15 HESI EXIT RN Nursing Exam V1.V2 V3 V4
V5 V6 V7 Final Exam 2 Questions with Complete
Solutions
1. Following discharge teaching, a male client with duodenal ulcer tells the nurse the
he 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?
• Review with the client the need to avoid foods that are rich in milk and cream
2.A male client with hypertension, who received new antihypertensive prescriptions
at 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?
• 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?
An adolescent with major depressive disorder has been taking duloxetine (Cymbalta) for
the past 12 days. Which assessment finding requires immediate follow-up?
• Describes life without purpose
5.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?
• Further evaluation involving surgery may be needed
6.A client who recently underwear a tracheostomy is being prepared for discharge to
home. Which instructions is most important for the nurse to include in the discharge
plan?
• Teach tracheal suctioning techniques
7. 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’s
respiratory rate is 14 breaths / minute. What action should the nurse
implement?
, • Document the assessment data
• Rational: reservoir bag should not deflate completely during inspiration
and the client’s respiratory rate is within normal limits.
8. During
shift report, the central electrocardiogram (EKG) monitoring system
alarms. Which client alarm should the nurse investigate firs?
,• Respiratory apnea of 30 seconds
9.During a home visit, the nurse observed an elderly client with diabetes slip and
fall. What action should the nurse take first?
• Check the client for lacerations or fractures
At 0600 while admitting a woman for a schedule repeat cesarean section (C-
10.
Section), the client tells the nurse that she drank a cup a coffee at 0400 because she
wanted to avoid getting a headache. Which action should the nurse take first?
• Inform the anesthesia care provider
11.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 the
nurse take first?
• Listen with the bell at the same location
12. 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
by the employee health nurse for health insurance needs?
• Medicare
13. 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?
• Toasted wheat bread and jelly
14. Following a lumbar puncture, a client voices several complaints. What
complaint indicated to the nurse that the client is experiencing a complication?
•
“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”
15. An elderly client seems confused and reports the onset of nausea,
dysuria, and urgency with incontinence. Which action should the nurse
implement?
• Obtain a clean catch mid-stream specimen
16. The nurse is assisting the mother of a child with phenylketonuria (PKU) to select
foods that are in keeping with the child’s dietary restrictions. Which foods are
, contraindicated for this child?
• Foods sweetened with aspartame
17. Beforepreparing 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?
V5 V6 V7 Final Exam 2 Questions with Complete
Solutions
1. Following discharge teaching, a male client with duodenal ulcer tells the nurse the
he 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?
• Review with the client the need to avoid foods that are rich in milk and cream
2.A male client with hypertension, who received new antihypertensive prescriptions
at 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?
• 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?
An adolescent with major depressive disorder has been taking duloxetine (Cymbalta) for
the past 12 days. Which assessment finding requires immediate follow-up?
• Describes life without purpose
5.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?
• Further evaluation involving surgery may be needed
6.A client who recently underwear a tracheostomy is being prepared for discharge to
home. Which instructions is most important for the nurse to include in the discharge
plan?
• Teach tracheal suctioning techniques
7. 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’s
respiratory rate is 14 breaths / minute. What action should the nurse
implement?
, • Document the assessment data
• Rational: reservoir bag should not deflate completely during inspiration
and the client’s respiratory rate is within normal limits.
8. During
shift report, the central electrocardiogram (EKG) monitoring system
alarms. Which client alarm should the nurse investigate firs?
,• Respiratory apnea of 30 seconds
9.During a home visit, the nurse observed an elderly client with diabetes slip and
fall. What action should the nurse take first?
• Check the client for lacerations or fractures
At 0600 while admitting a woman for a schedule repeat cesarean section (C-
10.
Section), the client tells the nurse that she drank a cup a coffee at 0400 because she
wanted to avoid getting a headache. Which action should the nurse take first?
• Inform the anesthesia care provider
11.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 the
nurse take first?
• Listen with the bell at the same location
12. 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
by the employee health nurse for health insurance needs?
• Medicare
13. 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?
• Toasted wheat bread and jelly
14. Following a lumbar puncture, a client voices several complaints. What
complaint indicated to the nurse that the client is experiencing a complication?
•
“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”
15. An elderly client seems confused and reports the onset of nausea,
dysuria, and urgency with incontinence. Which action should the nurse
implement?
• Obtain a clean catch mid-stream specimen
16. The nurse is assisting the mother of a child with phenylketonuria (PKU) to select
foods that are in keeping with the child’s dietary restrictions. Which foods are
, contraindicated for this child?
• Foods sweetened with aspartame
17. Beforepreparing 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?
