HESI EXIT RN EXAM-756 QA, HESI EXIT RN Exam (Version 1 to Version 7
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HESI EXIT RN EXAM-756 QA, HESI EXIT
RN Exam (Version 1 to Version 7)
1. The pathophysiological mechanisms are responsible for ascites related to liver failure? (Select all that apply)
a- Bleeding that results from a decreased production of the body’s clotting factors
b- Fluid shifts from intr...
HESI EXIT RN EXAM-756 QA, HESI EXIT
RN Exam (Version 1 to Version 7)
1. The pathophysiological mechanisms are responsible for ascites related to liver failure? (Select all that apply)
a- Bleeding that results from a decreased production of the body’s clotting factors
b- Fluid shifts from intravascular to interstitial area due to decreased serum protein
c- Increased hydrostatic pressure in portal circulation increases fluid shifts into abdomen
d- Increased circulating aldosterone levels that increase sodium and water retention
e- Decreased absorption of fatty acids in the duodenum leading to abdominal distention.
2. The nurse is auscultating a client’s heart sounds. Which description should the nurse use to document this sound? (Please
listen to the audio first to select the option that applies)
a- S1 S2
b- S1 S2 S3
c- Murmur
d- Pericardial friction rub.
3. The healthcare provider prescribes celtazidime (Fortax) 35 mg every 8 hours IM for an infant. The 500 mg vial is labeled
with the instruction to add 5.3 ml diluent to provide a concentration of 100 mg/ml. How many ml should the nurse
administered for each dose? (Enter numeric value only. If rounding is required, round to the nearest tenth)
a- 0.4
4. The nurse notes that a client has been receiving hydromorphone (Dilaudid) every six hours for four days. What
assessment is most important for the nurse to complete?
a- Auscultate the client's bowel sounds
b- Observe for edema around the ankles
c- Measure the client’s capillary glucose level
d- Count the apical and radial pulses simultaneously
5. A female client is admitted with end stage pulmonary disease is alert, oriented, and complaining of shortness of breath. The
client tells the nurse that she wants “no heroic measures” taken if she stops breathing, and she asks the nurse to document this
in her medical record. What action should the nurse implement?
a- Ask the client to discuss “do not resuscitate” with her healthcare provider
6. A client is receiving a full strength continuous enteral tube feeding at 50 ml/hour and has developed diarrhea. The client
has a new prescription to change the feeding to half strength. What intervention should the nurse implement?
a- Add equal amounts of water and feeding to a feeding bag and infuse at 50ml/hour
b- Continue the full strength feeding after decreasing the rate of infusion to 25 ml/hr.
c- Maintain the present feeding until diarrhea subsides and the begin the next new prescription.
d- Withhold any further feeding until clarifying the prescription with healthcare provides.
7. A female client reports that her hair is becoming coarse and breaking off, that the outer part of her eyebrows have
disappeared, and that her eyes are all puffy. Which follow-up question is best for the nurse to ask?
a- “Is there a history of female baldness in your family?”
b- “Are you under any unusual stress at home or work?”
c- “Do you work with hazardous chemicals?”
d- “Have you noticed any changes in your fingernails?”
,8. After a third hospitalization 6 months ago, a client is admitted to the hospital with ascites and malnutrition. The client is
drowsy but responding to verbal stimuli and reports recently spitting up blood. What assessment finding warrants immediate
intervention by the nurse?
a- Bruises on arms and legs
b- Round and tight abdomen
c- Pitting edema in lower legs
d- Capillary refill of 8 seconds
9. After the nurse witnesses a preoperative client sign the surgical consent form, the nurse signs the form as a witness. What
are the legal implications of the nurse’s signature on the client’s surgical consent form? (Select all that apply)
a- The client voluntarily grants permission for the procedure to be done
b- The surgeon has explained to the client why the surgery is necessary.
c- The client is competent to sign the consent without impairment of judgement
d- The client understands the risks and benefits associated with the procedure
e- After considering alternatives to surgery, the client elects to have the procedure.
10. Following surgery, a male client with antisocial personality disorder frequently requests that a specific nurse be assigned to
his care and is belligerent when another nurse is assigned. What action should the charge nurse implement?
a- Ask the client to explain why he constantly request the nurse
b- Encourage the client to verbalize his feelings about the nurse
c- Reassure the client that his request will be met whenever possible.
d- Advise the client that assignments are not based on client requests
11. A client with cervical cancer is hospitalized for insertion of a sealed internal cervical radiation implant. While providing care,
the nurse finds the radiation implant in the bed. What action should the nurse take?
a- Call the radiology department
b- Reinsert the implant into the vagina
c- Apply double gloves to retrieve the implant for disposal.
d- Place the implant in a lead container using long-handled forceps
12. The client with which type of wound is most likely to need immediate intervention by the nurse?
a- Laceration
b- Abrasion
c- Contusion
d- Ulceration
13. The nurse is planning care for a client admitted with a diagnosis of pheochromocytoma. Which intervention has the
highest priority for inclusion in this client’s plan of care?
a- Record urine output every hour
b- Monitor blood pressure frequently
c- Evaluate neurological status
d- Maintain seizure precautions
14. When caring for a client who has acute respiratory distress syndrome (ARDS), the nurse elevates the head of the bed 30
degrees. What is the reason for this intervention?
a- To reduce abdominal pressure on the diaphragm
b- to promote retraction of the intercostal accessory muscle of respiration
c- to promote bronchodilation and effective airway clearance
d- to decrease pressure on the medullary center which stimulates breathing
,15. When assessing a mildly obese 35-year-old female client, the nurse is unable to locate the gallbladder when palpating
below the liver margin at the lateral border of the rectus abdominal muscle. What is the most likely explanation for failure to
locate the gallbladder by palpation?
a- The client is too obese
b- Palpating in the wrong abdominal quadrant
c- The gallbladder is normal
d- Deeper palpation technique is needed
16. A woman with an anxiety disorder calls her obstetrician’s office and tells the nurse of increased anxiety since the normal
vaginal delivery of her son three weeks ago. Since she is breastfeeding, she stopped taking her antianxiety medications,
but thinks she may need to start taking them again because of her increased anxiety. What response is best for the nurse to
provide this woman?
a- Describe the transmission of drugs to the infant through breast milk
b- Encourage her to use stress relieving alternatives, such as deep breathing exercises
c- Inform her that some antianxiety medications are safe to take while breastfeeding
d- Explain that anxiety is a normal response for the mother of a 3-weekold.
17. An older male client with a history of type 1 diabetes has not felt well the past few days and arrives at the clinic with
abdominal cramping and vomiting. He is lethargic, moderately, confused, and cannot remember when he took his last dose of
insulin or ate last. What action should the nurse implement first?
a- obtain a serum potassium level
b- administer the client's usual dose of insulin
c- assess pupillary response to light
d- Start an intravenous (IV) infusion of normal saline
18. A client who received multiple antihypertensive medications experiences syncope due to a drop-in blood pressure to 70/40.
What is the rationale for the nurse’s decision to hold the client’s scheduled antihypertensive medication?
a- Increased urinary clearance of the multiple medications has produced diuresis and lowered the blood pressure
b- The antagonistic interaction among the various blood pressure medications has reduced their effectiveness
c- The additive effect of multiple medications has caused the blood pressure to drop too low.
d- The synergistic effect of the multiple medications has resulted in drug toxicity and resulting hypotension.
19. Which client is at the greatest risk for developing delirium?
a- An adult client who cannot sleep due to constant pain.
b- an older client who attempted 1 month ago
c- a young adult who takes antipsychotic medications twice a day
d- a middle-aged woman who uses a tank for supplemental oxygen
20. Which intervention should the nurse include in a long-term plan of care for a client with Chronic Obstructive Pulmonary
Disease (COPD)?
a- Reduce risks factors for infection
b- Administer high flow oxygen during sleep
c- Limit fluid intake to reduce secretions
d- Use diaphragmatic breathing to achieve better exhalation
21. Which location should the nurse choose as the best for beginning a screening program for hypothyroidism?
a- A business and professional women's group.
b- An African-American senior citizens center
c- A daycare center in a Hispanic neighborhood
d- An after-school center for Native-American teens
, 22. A female client has been taking a high dose of prednisone, a corticosteroid, for several months. After stopping the
medication abruptly, the client reports feeling “very tired”. Which nursing intervention is most important for the nurse to
implement?
a- Measure vital signs
b- Auscultate breath sounds
c- Palpate the abdomen
d- Observe the skin for bruising
23. A male client reports the onset of numbness and tingling in his fingers and around his mouth. Which lab is important for the
nurse to review before contacting the health care provider?
a- capillary glucose
b- urine specific gravity
c- Serum calcium
d- white blood cell count
24. What explanation is best for the nurse to provide a client who asks the purpose of using the log-rolling technique for
turning?
a- working together can decrease the risk for back injury
b- The technique is intended to maintain straight spinal alignment.
c- Using two or three people increases client safety.
d- turning instead of pulling reduces the likelihood of skin damage
25. A client receiving chemotherapy has severe neutropenia. Which snack is best for the nurse to recommend to the client?
a- Plain yogurt with sweetened with raw honey
b- Peanuts in the shell, roasted or un-roasted.
c- Aged farmer’s cheese with celery sticks
d- Baked apples topped with dried raisins
26. Which action should the school nurse take first when conducting a screening for scoliosis?
a- Compare dorsal measurement of trunk
b- Extend arms over head for visualization
c- Inspect for symmetrical shoulder height.
d- Observe weight-bearing on each leg.
27. An unlicensed assistive personnel (UAP) assigned to obtain client vital signs reports to the charge nurse that a client has a
weak pulse with a rate of 44 beat/ minutes. What action should the charge nurse implement?
a- Instruct the UAP to count the client apical pulse rate for sixty seconds
b- Determine if the UAP also measured the client’s capillary refill time.
c- Assign a practical nurse (LPN) to determine if an apical radial deficit is present.
d- Notify the health care provider of the abnormal pulse rate and pulse volume.
28. After a sudden loss of consciousness, a female client is taken to the ED and initial assessment indicate that her blood
glucose level is critically low. Once her glucose level is stabilized, the client reports that was recently diagnosed with anorexia
nervosa and is being treated at an outpatient clinic. Which intervention is more important to include in this client’s discharge
plan?
a- Describe the signs and symptoms of hypoglycemia.
b- Encourage a low-carbohydrate and high-protein diet
c- Reinforce the need to continue outpatient treatment
d- Suggest wearing a medical alert bracelet at all time.
53-A client with a peripherally inserted central catheter (PICC) line has a fever. What client assessment is most important for
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