2020 HESI EXIT V2
2020 HESI EXIT V2
1) The nurse knows that which statement by the mother indicates that the mother understands safety precautions with her four month-old infant and her 4 year-old child?
A) "I strap the infant car seat on the front seat to face backwards."
B) "I place my infa...
2020 hesi exit v2 1 the nurse knows that which statement by the mother indicates that the mother understands safety precautions with her four month old infant and her 4 year old ch
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2020 HESI EXIT V2
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2020 HESI EXIT V2
1) The nurse knows that which statement by the mother indicates that the
mother understands safety precautions with her four month-old infant and her
4 year-old child?
A) "I strap the infant car seat on the front seat to face backwards."
B) "I place my infant in the middle of the living room floor on a blanket to play
with my4 year old while I make supper in the kitchen."
C) "My sleeping baby lies so cute in the crib with the little buttocks stuck up
in the airwhile the four year old naps on the sofa."
D) "I have the 4 year-old hold and help feed the four month-old a bottle in the
kitchenwhile I make supper."
The correct answer is D: "I have the four year-old hold and help feed the four
month-olda bottle in the kitchen
2) Upon completing the admission documents, the nurse learns that the 87 year-
old clientdoes not have an advance directive. What action should the nurse
take?
A) Record the information on the chart
B) Give information about advance directives
C) Assume that this client wishes a full code
D) Refer this issue to the unit secretary
The correct answer is B: Give information about advance directives
3) A nurse administers the influenza vaccine to a client in a clinic. Within 15
minutes afterthe immunization was given, the client complains of itchy and
watery eyes, increased anxiety, and difficulty breathing. The nurse expects that
the first action in the sequence ofcare for this client will be to
A) Maintain the airway
B) Administer epinephrine 1:1000 as ordered
C) Monitor for hypotension with shock
D) Administer diphenhydramine as ordered
The correct answer is B: Administer epinephrine 1:1000 as ordered.
4) Which of these children at the site of a disaster at a child day care center
would thetriage nurse put in the "treat last" category?
A) An infant with intermittent bulging anterior fontanel between crying
episodesB) A toddler with severe deep abrasions over 98% of the body
C) A preschooler with 1 lower leg fracture and the other leg with an upper leg
fracture
D) A school-age child with singed eyebrows and hair on the arms
The correct answer is B: A toddler with severe deep abrasions over 98% of the body.
,5) When admitting a client to an acute care facility, an identification bracelet is
sent upwith the admission form. In the event these do not match, the nurse’s
best action is to
A) Change whichever item is incorrect to the correct information
B) Use the bracelet and admission form until a replacement is
supplied
C) C) Notify the admissions office and wait to apply the bracelet
D) Make a corrected identification bracelet for the client
The correct answer is C: notify the admissions office and wait to apply the bracelet
6) The nurse is having difficulty reading the health care provider's written order
that waswritten right before the shift change. What action should be taken?
A) Leave the order for the oncoming staff to follow-up
B) Contact the charge nurse for an interpretation
C) Ask the pharmacy for assistance in the
interpretation
D) D) Call the provider for clarification
The correct answer is D: Call the provider for clarification
7) An adult client is found to be unresponsive on morning rounds. After
checking for responsiveness and calling for help, the next action that should be
taken by the nurse isto:
A) check the carotid pulse
B) deliver 5 abdominal thrusts
C) give 2 rescue breaths
D) open the client's airway
The correct answer is D: open the client’s airway
8) A client has an order for 1000 ml of D5W over an 8 hour period. The nurse
discoversthat 800 ml has been infused after 4 hours. What is the priority
nursing action?
A) Ask the client if there are any breathing problems
B) Have the client void as much as possible
C) Check the vital
signs
D) Auscultate the lungs
The correct answer is D: Auscultate the lungs
9) Following change-of-shift report on an orthopedic unit, which client should
the nursesee first?
A) 16 year-old who had an open reduction of a fractured wrist 10 hours ago
B) 20 year-old in skeletal traction for 2 weeks since a motorcycle
accident
C) C) 72 year-old recovering from surgery after a hip replacement 2
hours ago
, D) 75 year-old who is in skin traction prior to planned hip pinning surgery.
The correct answer is C: 72 year-old recovering from surgery after a hip
replacement 2hours ago
10) A nurse observes a family member administer a rectal suppository by having
the client lie on the left side for the administration. The family member pushed
the suppository until the finger went up to the second knuckle. After 10 minutes
the client was told by the family member to turn to the right side and the client
did this. What is theappropriate comment for the nurse to make?
A) Why don’t we now have the client turn back to the left side.
B) That was done correctly. Did you have any problems with the insertion?
C) Let’s check to see if the suppository is in far enough.
D) Did you feel any stool in the intestinal tract?
The correct answer is B: That was done correctly. Did you have any problems
with theinsertion?
11) A client with a diagnosis of Methicillin resistant Staphylococcus aureus
(MRSA) hasdied. Which type of precautions is the appropriate type to use
when performing postmortem care?
A) airborne precautions
B) droplet
precautions
C) C) contact precautions
D) Compromised host precautions
The correct answer is C: contact precautions
12) The nurse is reviewing with a client how to collect a clean catch urine
specimen.Which sequence is appropriate teaching?
A) Void a little, clean the meatus, then collect
specimen
B) clean the meatus, begin voiding, then catch urine
stream
C) Clean the meatus, then urinate into container
D) Void continuously and catch some of the urine
The correct answer is B: clean the meatus, begin voiding, then catch urine stream
13) The provider orders Lanoxin (digoxin) 0.125 mg PO and furosemide 40
mg everyday. Which of these foods would the nurse reinforce for the client to
eat at least daily?
A) spaghetti
B)
watermelon
C) chicken
D) tomatoes
The correct answer is B: watermelon
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