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HESI Exit Exam Test Bank MED SURG HESI EXIT EXAM/Latest A+
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Created By: A SolutionHESI Exit Exam Test Bank 2023-2024 MED SURG HESI
EXIT EXAM/Latest A+
Following discharge teaching, a male client with duodenal ulcer tells the nurse thehe 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 prescriptionsat 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 to the side rails instead ofpillows.
An adolescent with major depressive disorder has been taking duloxetine (Cymbalta) for the past
12 days. Which assessment finding requires immediatefollow-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?
,Created By: A Solution
(ANS- Further evaluation involving surgery may be needed
A client who recently underwear a tracheostomy is being prepared for discharge tohome. Which
instructions is most important for the nurse to include in the discharge plan?
(ANS- Teach tracheal suctioning 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'srespiratory 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 theclient's
respiratory rate is within normal limits.
During shift report, the central electrocardiogram (EKG) monitoring system alarms. Which client
alarm should the nurse investigate firs?
(ANS- Respiratory apnea of 30 seconds
During a home visit, the nurse observed an elderly client with diabetes slip andfall. 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 shewanted to avoid getting a
headache. Which action should the nurse take first? (ANS- Inform the anesthesia care provider
,Created By: A Solution
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 thenurse 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 bythe 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 complaintindicated 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 mid-stream specimen
, Created By: A Solution
The nurse is assisting the mother of a child with phenylketonuria (PKU) to selectfoods 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 thatless 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 whohas a Foley
catheter and soft wrist restrains 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 nurseimplement first?
-Cleanse the foot with soap and water and apply an antibiotic ointment
-Provide teaching about the need for a tetanus booster within the next 72hours.
-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
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