NURS 209 EXAM ACTUAL EXAM 2026 (HESI) | ALL
QUESTIONS AND CORRECT ANSWERS WITH
DETAILED EXPLANATIONS| VERIFIED ANSWERS |
UPDATED VERSION!
A client admitted for heart failure has a priority problem of
hypervolemia related to compromised regulatory mechanisms. Which
assessment result obtained the day after admission is the best indicator
that the treatment has been effective?
A. The client has diuresis of 400 mL in 24 hours.
B. The client's blood pressure is 122/84 mm Hg.
C. The client has an apical pulse of 82 beats/min.
D. The client's weight decreases by 2.5 kg. ---------CORRECT ANSWER-----
------------D. The client's weight decreases by 2.5 kg.
The best indicator of fluid volume gain or loss is daily weight; because
each kilogram represents approximately 1 liter, this client has lost
approximately 2500 mL of fluid. Diuresis of 400 mL in 24 hours
represents oliguria. Although a blood pressure of 122/84 mm Hg is a
normal finding, alone it is not significant for relief of hypervolemia.
Although an apical pulse of 82 beats/min is a normal finding, alone it
is not significant to determine whether hypervolemia is relieved.
,When following up in the clinic with a client with heart failure, how
does the nurse recognize that the client has been compliant with fluid
restrictions?
A. Auscultation of crackles
B. Pedal edema
C. Weight loss of 6 pounds since the last visit
D. Reports sucking on ice chips all day for dry mouth ---------CORRECT
ANSWER-----------------C. Weight loss of 6 pounds since the last visit
Weight loss in this client indicates effective fluid restriction and
diuretic drug therapy. Lung crackles indicate intra-alveolar edema and
fluid excess. Pedal edema indicates fluid excess. Sucking on ice chips
indicates noncompliance with fluid restrictions; alternative methods
of treating dry mouth should be explored.
Which nursing action may be delegated to a nursing assistant working
on the medical unit?
A. Determine the usual alcohol intake for a client with cardiomyopathy.
B. Monitor the pain level for a client with acute pericarditis.
C. Obtain daily weights for several clients with class IV heart failure.
D. Check for peripheral edema in a client with endocarditis. ---------
CORRECT ANSWER-----------------C. Obtain daily weights for several
clients with class IV heart failure.
,Daily weight assessment is included in the role of the nursing
assistant, who will report the weights to the RN. The role of the
professional nurse is to perform assessments; determining alcohol
intake, monitoring pain level, and assessing for peripheral edema
should not be delegated.
After receiving change-of-shift report about these four clients, which
client should the nurse assess first?
A. A 46-year-old with aortic stenosis who takes digoxin (Lanoxin) and
has new-onset frequent premature ventricular contractions
B. A 55-year-old admitted with pulmonary edema who received
furosemide (Lasix) and whose current O2 saturation is 94%
C. A 68-year-old with pericarditis who is reporting sharp, stabbing chest
pain when taking deep breaths
D. A 79-year-old admitted for possible rejection of a heart transplant
who has sinus tachycardia, heart rate 104 beats/min ---------CORRECT
ANSWER-----------------A. A 46-year-old with aortic stenosis who takes
digoxin (Lanoxin) and has new-onset frequent premature ventricular
contractions
The 46-year-old's premature ventricular contractions may be
indicative of digoxin toxicity; further assessment for clinical
manifestations of digoxin toxicity should be done and the health care
provider notified about the dysrhythmia. The 55-year-old is stable and
can be assessed after the client with aortic stenosis. The 68-year-old
may be assessed after the client with aortic stenosis; this type of pain
, is expected in pericarditis. Tachycardia is expected in the 79-year-old
because rejection will cause signs of decreased cardiac output,
including tachycardia; this client may be seen after the client with
aortic stenosis.
Which client is best to assign to an LPN/LVN working on the telemetry
unit?
A. Client with heart failure who is receiving dobutamine (Dobutrex)
B. Client with dilated cardiomyopathy who uses oxygen for exertional
dyspnea
C. Client with pericarditis who has a paradoxical pulse and distended
jugular veins
D. Client with rheumatic fever who has a new systolic murmur ---------
CORRECT ANSWER-----------------B. Client with dilated cardiomyopathy
who uses oxygen for exertional dyspnea
The client with dilated cardiomyopathy who needs oxygen only with
exertion is the most stable; administration of oxygen to a stable client
is within the scope of LPN/LVN practice. The client with heart failure is
receiving an intravenous inotropic agent, which requires monitoring
by the RN. The client with pericarditis is displaying signs of cardiac
tamponade and requires immediate lifesaving intervention. The client
with a new-onset murmur requires assessment and notification of the
provider, which is within the scope of practice of the RN.
QUESTIONS AND CORRECT ANSWERS WITH
DETAILED EXPLANATIONS| VERIFIED ANSWERS |
UPDATED VERSION!
A client admitted for heart failure has a priority problem of
hypervolemia related to compromised regulatory mechanisms. Which
assessment result obtained the day after admission is the best indicator
that the treatment has been effective?
A. The client has diuresis of 400 mL in 24 hours.
B. The client's blood pressure is 122/84 mm Hg.
C. The client has an apical pulse of 82 beats/min.
D. The client's weight decreases by 2.5 kg. ---------CORRECT ANSWER-----
------------D. The client's weight decreases by 2.5 kg.
The best indicator of fluid volume gain or loss is daily weight; because
each kilogram represents approximately 1 liter, this client has lost
approximately 2500 mL of fluid. Diuresis of 400 mL in 24 hours
represents oliguria. Although a blood pressure of 122/84 mm Hg is a
normal finding, alone it is not significant for relief of hypervolemia.
Although an apical pulse of 82 beats/min is a normal finding, alone it
is not significant to determine whether hypervolemia is relieved.
,When following up in the clinic with a client with heart failure, how
does the nurse recognize that the client has been compliant with fluid
restrictions?
A. Auscultation of crackles
B. Pedal edema
C. Weight loss of 6 pounds since the last visit
D. Reports sucking on ice chips all day for dry mouth ---------CORRECT
ANSWER-----------------C. Weight loss of 6 pounds since the last visit
Weight loss in this client indicates effective fluid restriction and
diuretic drug therapy. Lung crackles indicate intra-alveolar edema and
fluid excess. Pedal edema indicates fluid excess. Sucking on ice chips
indicates noncompliance with fluid restrictions; alternative methods
of treating dry mouth should be explored.
Which nursing action may be delegated to a nursing assistant working
on the medical unit?
A. Determine the usual alcohol intake for a client with cardiomyopathy.
B. Monitor the pain level for a client with acute pericarditis.
C. Obtain daily weights for several clients with class IV heart failure.
D. Check for peripheral edema in a client with endocarditis. ---------
CORRECT ANSWER-----------------C. Obtain daily weights for several
clients with class IV heart failure.
,Daily weight assessment is included in the role of the nursing
assistant, who will report the weights to the RN. The role of the
professional nurse is to perform assessments; determining alcohol
intake, monitoring pain level, and assessing for peripheral edema
should not be delegated.
After receiving change-of-shift report about these four clients, which
client should the nurse assess first?
A. A 46-year-old with aortic stenosis who takes digoxin (Lanoxin) and
has new-onset frequent premature ventricular contractions
B. A 55-year-old admitted with pulmonary edema who received
furosemide (Lasix) and whose current O2 saturation is 94%
C. A 68-year-old with pericarditis who is reporting sharp, stabbing chest
pain when taking deep breaths
D. A 79-year-old admitted for possible rejection of a heart transplant
who has sinus tachycardia, heart rate 104 beats/min ---------CORRECT
ANSWER-----------------A. A 46-year-old with aortic stenosis who takes
digoxin (Lanoxin) and has new-onset frequent premature ventricular
contractions
The 46-year-old's premature ventricular contractions may be
indicative of digoxin toxicity; further assessment for clinical
manifestations of digoxin toxicity should be done and the health care
provider notified about the dysrhythmia. The 55-year-old is stable and
can be assessed after the client with aortic stenosis. The 68-year-old
may be assessed after the client with aortic stenosis; this type of pain
, is expected in pericarditis. Tachycardia is expected in the 79-year-old
because rejection will cause signs of decreased cardiac output,
including tachycardia; this client may be seen after the client with
aortic stenosis.
Which client is best to assign to an LPN/LVN working on the telemetry
unit?
A. Client with heart failure who is receiving dobutamine (Dobutrex)
B. Client with dilated cardiomyopathy who uses oxygen for exertional
dyspnea
C. Client with pericarditis who has a paradoxical pulse and distended
jugular veins
D. Client with rheumatic fever who has a new systolic murmur ---------
CORRECT ANSWER-----------------B. Client with dilated cardiomyopathy
who uses oxygen for exertional dyspnea
The client with dilated cardiomyopathy who needs oxygen only with
exertion is the most stable; administration of oxygen to a stable client
is within the scope of LPN/LVN practice. The client with heart failure is
receiving an intravenous inotropic agent, which requires monitoring
by the RN. The client with pericarditis is displaying signs of cardiac
tamponade and requires immediate lifesaving intervention. The client
with a new-onset murmur requires assessment and notification of the
provider, which is within the scope of practice of the RN.
