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266 HESI exam with complete solutions 2024_2025.
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266 HESI exam with complete solutions 2024_2025.
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266 HESI exam with complete solutions2024/2025
- D Enjoys fat-free yogurt as an occasional snack food.
Question 1 of 55
The nurse is evaluating a client's understanding about the DASH (Dietary
Approaches to Stop Hypertension) eating plan. Which behavior indicates that the
client is adhering to the eating plan?
- A Uses only lactose-free dairy products.
- B Carefully cleans and peels all fresh fruit and vegetables.
- C No longer includes grains in daily diet.
- D Enjoys fat-free yogurt as an occasional snack food.
- A Further decline in level of consciousness.
Question 2 of 55
A client who has a history of hypothyroidism was initially admitted with lethargy
and confusion. Which additional finding warrants the most immediate action by
the nurse? [Hematocrit (Reference Range: Male: 42% to 52% (0.42 to 0.52 volume
fraction)]
- A Further decline in level of consciousness.
- B Hematocrit of 30% (0.30 volume fraction)
- C Cold and dry skin.
- D Facial puffiness and periorbital edema
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- B Full thickness.
Question 3 of 55
,The nurse is caring for a client with a burn that is severely edematous with a
wound bed that is brown and yellow in appearance. The client expresses feeling
no pain. Which classification of burn depth should the nurse document?
- A Deep full-thickness.
- B Full thickness.
- C Deep partial-thickness.
- D Superficial partial-thickness.
- A Urinary output.
- B Oxygen saturation.
- D Lung sounds.
Orthopneic position, sometimes called tripod position, is a sitting position where
an individual leans slightly forward with their arms propped up on an overbed
table or their knees.
Orthopnea is the sensation of breathlessness in the recumbent (lying down)
position, relieved by sitting or standing.
Question 4 of 55
An older client who is agitated, dyspneic, orthopneic, and using accessory
muscles to breathe is admitted for further treatment. Initial assessment includes a
heart rate 128 beats/minute and irregular, respirations 38 breaths/minute, blood
pressure 168/100 mm Hg, wheezes and crackles in all lung fields. An hour after
the administration of furosemide 60 mg intravenous (IV), which assessment(s)
should the nurse obtain to determine the client's response to treatment? (Select
all that apply.)
- A Urinary output.
- B Oxygen saturation.
- C Pain scale.
- D Lung sounds.
- E Skin elasticity.
- B Crohn's disease with colectomy.
Question # 5
Rationale - B Crohn's disease with colectomy.
The nurse should recognize that clients with extensive intra-abdominal surgical
history are not candidates for peritoneal dialysis, as these clients may have
decreased peritoneal membrane surface areas and scar tissue formation, which
would make it insufficient for adequate dialysis exchange.
Question 5 of 55
,A client is diagnosed with chronic kidney disease and needs to begin dialysis.
Which condition entered on the client's medical record should the nurse
recognize as a contraindication for peritoneal dialysis?
- A Nephrotic syndrome history.
- B Crohn's disease with colectomy.
- C Type 2 diabetes mellitus.
- D Latent hepatitis C.
- D Hypoalbuminemia that results in a decreased colloidal oncotic pressure.
The three main things that the liver produces are albumin, bile (digestive
enzymes), and prothrombin (clotting factors).
Albumin plays many important roles including maintenance of appropriate
osmotic pressure, binding and transport of various substances like hormones,
drugs etc. in blood, and neutralisation of free radicals. It prevents fluid from
leaking out of blood vessels into your tissues. Albumin is also responsible for
transporting vitamins, enzymes and hormones throughout your body. Albumin
makes up 50% of the proteins found in your plasma.
Question 6 of 55
The nurse assesses a client with cirrhosis and finds 4+ pitting edema of the feet
and legs, and massive ascites. Which mechanism contributes to edema and
ascites in clients with cirrhosis?
- A Decreased portacaval pressure with greater collateral circulation.
- B Hyperaldosteronism causing an increased sodium reabsorption in renal
tubules.
- C Decreased renin-angiotensin response related to an increase in renal blood
flow.
- D Hypoalbuminemia that results in a decreased colloidal oncotic pressure.
- B Discuss approaches to chronic pain control with the client.
Question 7 of 55
While assessing a client with degenerative joint disease, the nurse observes
Heberden's nodes, large prominences on the client's fingers that are reddened.
The client reports that the nodes are painful. Which action should the nurse take?
- A Review the client's dietary intake of high-protein foods.
- B Discuss approaches to chronic pain control with the client.
- C Notify the healthcare provider of the finding immediately.
- D Assess the client's radial pulses and capillary refill time.
- B Minimize symptoms by wearing loose, comfortable clothing.
Question 8 of 55
, Which information should the nurse include in the teaching plan of a client
diagnosed with gastroesophageal reflux disease (GERD)?
- A Adjust food intake to three full meals per day and no snacks.
- B Minimize symptoms by wearing loose, comfortable clothing.
- C Avoid participation in any aerobic exercise programs.
- D Sleep without pillows at night to maintain neck alignment.
- D Platelet count.
Question 9 of 55
The nurse assesses a client with petechiae and ecchymosis scattered across the
arms and legs. Which laboratory result should the nurse review?
- A Red blood cell count.
- B Hemoglobin levels.
- C White blood cell count.
- D Platelet count.
- A Family members can help with regular foot exams.
Question 10 of 55
The nurse is providing teaching to a client with Type 2 diabetes mellitus and
peripheral neuropathy. Which information should the nurse provide?
- A Family members can help with regular foot exams.
- B Heating pads are useful if on the lowest setting.
- C Shoes should be worn outside the house, but it is fine to be barefoot inside.
- D Aching feet may be soaked in lukewarm water for one hour or more.
- A: Inspect ankles daily for areas of darkening skin.
Regular inspection can help detect any changes or worsening of the condition
early.
- C: Keep legs elevated when sitting or lying down.
Elevation can help reduce swelling and improve blood circulation.
- E: Eat a diet that is high in protein and vitamins A and C.
A nutritious diet can support wound healing and overall health.
The nurse should not include the following instructions:
- B: Apply intermittent cold compresses four times daily. There is no evidence
from the search results that cold compresses are beneficial for venous leg ulcers.
- D: Maintain bed rest as much as possible. On the contrary, physical activity,
such as walking, can promote blood circulation and aid in wound healing.
Question 11 of 55
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