HESI Exit Practice Questions and
Rationale (2) 100% Correct!
The nurse has completed giving discharge instructions to a client who has had a total
joint replacement (TJR) of the knee with a metal prosthetic system. The nurse
determines that the client understands the instructions if the client makes which
statement?
1."Changes in the shape of the knee are expected."
2."Fever, redness, and increased pain are expected."
3."All caregivers should be told about the metal implant."
4."Bleeding gums or black stools may occur, but this is normal." - ANSWERS3
A TJR is also known as a total joint arthroplasty (TJA). The client must inform other
caregivers of the presence of the metal implant because certain tests and procedures
will need to be avoided. After total knee replacement, the client should report signs and
symptoms of infection and any changes in the shape of the knee. These could indicate
developing complications. With a metal implant, the client may be on anticoagulant
therapy and should report adverse effects of this therapy, including bleeding from a
variety of sources, and the client will need antibiotic prophylaxis for invasive procedures.
The nurse is caring for a client after the application of a plaster cast for a fractured left
radius. The nurse should suspect impairment with the neurovascular status of the
client's casted extremity if which findings are noted? Select all that apply.
1.Capillary refill is less than 3 seconds 2.Pulses present and with swollen, pink fingers
3.Client report of severe, deep, unrelenting pain
4.Client report of pain as nurse assesses finger movement
5.Client report of numbness and tingling sensation in the fingers - ANSWERS3, 4, 5
The pressure in compartment syndrome, if unrelieved, will cause permanent damage to
nerve and muscle tissue distal to the pressure. Circulatory damage may result in
necrosis. Nerve and muscle damage may result in permanent contractures, deformity of
the extremity, and functional impairment. Normal capillary refill time is 3 seconds or
less. Pink appearance and a pulse indicate adequate blood flow; swelling is expected
after a fracture. Client report of severe, deep, unrelenting pain; client report of
numbness and tingling sensation; and client report of pain as the nurse assesses finger
movement are indicative of development of compartment syndrome.
A client with a 4-day-old lumbar vertebral fracture is experiencing muscle spasms.
Which are interventions to aid the client in relieving the spasm? Select all that apply.
1.Ice
2.Heat
3.Analgesics
4.Muscle relaxers
5.Intermittent traction - ANSWERS2, 3, 4, 5
,Heat, analgesics, muscle relaxers, and traction all may be used to relieve the pain of
muscle spasm in the client with a vertebral fracture. Ice is applied to a painful site only
for the first 48 to 72 hours (depending on the health care provider's preference) after an
injury. Application of ice to the spine of a client could be uncomfortable and could result
in feelings of being chilled.
The nurse is caring for a client who had surgery to repair a fractured left-sided hip using
a posterior approach. In implementing hip precautions, which action should the nurse
teach the client to avoid?
1.Crossing legs at the ankle
2.Using an elevated toilet seat 3.Placing a pillow between the legs 4.Keeping the legs
abducted from the midline - ANSWERS1
Following surgery to repair a fractured hip using a posterior approach, client education
should include the following: avoiding crossing the legs at the ankle or the knee, using
an elevated toilet seat, placing a pillow between the legs while lying down for the first 6
weeks, keeping the legs abducted from the midline, and keeping the hip in a neutral
position at all times.
An older client is diagnosed with osteoporosis. The nurse teaches the client about self-
care measures, knowing that the client is most at risk for which problem as a result of
this disorder of the bones?
1.Anemia
2.Fractures
3.Infection
4.Muscle sprains - ANSWERS2
The client is most at risk for fractures as a result of osteoporosis. Although other
complications can occur, fracture is the greatest concern. Anemia and infection can
occur with bone marrow disorders, and muscle sprains are unrelated to osteoporosis.
A client with a new medication prescription for allopurinol asks the nurse, "I know this is
for gout, but how does it work?" The nurse plans to reply based on which medication
action?
1.Allopurinol decreases uric acid production.
2.Allopurinol reduces the production of fibrinogen.
3.Allopurinol decreases the risk of sulfa crystal formation in the urine. 4.Allopurinol
prevents influx of calcium ions during cell depolarization. - ANSWERS1
Allopurinol is classified as an antigout medication. It decreases uric acid production by
inhibiting the xanthine oxidase enzyme, and it reduces uric acid concentrations in both
serum and urine. The other options are incorrect.
The nurse is caring for a client diagnosed with osteitis deformans (Paget's disease).
Which does the nurse identify as the cause of the client's stooped posture and bowing
of lower extremities?
1.Muscle metabolism and growth 2.Bone resorption and regeneration 3.Nervous
system impulse transmission 4.Joint integrity and synovial fluid production -
ANSWERS2
,Paget's disease is characterized by skeletal deformities resulting from abnormal bone
resorption followed by abnormal regeneration. It is not caused by problems with muscle,
nervous system, or joint functioning.
A client has been diagnosed with gout, and the nurse provides dietary instructions. The
nurse determines that the client needs additional teaching if the client states that it is
acceptable to eat which food?
1.Carrots
2.Tapioca
3.Chocolate
4.Chicken liver - ANSWERS4
Liver and other organ meats should be omitted from the diet of a client who has gout
because of their high purine content. Purines are a form of protein. The food items
identified in the other options contain negligible amounts of purines and may be
consumed freely by the client with gout.
Diagnostic studies are prescribed for a client with suspected Paget's disease. In
reviewing the client's record, the nurse would expect to note that the health care
provider has prescribed which laboratory study?
1.Platelet count
2.Alkaline phosphatase
3.White blood cell count
4.Complete blood cell count - ANSWERS2
Paget's disease is a chronic metabolic disorder in which bone is excessively broken
down and reformed. The result is bone that is structurally disorganized, causing bone to
be weak with increased risk for bowing of long bones and fractures. Diagnostic
laboratory findings for Paget's disease include an elevated serum alkaline phosphatase
level and elevated urinary hydroxyproline excretion. The remaining options are
unrelated to diagnostic evaluation of this disease.
A client is to receive a prescription for methocarbamol. The nurse provides instructions
to the client about the medication. Which client statement would indicate a need for
further education?
1."My urine may turn brown or green." 2."I might get some nasal congestion from this
medication."
3."This medication is prescribed to help relieve my muscle spasms."
4."If my vision becomes blurred, I don't need to be concerned about it." - ANSWERS4
Methocarbamol is a muscle relaxant that works by blocking nerve impulses (or pain
sensations) that are sent to the brain. The client needs to be told that the urine may turn
brown, black, or green. Other adverse effects include blurred vision, nasal congestion,
urticaria, and rash. The client needs to be instructed to notify the health care provider if
these side/adverse effects occur.
The nurse is planning measures to increase bed mobility for a client in skeletal leg
traction. Which item should the nurse consider to be most helpful for this client?
1.Television
, 2.Fracture bedpan
3.Overhead trapeze
4.Reading materials - ANSWERS3
The use of an overhead trapeze is extremely helpful for a client to move about in bed
and to get on and off the bedpan. This device has the greatest value in increasing
overall bed mobility. Television and reading materials, although helpful in reducing
boredom and providing distraction, do not increase bed mobility. A fracture bedpan is
useful in reducing discomfort with elimination.
The nurse is caring for a client who sustained an open fracture and is diagnosed with
acute osteomyelitis of the right lower extremity. Which intervention should the nurse
plan to perform?
1.Apply ice to the affected area. 2.Perform sterile dressing changes. 3.Instruct the
client on leg exercises. 4.Measure the leg circumference daily. - ANSWERS2
Osteomyelitis is a severe infection of the bone, bone marrow, and surrounding soft
tissue. Clinical manifestations include constant bone pain unrelieved by rest that
worsens with activity; swelling, tenderness, and warmth at the infection site; restricted
movement of the affected part; fever, night sweats, chills, restlessness, nausea, and
malaise. Option 2 is the correct option, as treatment of osteomyelitis often includes
surgical debridement and requires sterile dressing changes. Option 1 is incorrect, as
osteomyelitis is an infection and applying ice to the area will not help any swelling and
may cause vasoconstriction. Option 3 is incorrect, as movement worsens the pain and
some immobilization of the affected limb (e.g., splint, traction) is usually indicated.
Option 4, measuring leg circumference daily, is not necessary.
The health care provider has prescribed a lidocaine 5% patch for a client with a
diagnosis of neck pain due to osteoarthritis. Which should the nurse tell the client
regarding this medication?
1.The medication patch will act as a local anesthetic.
2.The medication patch acts by decreasing muscle spasms.
3.The medication is prescribed to cause the skin to peel below the patch.
4.Apply a heating pad to the area after applying the medication patch to increase the
effectiveness. - ANSWERS1
A lidocaine patch provides a local anesthetic effect to the site of application. The
medication does not act in a systemic manner. It is not prescribed to cause the skin to
peel, so if this reaction occurs, the health care provider should be notified. A heating
pad should not be applied because irritation or burning of the skin may occur.
The nurse witnessed a vehicle hit a pedestrian. The victim is dazed and tries to get up.
A leg appears fractured. Which intervention should the nurse take?
1.Try to reduce the fracture manually. 2.Assist the victim to get up and walk to the
sidewalk.
3.Leave the victim for a few moments to call an ambulance.
4.Stay with the victim and encourage him or her to remain still. - ANSWERS4
With a suspected fracture, the victim is not moved unless it is dangerous to remain in
that spot. The nurse should remain with the victim and have someone else call for
Rationale (2) 100% Correct!
The nurse has completed giving discharge instructions to a client who has had a total
joint replacement (TJR) of the knee with a metal prosthetic system. The nurse
determines that the client understands the instructions if the client makes which
statement?
1."Changes in the shape of the knee are expected."
2."Fever, redness, and increased pain are expected."
3."All caregivers should be told about the metal implant."
4."Bleeding gums or black stools may occur, but this is normal." - ANSWERS3
A TJR is also known as a total joint arthroplasty (TJA). The client must inform other
caregivers of the presence of the metal implant because certain tests and procedures
will need to be avoided. After total knee replacement, the client should report signs and
symptoms of infection and any changes in the shape of the knee. These could indicate
developing complications. With a metal implant, the client may be on anticoagulant
therapy and should report adverse effects of this therapy, including bleeding from a
variety of sources, and the client will need antibiotic prophylaxis for invasive procedures.
The nurse is caring for a client after the application of a plaster cast for a fractured left
radius. The nurse should suspect impairment with the neurovascular status of the
client's casted extremity if which findings are noted? Select all that apply.
1.Capillary refill is less than 3 seconds 2.Pulses present and with swollen, pink fingers
3.Client report of severe, deep, unrelenting pain
4.Client report of pain as nurse assesses finger movement
5.Client report of numbness and tingling sensation in the fingers - ANSWERS3, 4, 5
The pressure in compartment syndrome, if unrelieved, will cause permanent damage to
nerve and muscle tissue distal to the pressure. Circulatory damage may result in
necrosis. Nerve and muscle damage may result in permanent contractures, deformity of
the extremity, and functional impairment. Normal capillary refill time is 3 seconds or
less. Pink appearance and a pulse indicate adequate blood flow; swelling is expected
after a fracture. Client report of severe, deep, unrelenting pain; client report of
numbness and tingling sensation; and client report of pain as the nurse assesses finger
movement are indicative of development of compartment syndrome.
A client with a 4-day-old lumbar vertebral fracture is experiencing muscle spasms.
Which are interventions to aid the client in relieving the spasm? Select all that apply.
1.Ice
2.Heat
3.Analgesics
4.Muscle relaxers
5.Intermittent traction - ANSWERS2, 3, 4, 5
,Heat, analgesics, muscle relaxers, and traction all may be used to relieve the pain of
muscle spasm in the client with a vertebral fracture. Ice is applied to a painful site only
for the first 48 to 72 hours (depending on the health care provider's preference) after an
injury. Application of ice to the spine of a client could be uncomfortable and could result
in feelings of being chilled.
The nurse is caring for a client who had surgery to repair a fractured left-sided hip using
a posterior approach. In implementing hip precautions, which action should the nurse
teach the client to avoid?
1.Crossing legs at the ankle
2.Using an elevated toilet seat 3.Placing a pillow between the legs 4.Keeping the legs
abducted from the midline - ANSWERS1
Following surgery to repair a fractured hip using a posterior approach, client education
should include the following: avoiding crossing the legs at the ankle or the knee, using
an elevated toilet seat, placing a pillow between the legs while lying down for the first 6
weeks, keeping the legs abducted from the midline, and keeping the hip in a neutral
position at all times.
An older client is diagnosed with osteoporosis. The nurse teaches the client about self-
care measures, knowing that the client is most at risk for which problem as a result of
this disorder of the bones?
1.Anemia
2.Fractures
3.Infection
4.Muscle sprains - ANSWERS2
The client is most at risk for fractures as a result of osteoporosis. Although other
complications can occur, fracture is the greatest concern. Anemia and infection can
occur with bone marrow disorders, and muscle sprains are unrelated to osteoporosis.
A client with a new medication prescription for allopurinol asks the nurse, "I know this is
for gout, but how does it work?" The nurse plans to reply based on which medication
action?
1.Allopurinol decreases uric acid production.
2.Allopurinol reduces the production of fibrinogen.
3.Allopurinol decreases the risk of sulfa crystal formation in the urine. 4.Allopurinol
prevents influx of calcium ions during cell depolarization. - ANSWERS1
Allopurinol is classified as an antigout medication. It decreases uric acid production by
inhibiting the xanthine oxidase enzyme, and it reduces uric acid concentrations in both
serum and urine. The other options are incorrect.
The nurse is caring for a client diagnosed with osteitis deformans (Paget's disease).
Which does the nurse identify as the cause of the client's stooped posture and bowing
of lower extremities?
1.Muscle metabolism and growth 2.Bone resorption and regeneration 3.Nervous
system impulse transmission 4.Joint integrity and synovial fluid production -
ANSWERS2
,Paget's disease is characterized by skeletal deformities resulting from abnormal bone
resorption followed by abnormal regeneration. It is not caused by problems with muscle,
nervous system, or joint functioning.
A client has been diagnosed with gout, and the nurse provides dietary instructions. The
nurse determines that the client needs additional teaching if the client states that it is
acceptable to eat which food?
1.Carrots
2.Tapioca
3.Chocolate
4.Chicken liver - ANSWERS4
Liver and other organ meats should be omitted from the diet of a client who has gout
because of their high purine content. Purines are a form of protein. The food items
identified in the other options contain negligible amounts of purines and may be
consumed freely by the client with gout.
Diagnostic studies are prescribed for a client with suspected Paget's disease. In
reviewing the client's record, the nurse would expect to note that the health care
provider has prescribed which laboratory study?
1.Platelet count
2.Alkaline phosphatase
3.White blood cell count
4.Complete blood cell count - ANSWERS2
Paget's disease is a chronic metabolic disorder in which bone is excessively broken
down and reformed. The result is bone that is structurally disorganized, causing bone to
be weak with increased risk for bowing of long bones and fractures. Diagnostic
laboratory findings for Paget's disease include an elevated serum alkaline phosphatase
level and elevated urinary hydroxyproline excretion. The remaining options are
unrelated to diagnostic evaluation of this disease.
A client is to receive a prescription for methocarbamol. The nurse provides instructions
to the client about the medication. Which client statement would indicate a need for
further education?
1."My urine may turn brown or green." 2."I might get some nasal congestion from this
medication."
3."This medication is prescribed to help relieve my muscle spasms."
4."If my vision becomes blurred, I don't need to be concerned about it." - ANSWERS4
Methocarbamol is a muscle relaxant that works by blocking nerve impulses (or pain
sensations) that are sent to the brain. The client needs to be told that the urine may turn
brown, black, or green. Other adverse effects include blurred vision, nasal congestion,
urticaria, and rash. The client needs to be instructed to notify the health care provider if
these side/adverse effects occur.
The nurse is planning measures to increase bed mobility for a client in skeletal leg
traction. Which item should the nurse consider to be most helpful for this client?
1.Television
, 2.Fracture bedpan
3.Overhead trapeze
4.Reading materials - ANSWERS3
The use of an overhead trapeze is extremely helpful for a client to move about in bed
and to get on and off the bedpan. This device has the greatest value in increasing
overall bed mobility. Television and reading materials, although helpful in reducing
boredom and providing distraction, do not increase bed mobility. A fracture bedpan is
useful in reducing discomfort with elimination.
The nurse is caring for a client who sustained an open fracture and is diagnosed with
acute osteomyelitis of the right lower extremity. Which intervention should the nurse
plan to perform?
1.Apply ice to the affected area. 2.Perform sterile dressing changes. 3.Instruct the
client on leg exercises. 4.Measure the leg circumference daily. - ANSWERS2
Osteomyelitis is a severe infection of the bone, bone marrow, and surrounding soft
tissue. Clinical manifestations include constant bone pain unrelieved by rest that
worsens with activity; swelling, tenderness, and warmth at the infection site; restricted
movement of the affected part; fever, night sweats, chills, restlessness, nausea, and
malaise. Option 2 is the correct option, as treatment of osteomyelitis often includes
surgical debridement and requires sterile dressing changes. Option 1 is incorrect, as
osteomyelitis is an infection and applying ice to the area will not help any swelling and
may cause vasoconstriction. Option 3 is incorrect, as movement worsens the pain and
some immobilization of the affected limb (e.g., splint, traction) is usually indicated.
Option 4, measuring leg circumference daily, is not necessary.
The health care provider has prescribed a lidocaine 5% patch for a client with a
diagnosis of neck pain due to osteoarthritis. Which should the nurse tell the client
regarding this medication?
1.The medication patch will act as a local anesthetic.
2.The medication patch acts by decreasing muscle spasms.
3.The medication is prescribed to cause the skin to peel below the patch.
4.Apply a heating pad to the area after applying the medication patch to increase the
effectiveness. - ANSWERS1
A lidocaine patch provides a local anesthetic effect to the site of application. The
medication does not act in a systemic manner. It is not prescribed to cause the skin to
peel, so if this reaction occurs, the health care provider should be notified. A heating
pad should not be applied because irritation or burning of the skin may occur.
The nurse witnessed a vehicle hit a pedestrian. The victim is dazed and tries to get up.
A leg appears fractured. Which intervention should the nurse take?
1.Try to reduce the fracture manually. 2.Assist the victim to get up and walk to the
sidewalk.
3.Leave the victim for a few moments to call an ambulance.
4.Stay with the victim and encourage him or her to remain still. - ANSWERS4
With a suspected fracture, the victim is not moved unless it is dangerous to remain in
that spot. The nurse should remain with the victim and have someone else call for
