HESI Exit Exam RN 2018 (Updated) - Over 500 Questions | HESI Exit Exam RN 2018 (A Grade) - Over 500 Questions

HESI Exit Exam RN 2018 (Updated) - Over 500 Questions by Henry G January 22, 2019 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 • A male client with hypertension, who received new antihypertensive prescriptions at his last visit returns to the clinic two weeks later to evaluate his blood pressure (BP). His BP is 158/106 and he admits that he has not been taking the prescribed medication because the drugs make him “feel bad”. In explaining the need for hypertension control, the nurse should stress that an elevated BP places the client at risk for which pathophysiological condition? • Stroke secondary to hemorrhage • 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 of pillows. • An adolescent with major depressive disorder has been taking duloxetine (Cymbalta) for the past 12 days. Which assessment finding requires immediate follow-up? • Describes life without purpose • 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. What information should the nurse include in the client’s teaching plan? • Further evaluation involving surgery may be needed • 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 • In assessing an adult client with a partial rebreather mask, the nurse notes that the oxygen reservoir bag does not deflate completely during inspiration and the client’s respiratory rate is 14 breaths / minute. What action should the nurse implement? • Document the assessment data • Rational: reservoir bag should not deflate completely during inspiration and the client’s respiratory rate is within normal limits. • During shift report, the central electrocardiogram (EKG) monitoring system alarms. Which client alarm should the nurse investigate firs? • Respiratory apnea of 30 seconds • 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 • 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 action should the nurse take first? • Inform the anesthesia care provider • 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 take first? • Listen with the bell at the same location • 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 • 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 • Following a lumbar puncture, a client voices several complaints. What complaint indicated to the nurse that the client is experiencing a complication? • “I have a headache that gets worse when I sit up” • “I am having pain in my lower back when I move my legs” • “My throat hurts when I swallow” • “I feel sick to my stomach and am going to throw up” • 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 catch mid-stream specimen • The nurse is assisting the mother of a child with phenylketonuria (PKU) to select foods that are in keeping with the child’s dietary restrictions. Which foods are contraindicated for this child? • Foods sweetened with aspartame • 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 for this client. Which response should the circulating nurse provide? • Direct the nurse to continue the surgical hand scrub for a 5 minute duration • Which breakfast selection indicates that the client understands the nurse’s instructions about the dietary management of osteoporosis? • Bagel with jelly and skim milk 1. 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 client should receive the most care hours by a registered nurse (RN)? • An 82-year-old client with Alzheimer’s disease newly-fractures femur who has a Foley catheter and soft wrist restrains applied 1. A mother brings her 6-year-old child, who has just stepped on a rusty nail, to the pediatrician’s office. Upon inspection, the nurse notes that the nail went through the shoe and pierced the bottom of the child’s foot. Which action should the nurse implement 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 globulin injection • The mother of an adolescent tells the clinic nurse, “My son has athlete’s foot, I have been applying triple antibiotic ointment for two days, but there has been no improvement.” What instruction should the nurse provide? • Stop using the ointment and encourage complete drying of the feet and wearing clean socks. • 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 • 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 to the client? • Obtain a list of medications taken for cardiac history • 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 • 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 into abdomen • Increased circulating aldosterone levels that increase sodium and water retention • The nurse is auscultating a client’s heart sounds. Which description should the nurse use to document this sound? (Please listen to the audio first to select the option that applies) • Murmur • Rationale: A murmur is auscultated as a swishing sound that is associated with the blood turbulence created by the heart or valvular defect. 1. 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 • The nurse notes that a client has been receiving hydromorphone (Dilaudid) every six hours 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 client’s capillary glucose level • Count the apical and radial pulses simultaneously • Rationale: hydromorphone is a potent opioid analgesic that slows peristalsis and frequently causes constipation, so it is most important to Auscultate the client's bowel sounds • A female client is admitted with end stage pulmonary disease is alert, oriented, and complaining of shortness of breath. The client tells the nurse that she wants “no heroic measures” taken if she stops breathing, and she asks the nurse to document this in her medical record. What action should the nurse implement? • Ask the client to discuss “do not resuscitate” with her healthcare provider • A client is receiving a full strength continuous enteral tube feeding at 50 ml/hour and has developed 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 • 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-up question 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 • After a third hospitalization 6 months ago, a client is admitted to the hospital with ascites and malnutrition. The client is drowsy but responding to verbal stimuli and reports recently spitting up blood. What assessment finding warrants immediate intervention by the nurse? • Capillary refill of 8 seconds • bruises on arms and legs • round and tight abdomen • pitting edema in lower legs • After the nurse witnesses a preoperative client sign the surgical consent form, the nurse signs the form as a witness. What are the legal implications of the nurse’s signature on the client’s surgical 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 • 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? - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - -- -- - - - - - - - - - - - -- - - - - - - - - - -- • Complain of headaches and stiff neck • A woman who takes pyridostigmine for myasthenia gravis (MG) arrives at the emergency department complaining of extreme muscle weakness. Her adult daughter tells the nurse that since yesterday her mother has been unable to smile, which assessment finding warrants immediate intervention by the nurse? • Uncontrollable drooling • Inability to raise voice • Tingling of extremities • Eyelid drooling • A client with multiple sclerosis (MS) is admitted to the medical unit. The client reports…which action should the nurse implement to reduce the client’s risk for falls? • Schedule frequent rest periods • Provide assistance to bedside commode • Teach to patch one eye when ambulating • What is the nurse’s priority goal when providing care for a 2-year-old child experiencing seizure… • Stop the seizure activity • Decrease the temperature • Manage the airway • Protect the body from injury • A client is complaining of intermittent, left, lower abdominal pain that began two days ago…implement the following interventions? • Correct orders: (DPIA) 1. Determine when the client had last bowel movement 2. Position client supine with knees bent 3. Inspect abdominal contour 4. Auscultate all four abdominal quadrants 1. The nurse is caring for four clients…postoperative hemoglobin of 8.7 mg/dl; client C, newly admitted with potassium…an appendectomy who has a white blood cell count of 15,000mm3. What intervention… • Determine the availability of two units of packed cells in the blood bank for client B • Increase the oxygen flow rate to 4 liters/minute per face mask for client A • Remove any foods, such as banana or orange juice, for the breakfast tray for client C • Inform client D that surgery is likely to be delayed until the infection responds to antibiotics • A client with a new diagnosis of Raynaud’s disease lives alone. Which instruction should the nurse include in the client’s discharged teaching plan? • Keep room temperature 80 • Sublingual nitroglycerin is administered to a male client with unstable angina who complains of crushing chest pain. Five minutes later the client becomes nauseated and his bloods pressure drops to 60/40. Which intervention should the nurse implement? • Infuse a rapid IV normal saline bolus • A male client tells the nurse that he is concerned that he may have a stomach ulcer, because he is experiencing heartburn and a dull growing pain that is relieved when he eats. What is the best response by the nurse? • Encourage the client to obtain a complete physical exam since these symptoms are consistent with an ulcer • A mother calls the nurse to report that at 0900 she administered a PO dose of digoxin to her 4-month-old infant, but at 0920 the baby vomited the medicine, what instruction should the nurse provide to this mother • Withhold this dose • When checking a third grader’s height and weight the school nurse notes that these measurements have not changed in the last year. The child is currently taking daily vitamins, albuterol, and methylphenidate for attention deficit hyperactivity disorder (ADHD). Which intervention should the nurse implement? • Refer child to the family healthcare provider • An adolescent receives a prescription for an injection of s-matriptan succinate 4 mg subcutaneously for a migraine headache. Using a vial labeled, 6 mg/ 0.5 ml, how many ml should the nurse administer? (Enter the numerical value only. If rounding is required, round to the nearest hundredth.) 0.33 mL • Rationale: 4mg x 0.5 ml=2/6=0.33 ml • An unlicensed assistive personnel (UAP) informs the nurse who is giving medications that a female client is crying. The client was just informed that she has a malignant tumor. What action should the nurse implement first? • Tell the client that the nurse will be back to talk to her after medications are given • The husband of an older woman, diagnosed with pernicious anemia, calls the clinic to report that his wife still has memory loss and some confusion since she received the first dose of nasal cyanocobalamin two days ago. He tells the nurse that he is worried that she might be getting Alzheimer’s disease. What action should the nurse take? • Explain that memory loss and confusion are common with vitamin B12 deficiency • While the school nurse is teaching a group of 14-year-olds, one of the participants remarks, “You are too young to be our teacher! You’re not much older than we are!” How should the nurse respond? • “How old do you think I am?” • “We need to stay focused on the topic.” • “I think I am qualified to teach this group.” • “Do you think you can teach it any better?” • An unconscious client is admitted to the intensive care unit and is placed on a ventilator. The ventilator alarms continuously and the client's oxygen saturation level is 62%. What action should the nurse take first? • Begin manual ventilation immediately. • After diagnosis and initial treatment of a 3 year old with Cystic fibrosis, the nurse provides home care instructions to the mother, which statement by the child's mother indicates that she understands home care treatment to promote pulmonary functions? • Chest physiotherapy should be performed twice a day before a meal. • A middle-aged woman, diagnosed with Graves’ disease, asks the nurse about this condition. Which etiological pathology should the nurse include in the teaching plan about hyperthyroidism? (Select all that apply.) • Graves’ disease, an autoimmune condition, affects thyroid stimulating hormone receptors. • T3 and T4 hormone levels are increased • Large protruding eyeballs are a sign of hyperthyroid function • Weight gain is a common complaint in hyperthyroidism • Early treatment includes levothyroxine (Synthroid). • A male client who was admitted with an acute myocardial infarction receives a cardiac diet with sodium restriction and complains that his hamburger is flavorless. Which condiment should the nurse offer? • Fresh horseradish • While completing an admission assessment for a client with unstable angina, which closed questions should the nurse ask about the client's pain? • Does your pain occur when walking short distances? • A nurse who works in the nursery is attending the vaginal delivery of a term infant. What action should the nurse complete prior to leaving the delivery room? • place the id bands on the infant and mother • A female client with chronic urinary retention explains double voiding technique to the nurse by stating she voids partially, hold the remaining urine in her bladder for three minutes, then voids again to empty her bladder fully. How should the nurse respond? • Advise the client to empty her bladder fully when she first voids • A client is receiving an IV solution of nitroglycerin 100mg/500ml D5W at 10 mcg/ minute. The nurse should program the infusion pump to deliver how many ml/hour? ( Enter numeric value only) 3 ml/hour • Rationale : 0.01 x 500 x 60 / 100 = 3 • When assessing a multigravida the first postpartum day, the nurse finds a moderate amount of lochia rubra, with the uterus firm, and three fingerbreadths above the umbilicus. What action should the nurse implement first? • Massage the uterus to decrease atony • Review the hemoglobin to determine hemorrhage • Increase intravenous infusion • Check for a distended bladder • A-12-years old boy has a body mass index (BMI) of 28, a systolic pressure and a glycosylated hemoglobin (HBA1C) of 7.8%. Which selection indicated that his mother understands the management of his diet? • One whole-wheat bagel with cream cheese, two strips of bacon, six ounces of orange juice. • Rationale: Diet - Foods high in carbohydrates and fiber, low fat. No honey, no ham, no high sugar, no frost food, avoid all whole wheat products. • Which class of drugs is the only source of a cure for septic shock? • Antiinfectives • A 59-year-old male client comes to the clinic and reports his concern over a lump that, “just popped up on my neck about a week ago.” In performing an examination of the lump, the nurse palpates a large, nontender, hardened left subclavian lymph node. There is not overlying tissue inflammation. What do these findings suggest? • Malignancy • Bacterial infection • Viral infection • Lymphangitis • A gravida 2 para 1, at 38-weeks gestation, scheduled for a repeat cesarean section in one week, is brought to the labor and delivery unit complaining of contractions every 10 minutes. While assessing the client, the client’s mothers enter the labor suite and says in a loud voice, “I’ve had 8 children and I know she’s in labor. I want her to have her cesarean section right now!” what action should the nurse take? • Request the mother to leave the room • Tell the mother to stop speaking for the client • Request security to remove her from the room • Notify the charge nurse of the situation • While caring for a toddler receiving oxygen (02) via face mask, the nurse observes that the child’s lips and nares are dry and cracked. Which intervention should the nurse implement? • Ask the mother what she usually uses on the child’s lips and nose • Apply a petroleum jelly (Vaseline) to the child’s nose and lips • Use a topical lidocaine (Zylocaine viscous) analgesic for cracked lips • Use a water soluble lubricant on affected oral and nasal mucosa • The healthcare provider prescribes carboprost tromethamine (Hemabate) 250 mcg IM for a multigravida postpartum client who is experiencing heavy, bright red vaginal bleeding. Prior to administering this medication, which interventions should the RN implement? • Obtain a second IV access. • Decrease the room temperature. • Give the prescribed antiemetic. • Insert an indwelling catheter.