HESI Exit Exam WITH CORRECT ANSWERS WITH VERRIFFIED WNSWERS (HESI)
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Module
HESI ExiT
Institution
HESI ExiT
HESI Exit Exam WITH CORRECT ANSWERS WITH VERRIFFIED WNSWERS (HESI)A client with myasthenia Gravis (MG) is receiving immunosuppressive therapy. Review recent laboratory test results show that the client's serum magnesium level has decreased below the normal range. In
addition to contacting the hea...
HESI Exit Exam WITH CORRECT
ANSWERS 2024-2025 WITH VERRIFFIED
WNSWERS (HESI)
,A male client with cancer is admired to the oncology unit and tells the nurse that he is in
the hospital for palliative care measures. The nurse notes that the client's admission
prescription include radiation
therapy. What action should the nurse implement? - CORRECT ANSWERS-Ask the
client about his expected goals for the hospitalization.
Rationale: Palliative care measures provide relief or control of symptoms, so it is
important for the nurse to determine the client's goals for symptom control while
receiving treatment in the hospital. Although home care is available the client may not
be legible for palliative care at home. Radiation therapy is an effective positive care
measure used to manage symptoms and would be appropriate unless the radiation
conflicts with the client goals.
A client with myasthenia Gravis (MG) is receiving immunosuppressive therapy. Review
recent laboratory test results show that the client's serum magnesium level has
decreased below the normal range. In
addition to contacting the healthcare provider, what nursing action is most important? -
CORRECT ANSWERS-Observe rhythm on telemetry monitor.
Rationale: If not treated a low little Serum magnesium level can affect myocardial
depolarization leading to a lethal arrhythmia, and the nurse should assess for
dysrhythmias before contacting the healthcare provider. Other choices are common in
MG but do not contribute the Safety risk of low magnesium levels
While assessing a radial artery catheter, the client complains of numbness and pain
distal to the insertion site. What interventions should the nurse implement? - CORRECT
ANSWERS-Promptly remove the arterial catheter from the radial artery.
A client is admitted with an epidural hematoma that resulted from a skateboarding
accident. To differentiate the vascular source of the intracranial bleeding, which finding
should the nurse monitor? - CORRECT ANSWERS-Rapid onset of decreased level of
consciousness.
,When preparing a client for discharge from the hospital following a cystectomy and a
urinary diversion to treat bladder cancer, which instruction is most important for the
nurse to include in the client's discharge teaching plan? - CORRECT ANSWERS-Report
any signs of cloudy urine output.
After repositioning an immobile client, the nurse observes an area of hyperemia. To
assess for blanching, what action should the nurse take? - CORRECT ANSWERS-
Apply light pressure over the area.
The nurse enters a client's room and observes the client's wrist restraint secured as
seen in the picture. What action should the nurse take? - CORRECT ANSWERS-
Reposition the restraint tie onto the bedframe.
A female client with acute respiratory distress syndrome (ARDS) is chemically
paralyzed and sedated while she is on as assist-control ventilator using 50% FIO2.
Which assessment finding warrants
immediate intervention by the nurse? - CORRECT ANSWERS-Diminished left lower
lobe sounds
Rationale: Diminished lobe sounds indicate collapsed alveoli or tension pneumothorax,
which required
immediate chest tube insertion to re-inflate the lung.
The development of atherosclerosis is a process of sequential events. Arrange the
pathophysiological events in orders of occurrence. (Place the first event on top and the
last on the bottom) - CORRECT ANSWERS-Arterial endothelium injury causes
inflammation
Macrophages consume low density lipoprotein (LDL), creating foam cells
Foam cells release growth factors for smooth muscle cells
Smooth muscle grows over fatty streaks creating fibrous plaques
Vessel narrowing results in ischemia
Following a motor vehicle collision, an adult female with a ruptured spleen and a blood
pressure of 70/44, had an emergency splenectomy. Twelve hours after the surgery, her
urine output is 25 ml/hour for the last two hours. What pathophysiological reason
supports the nurse's decision to report this finding to the healthcare provider? -
CORRECT ANSWERS-Oliguria signals tubular necrosis related to hypoperfusion
A nurse-manager is preparing the curricula for a class for charge nurses. A staffing
formula based on what data ensures quality client care and is most cost-effective? -
CORRECT ANSWERS-Skills of staff and client acuity
When performing postural drainage on a client with Chronic Obstructive Pulmonary
Disease (COPD), which approach should the nurse use? - CORRECT ANSWERS-
Explain that the client may be placed in five positions
, A client presents in the emergency room with right-sided facial asymmetry. The nurse
asks the client to perform a series of movements that require use of the facial muscles.
What symptoms suggest that the client has most likely experience a Bell's palsy rather
than a stroke? - CORRECT ANSWERS-Inability to close the affected eye, raise brow, or
smile
The nurse is teaching a client how to perform colostomy irrigations. When observing the
client's return demonstration, which action indicated that the client understood the
teaching? - CORRECT ANSWERS-Keeps the irrigating container less than 18 inches
above the stoma
The nurse should teach the client to observe which precaution while taking
dronedarone? - CORRECT ANSWERS-Avoid grapefruits and its juice
A client who sustained a head injury following an automobile collision is admitted to the
hospital. The nurse include the client's risk for developing increased intracranial
pressure (ICP) in the plan of care. Which signs indicate to the nurse that ICP has
increased? - CORRECT ANSWERS-Increased Glasgow coma scale score.
Nuchal rigidity and papilledema.
Confusion and papilledema
Periorbital ecchymosis.
Rationale: papilledema is always an indicator of increased ICP, and confusion is usually
the first sign of
increased ICP. Other options do not necessarily reflect increased ICP.
The nurse is caring for a client receiving continuous IV fluids through a single lumen
central venous catheter (CVC). Based on the CVC care bundle, which action should be
completed daily to reduce the
risk for infection? - CORRECT ANSWERS-Confirm the necessity for continued use of
the CVC.
During an annual physical examination, an older woman's fasting blood sugar (FBS) is
determined to be 140 mg/dl or 7.8 mmol/L (SI). Which additional finding obtained during
a follow-up visit 2 weeks later is most indicative that the client has diabetes mellitus
(DM)? - CORRECT ANSWERS-Repeated fasting blood sugar (FBS) is 132 mg/dl or 7.4
mmol/L (SI).
A client who was admitted yesterday with severe dehydration is complaining of pain a
24 gauge IV with normal saline is infusing at a rate of 150 ml/hour. Which intervention
should the nurse implement first? - CORRECT ANSWERS-Stop the normal saline
infusion.
An elderly female is admitted because of a change in her level of sensorium. During the
evening shift, the client attempts to get out bed and falls, breaking her left hip. Buck's
skin traction is applied to the left leg while waiting for surgery. Which intervention is
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