclient’sKdischargeKteachingKplan?
• WeighKeveryKmorning

• EatKaKhighKproteinKdiet
• PerformKrangeKofKmotionKexercises
• LimitKfluidKintakeKtoK1,500KmlKdaily
11. AKwomanKjustKlearnedKthatKsheKwasKinfectedKwithKHeliobacterKpylori.KBasedKonKthisKfindin
g,KwhichKhealthKpromotionKpracticeKshouldKtheKnurseKsuggest?
• EncourageKscreeningKforKaKpepticKulcer
12. AKclientKwhoKrecentlyKunderwearKaKtracheostomyKisKbeingKpreparedKforKdischargeKtoKhom
e.KWhichKinstructionsKisKmostKimportantKforKtheKnurseKtoKincludeKinKtheKdischargeKplan?
• TeachKtrachealKsuctioningKtechniques
13. AKchildKwithKheartKfailureKisKreceivingKtheKdiureticKfurosemideK(Lasix)KandKhasKserumKp
otassiumKlevelK3.0KmEq/L.KWhichKassessmentKisKmostKimportantKforKtheKnurseKtoKobtain?

• CardiacKrhythmKandKheartKrate.
• DailyKintakeKofKfoodsKrichKinKpotassium.

• HourlyKurinaryKoutput
• ThirstKadKskinKturgor.
14. TheKnurseKnoteKaKdepressedKfemaleKclientKhasKbeenKmoreKwithdrawnKandKnon-
communicativeKduringKtheKpastKtwoKweeks.KWhichKinterventionKisKmostKimportantKtoKinclu
deKinKtheKupdatedKplanKofKcareKforKthisKclient?