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HESI EXIT RN EXAM V1-V7 2021 UPDATED - SCORED 100%
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HESI EXIT RN EXAM V1-V7 2021 UPDATED - SCORED 100%
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HESI EXIT RN EXAM V1-V7 2021 UPDATED - SCORED 100%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? Ans -
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? Ans - 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? Ans - Instruct the UAP to obtain soft blankets to secure
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? Ans - 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? Ans -
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? Ans - teach tracheal suction 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? Ans - Document the assessment data
Rationale: 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 first? Ans -
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? Ans - 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? Ans - 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? Ans - 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? Ans -
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? Ans - 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? Ans - -"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?
Ans - Obtain a clean-catch midstream 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? Ans - 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? Ans - 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? Ans - Bagel
with jelly and skim milk
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)? Ans - An 82-year old client with
Alzheimer's disease newly-fractures femur who has a foley catheter and soft
wrist restraints applied
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? Ans - -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? Ans -
Stop using of 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 Ans - -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? Ans - 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
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