2020 HESI EXIT V1
1. Which information is a priority for the RN to reinforce to an older client after
intravenous pyelography?
A) Eat a light diet for the rest of the day
B) Rest for the next 24 hours since the preparation and the test is tiring.
C) During waking hours drink at least 1 8-ounce glass of fluid every hour for
the next 2 days
D) Measure the urine output for the next day and immediately notify the health
care provider if it should decrease.
- It’s important to drink more fluid afterwards to help flush out the iodine.
2. A client has altered renal function and is being treated at home. The nurse
recognizes that the most accurate indicator of fluid balance during the weekly
visits is?
A) difference in the intake and output
B) changes in the mucous membranes
C) skin turgor
D) weekly weight
- Daily weight is the best indicater for fluid balance, as opposed to I&O.
3. A client has been diagnosed with Zollinger-Ellison syndrome.Which
information is most important for the nurse to reinforce with the client?
A) It is a condition in which one or more tumors called gastrinomas form in the
pancreas or in the upper part of the small intestine (duodenum)
B) It is critical to report promptly to your health care provider any findings of
peptic ulcers
C) Treatment consists of medications to reduce acid and heal any peptic ulcers
and, if possible, surgery to remove any tumors
D) With the average age at diagnosis at 50 years the peptic ulcers may occur at
unusual areas of the stomach or intestine
- ZE syndrome is a disease in which tumors cause the stomach to produce too much acid, resulting
in peptic ulcers. Treatment is surgery.
,NUR HESI EXIT VI
4. A primigravida in the third trimester is hospitalized for preeclampsia. The
nurse determines that the client’s blood pressure is increasing. Which action
should the nurse take first?
A) Check the protein level in urine
B) Have the client turn to the left side
C) Take the temperature
D) Monitor the urine output
- LION: Left Side, Increase IV, O2, Notify MD (unless PITCON is running, stop that first)
5. The nurse is caring for a client in atrial fibrillation. The atrial heart rate is 250
and the ventricular rate is controlled at 75. Which of the following findings is
cause for the most concern?
A) Diminished bowel sounds
B) Loss of appetite
C) A cold, pale lower leg
D) Tachypnea
- A-Fib can cause fluid buildup in the lower extremities. It causes blood to pool up in the atria.
6. The client with infective endocarditis must be assessed frequently by the
home health nurse. Which finding suggests that antibiotic therapy is not
effective, and must be reported by the nurse immediately to the healthcare
provider?
A) Nausea and vomiting
B) Fever of 103 degrees Fahrenheit (39.5 degrees Celsius)
C) Diffuse macular rash
D) Muscle tenderness
- Pt should not have a high fever at this point if he/she is being given antibiotics.
7. A client who had a vasectomy is in the post recovery unit at an outpatient
clinic. Which of these points is most important to be reinforced by the nurse?
A) Until the health care provider has determined that your ejaculate doesn't
contain sperm, continue to use another form of contraception.
B) This procedure doesn't impede the production of male hormones or the
production of sperm in the testicles. The sperm can no longer enter your semen
and no sperm are in your ejaculate.
,NUR HESI EXIT VI
C) After your vasectomy, strenuous activity needs to be avoided for at least 48
hours. If your work doesn't involve hard physical labor, you can return to your
job as soon as you feel up to it. The stitches generally dissolve in seven to ten
days.
D) The health care provider at this clinic recommends rest, ice, an athletic
supporter or. over-the-counter pain medication to relieve any discomfort.
- Pt came in for a VASECTOMY. It’s important for pt to know that he can still get a partner
pregnant if sperm is found in his semen, therefore he should used an alternative contraception.
It usually takes about 3 months for the sperm to be non-existent in the semen.
8. A client who is to have antineoplastic chemotherapy tells the nurses of a fear
of being sick all the time and wishes to try acupuncture. Which of these beliefs
stated by the client would be incorrect about acupuncture?
A) Some needles go as deep as 3 inches, depending on where they're placed in
the body and what the treatment is for. The needles usually are left in for 15 to
30 minutes.
B) In traditional Chinese medicine, imbalances in the basic energetic flow of life
known as qi or chi are thought to cause illness.
C) The flow of life is believed to flow through major pathways or nerve clusters
in your body.
D) By inserting extremely fine needles into some of the over 400 acupuncture
points in various combinations it is believed that energy flow will rebalance to
allow the body'snatural healing mechanisms to take over.
9. The nurse is discussing with a group of students the disease Kawasaki. What
statement made by a student about Kawasaki disease is incorrect?
A)It also called mucocutaneous lymph node syndrome because it affects the
mucous membranes (inside the mouth, throat and nose), skin and lymph nodes.
B)In the second phase of the disease, findings include peeling of the skin on the
hands and feet with joint and abdominal pain
C) Kawasaki disease occurs most often in boys, children younger than age 5 and
children of Hispanic descent
D) Initially findings are a sudden high fever, usually above 104 degrees
Fahrenheit, which lasts 1 to 2 weeks
, NUR HESI EXIT VI
10. A client has viral pneumonia affecting 2/3 of the right lung. What would be
the best position to teach the client to lie in every other hour during first 12
hours after admission?
A) Side-lying on the left with the head elevated 10 degrees
B) Side-lying on the left with the head elevated 35 degrees
C) Side-lying on the right wil the head elevated 10 degrees
D) Side-lying on the right with the head elevated 35 degrees
11. A client has an indwelling catheter with continuous bladder irrigation after
undergoing a transurethral resection of the prostate (TURP) 12 hours ago.
Which finding at this time should be reported to the health care provider?
A) Light, pink urine
B) occasional suprapubic cramping
C) minimal drainage into the urinary collection bag
D) complaints of the feeling of pulling on the urinary catheter
- TURP: surgery for urinary retention caused by BPH so we would expect to see more urine in the
collection bag not ‘minimal’.
12. A nurse is performing CPR on an adult who went into cardiopulmonary
arrest. Another nurse enters the room in response to the call. After checking the
client’s pulseand respirations, what should be the function of the second nurse?
A) Relieve the nurse performing CPR
B) Go get the code cart
C) Participate with the compressions or breathing
D) Validate the client's advanced directive
13. The nurse assesses a 72 year-old client who was admitted for right-sided
congestive heart failure. Which of the following would the nurse anticipate
finding?
A) Decreased urinary output
B) Jugular vein distention
C) Pleural effusion
D) Bibasilar crackles
- RHF: fluid may back up into your abdomen, legs, feet & produces swelling like neck vein distention.
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