HESI RN 2024 EXIT EXAM –QUESTIONS WITH
ACCURATE SOLUTIONS
When preparing to administer a prescribed medication to a homeless client at
a community psychiatric clinic. The client tells the nurse that the usual dosage
taken is different from the dose the nurse is giving. Which action should the
nurse take?
A) Inform the client that he may refuse the medication and document whether
or not the client takes it.
B) Withhold the medication until the dosage can be confirmed.
C) Explain to the client that the dosage has been changed.
D) Tell the client to take the medication then verify the dosage at the next
healthcare team meeting. Right Ans - B) Withhold the medication until the
dosage can be confirmed.
The charge nurse is making assignments for one practical nurse and three
registered nurses who are caring for neurologically compromised clients.
Which client with which change in status is best to assign to the PN?
A) Subdural hematoma whose blood pressure changed from 150/80 to
170/60.
B) Viral meningitis whose temperature change from 101 S to 102F.
C) Diabetic keto acidosis who is Glasgow coma scale score changed from 10 to
7.
D) Myxedema, whose blood pressure change from 80/50 to 70/40. Right
Ans - B) Viral meningitis whose temperature change from 101 S to 102F.
The nurse is caring for a client with pneumonia who now develops initial
signs of septic shock and multi organ failure. The healthcare provider
prescribes a sepsis protocol. Which intervention is most important for the
nurse to include in the plan of care?
A) Maintain strict intake and output.
B) Keep head of bed raised 45°.
C) Excess warmth of extremities.
,D) Monitor blood glucose level. Right Ans - A) Maintain strict intake and
output.
And adolescent client is admitted to the hospital because of writing a suicide
note to a teacher at school. On the second day of hospitalization, the nurse
asked the client to meet with the treatment team. After the team meeting, the
client leaves in tears and goes to their room. Which nursing intervention is
best?
A) Let the client rest quietly in their room for a while.
B) Explore the clients goals and desire for treatment.
C) Ask the treatment team about the clients behavior.
D) Go to the clients room and ask what happened. Right Ans - D) Go to the
clients room and ask what happened.
The healthcare provider prescribes dalteparin 200 units per kilogram
subcutaneous once a day for a client who weighs 154 pounds. The medication
is available and 25,000 units per milliliter vial. How many milliliters should
the nurse administer? (Enter numerical value only. If rounding is required,
round to the nearest 10th.) Right Ans - 0.6
NGN: The client is a 49-year-old male who reports flu like symptoms including
fever and chest congestion for four days. He came to the emergency
department last night when he was having more difficulty breathing he has a
history of 1/2 pack a day cigarette smoking for 20 years. He has no significant
medical or surgical history.
Which two orders should the nurse complete first?
A) Sputum culture.
B) Start oxygen 3 L per minute via nasal cannula.
C) Place the client on a cardio respiratory monitor.
D) Chest x-ray.
E) Acetominophen 350 mg PO every six hours for temperature control.
F) Run 0.9% sodium chloride IV infusion at 150 mL per hour.
G) Start peripheral IV.
H) NPO. Right Ans - B) Start oxygen 3 L per minute via nasal cannula.
C) Place the client on a cardio respiratory monitor.
,NGN: 0330: place the client on a cardio respiratory monitor, NPO, sputum
culture, start a peripheral IV infusion, start oxygen 3 L per minute via nasal
cannula, begin 0.9% sodium chloride IV infusion at 150 mL per hour,
acetaminophen 350 mg PO every six hours for temperature.
To start the client on oxygen as ordered which items should the nurse collects
from the supply room? SATA
A) humidifier bottle.
B)Suction canister.
C)Sterile water.
D) Nasal cannula.
E) Flow meter.
F) Lambs wool.
G) Tape. Right Ans - D) Nasal cannula.
E) Flow meter.
NGN: states, I am feeling extremely anxious right now. The client has
decreased breath sounds in the left lower low. His mucus membranes are dry.
He has a productive cough with thick, yellow secretions. His capillary refill is
four seconds. Vital signs, temperature 100.2. Heart rate 101 bpm, respiratory
rate 28 breaths per minute, blood pressure 145/89, oxygen saturation 90%
on room air.
(for each body system click to specify the assessment findings that indicates
hypoxia)
Cardiovascular: heart rate 100 bpm, capillary refill for seconds, blood
pressure 145/89.
Neurological: anxious, awake and alert, restless.
Respiratory: oxygen saturation 90% on room air, respiratory rate 28 bpm,
productive cough. Right Ans - Cardiovascular: capillary refill for seconds,
blood pressure 145/89.
Neurological: anxious, restless.
Respiratory: oxygen saturation 90% on room air, respiratory rate 28 bpm.
NGN: The client is a 49-year-old male who reports flu like symptoms including
fever and chest congestion for four days. He came to the emergency
department last night when he was having more difficulty breathing he has a
history of 1/2 pack a day cigarette smoking for 20 years. He has no significant
medical or surgical history.
, The nurse should place the client in a _______________ position to promote
_____________. Right Ans - Semi-Fowler , lung expansion.
NGN: Orders: 0330: place the client on a cardio respiratory monitor, NPO,
sputum culture, start a PIV, start oxygen 3L via nasal cannula, normal saline
150 ML per hour, acetaminophen 350mg PO every six hours for temp greater
than 101F, chest x-ray.
0500: Oxygen 8Lvia simple facemask, titrate to keep oxygen saturation
greater than 94%.
(mark whether the statements by the new grad nurse indicate understanding
or no understanding of the use of facemask in the care of this client)
-I should clean the facemask once per shift.
-The client should take a 1 to 2 minute break from the facemask each hour.
-I should put gauze under the elastic straps over the ears.
-I can adjust the oxygen level on the flow meter to keep the clients oxygen
saturation greater than 94%.
-The mask should cover only the mouth and leave the nose open for
expiration.
-I should place the mask first over the nose and then cover the mouth.
Right Ans - -I should clean the facemask once per shift. (UNDERSTANDING)
-The client should take a 1 to 2 minute break from the facemask each hour.
(NOT UNDERSTANDING)
-I should put gauze under the elastic straps over the ears. (NOT
UNDERSTANDING ????)
-I can adjust the oxygen level on the flow meter to keep the clients oxygen
saturation greater than 94%. (UNDERSTANDING)
-The mask should cover only the mouth and leave the nose open for
expiration. (NOT UNDERSTANDING)
-I should place the mask first over the nose and then cover the mouth.
(UNDERSTANDING)
NGN: Nurses Notes: 0400, the client is awake and alert but restless. He states I
am feeling extremely anxious right now. The client has decreased breath
sounds in the left lower lobe. His mucus membranes are dry. He has a
productive cough with thick, yellow secretions. His capillary refill is four
ACCURATE SOLUTIONS
When preparing to administer a prescribed medication to a homeless client at
a community psychiatric clinic. The client tells the nurse that the usual dosage
taken is different from the dose the nurse is giving. Which action should the
nurse take?
A) Inform the client that he may refuse the medication and document whether
or not the client takes it.
B) Withhold the medication until the dosage can be confirmed.
C) Explain to the client that the dosage has been changed.
D) Tell the client to take the medication then verify the dosage at the next
healthcare team meeting. Right Ans - B) Withhold the medication until the
dosage can be confirmed.
The charge nurse is making assignments for one practical nurse and three
registered nurses who are caring for neurologically compromised clients.
Which client with which change in status is best to assign to the PN?
A) Subdural hematoma whose blood pressure changed from 150/80 to
170/60.
B) Viral meningitis whose temperature change from 101 S to 102F.
C) Diabetic keto acidosis who is Glasgow coma scale score changed from 10 to
7.
D) Myxedema, whose blood pressure change from 80/50 to 70/40. Right
Ans - B) Viral meningitis whose temperature change from 101 S to 102F.
The nurse is caring for a client with pneumonia who now develops initial
signs of septic shock and multi organ failure. The healthcare provider
prescribes a sepsis protocol. Which intervention is most important for the
nurse to include in the plan of care?
A) Maintain strict intake and output.
B) Keep head of bed raised 45°.
C) Excess warmth of extremities.
,D) Monitor blood glucose level. Right Ans - A) Maintain strict intake and
output.
And adolescent client is admitted to the hospital because of writing a suicide
note to a teacher at school. On the second day of hospitalization, the nurse
asked the client to meet with the treatment team. After the team meeting, the
client leaves in tears and goes to their room. Which nursing intervention is
best?
A) Let the client rest quietly in their room for a while.
B) Explore the clients goals and desire for treatment.
C) Ask the treatment team about the clients behavior.
D) Go to the clients room and ask what happened. Right Ans - D) Go to the
clients room and ask what happened.
The healthcare provider prescribes dalteparin 200 units per kilogram
subcutaneous once a day for a client who weighs 154 pounds. The medication
is available and 25,000 units per milliliter vial. How many milliliters should
the nurse administer? (Enter numerical value only. If rounding is required,
round to the nearest 10th.) Right Ans - 0.6
NGN: The client is a 49-year-old male who reports flu like symptoms including
fever and chest congestion for four days. He came to the emergency
department last night when he was having more difficulty breathing he has a
history of 1/2 pack a day cigarette smoking for 20 years. He has no significant
medical or surgical history.
Which two orders should the nurse complete first?
A) Sputum culture.
B) Start oxygen 3 L per minute via nasal cannula.
C) Place the client on a cardio respiratory monitor.
D) Chest x-ray.
E) Acetominophen 350 mg PO every six hours for temperature control.
F) Run 0.9% sodium chloride IV infusion at 150 mL per hour.
G) Start peripheral IV.
H) NPO. Right Ans - B) Start oxygen 3 L per minute via nasal cannula.
C) Place the client on a cardio respiratory monitor.
,NGN: 0330: place the client on a cardio respiratory monitor, NPO, sputum
culture, start a peripheral IV infusion, start oxygen 3 L per minute via nasal
cannula, begin 0.9% sodium chloride IV infusion at 150 mL per hour,
acetaminophen 350 mg PO every six hours for temperature.
To start the client on oxygen as ordered which items should the nurse collects
from the supply room? SATA
A) humidifier bottle.
B)Suction canister.
C)Sterile water.
D) Nasal cannula.
E) Flow meter.
F) Lambs wool.
G) Tape. Right Ans - D) Nasal cannula.
E) Flow meter.
NGN: states, I am feeling extremely anxious right now. The client has
decreased breath sounds in the left lower low. His mucus membranes are dry.
He has a productive cough with thick, yellow secretions. His capillary refill is
four seconds. Vital signs, temperature 100.2. Heart rate 101 bpm, respiratory
rate 28 breaths per minute, blood pressure 145/89, oxygen saturation 90%
on room air.
(for each body system click to specify the assessment findings that indicates
hypoxia)
Cardiovascular: heart rate 100 bpm, capillary refill for seconds, blood
pressure 145/89.
Neurological: anxious, awake and alert, restless.
Respiratory: oxygen saturation 90% on room air, respiratory rate 28 bpm,
productive cough. Right Ans - Cardiovascular: capillary refill for seconds,
blood pressure 145/89.
Neurological: anxious, restless.
Respiratory: oxygen saturation 90% on room air, respiratory rate 28 bpm.
NGN: The client is a 49-year-old male who reports flu like symptoms including
fever and chest congestion for four days. He came to the emergency
department last night when he was having more difficulty breathing he has a
history of 1/2 pack a day cigarette smoking for 20 years. He has no significant
medical or surgical history.
, The nurse should place the client in a _______________ position to promote
_____________. Right Ans - Semi-Fowler , lung expansion.
NGN: Orders: 0330: place the client on a cardio respiratory monitor, NPO,
sputum culture, start a PIV, start oxygen 3L via nasal cannula, normal saline
150 ML per hour, acetaminophen 350mg PO every six hours for temp greater
than 101F, chest x-ray.
0500: Oxygen 8Lvia simple facemask, titrate to keep oxygen saturation
greater than 94%.
(mark whether the statements by the new grad nurse indicate understanding
or no understanding of the use of facemask in the care of this client)
-I should clean the facemask once per shift.
-The client should take a 1 to 2 minute break from the facemask each hour.
-I should put gauze under the elastic straps over the ears.
-I can adjust the oxygen level on the flow meter to keep the clients oxygen
saturation greater than 94%.
-The mask should cover only the mouth and leave the nose open for
expiration.
-I should place the mask first over the nose and then cover the mouth.
Right Ans - -I should clean the facemask once per shift. (UNDERSTANDING)
-The client should take a 1 to 2 minute break from the facemask each hour.
(NOT UNDERSTANDING)
-I should put gauze under the elastic straps over the ears. (NOT
UNDERSTANDING ????)
-I can adjust the oxygen level on the flow meter to keep the clients oxygen
saturation greater than 94%. (UNDERSTANDING)
-The mask should cover only the mouth and leave the nose open for
expiration. (NOT UNDERSTANDING)
-I should place the mask first over the nose and then cover the mouth.
(UNDERSTANDING)
NGN: Nurses Notes: 0400, the client is awake and alert but restless. He states I
am feeling extremely anxious right now. The client has decreased breath
sounds in the left lower lobe. His mucus membranes are dry. He has a
productive cough with thick, yellow secretions. His capillary refill is four
