HESI 799 RN EXIT EXAM
WITH RATIONALES
COMPREHENSIVE STUDY GUIDE
SECTION 1: GASTROINTESTINAL
QUESTION 1
Client with duodenal ulcer says he will drink plenty of dairy to coat and protect his ulcer. Best
follow-up action?
ANSWER
Review with the client the need to avoid foods that are rich in milk and cream
RATIONALE / EXPLANATION
Diets rich in milk and cream stimulate gastric acid secretion and should be avoided.
QUESTION 2
Pathophysiological mechanisms responsible for ascites related to liver failure? (Select all
that apply)
ANSWER
Fluid shifts from intravascular to interstitial area due to decreased serum
protein
Increased hydrostatic pressure in portal circulation
Increased circulating aldosterone levels that increase sodium and water
retention
RATIONALE / EXPLANATION
Reduced albumin allows fluid shift into interstitial space. Portal pressure increases fluid shifts.
Failing liver cannot inactivate aldosterone causing retention.
QUESTION 3
Client receiving hydromorphone (Dilaudid) every six hours for four days. Most important
assessment?
ANSWER
Page 1 of 33
,Auscultate the client's bowel sounds
RATIONALE / EXPLANATION
Hydromorphone is a potent opioid analgesic that slows peristalsis and frequently causes
constipation.
QUESTION 4
Client has not had bowel movement for 3 days, but now defecating frequent small amounts
of liquid stool. Action?
ANSWER
Digitally check the client for a fecal impaction
RATIONALE / EXPLANATION
Small amounts of liquid stool around an impaction (paradoxical diarrhea) indicates fecal
impaction requiring digital removal.
QUESTION 5
Client with intestinal obstruction has NG tube to suction, IV LR at 100 mL/hr. Most important
finding to report?
ANSWER
Serum potassium level of 3.1 mEq/L
RATIONALE / EXPLANATION
Normal potassium is 3.5-5.0 mEq/L. NG suctioning causes potassium loss. Hypokalemia can
cause cardiac arrhythmias.
Page 2 of 33
, SECTION 2: CARDIOVASCULAR
QUESTION 6
Client with hypertension not taking meds because they make him 'feel bad'. What risk should
nurse stress?
ANSWER
Stroke secondary to hemorrhage
RATIONALE / EXPLANATION
Stroke related to cerebral hemorrhage is a major risk for uncontrolled hypertension.
QUESTION 7
Client with heart failure history presents with nausea, vomiting, yellow vision, palpitations.
Most important assessment?
ANSWER
Obtain a list of medications taken for cardiac history
RATIONALE / EXPLANATION
Client is presenting with signs of digitalis toxicity. Medication list will likely show digoxin - validate
toxicity with serum levels >2 mg/mL.
QUESTION 8
After placing stethoscope and hearing S1 and S2, how to determine if S3 heart sound is
present?
ANSWER
Listen with the bell at the same location
RATIONALE / EXPLANATION
The bell of the stethoscope is used to hear low-pitched sounds such as S3 and S4.
QUESTION 9
Page 3 of 33
, Client received multiple antihypertensive medications and has syncope with BP 70/40.
Rationale for holding meds?
ANSWER
The additive effect of multiple medications has caused the blood pressure to
drop too low
RATIONALE / EXPLANATION
When medications with similar action are administered, an additive effect occurs that is the sum
of each medication's effect.
QUESTION 10
Client admitted 2 hours ago with chest pain, EKG shows bradycardia, ST depression. Now
reports 'elephant on chest', Q waves and ST elevation. Intervention?
ANSWER
Administer prescribed morphine sulfate IV and provide oxygen at 2 L/min per
nasal cannula
RATIONALE / EXPLANATION
Morphine sulfate increases oxygen supply - priority for acute MI symptoms. Supplement with
nitroglycerin and aspirin.
QUESTION 11
Development of atherosclerosis - arrange events in order:
ANSWER
1. Arterial endothelium injury causes inflammation
2. Macrophages consume LDL, creating foam cells
3. Foam cells release growth factors for smooth muscle cells
4. Smooth muscle grows over fatty streaks creating fibrous plaques
5. Vessel narrowing results in ischemia
RATIONALE / EXPLANATION
Sequential progression from initial injury through inflammation, lipid accumulation, smooth
muscle proliferation, to vessel narrowing.
Page 4 of 33
WITH RATIONALES
COMPREHENSIVE STUDY GUIDE
SECTION 1: GASTROINTESTINAL
QUESTION 1
Client with duodenal ulcer says he will drink plenty of dairy to coat and protect his ulcer. Best
follow-up action?
ANSWER
Review with the client the need to avoid foods that are rich in milk and cream
RATIONALE / EXPLANATION
Diets rich in milk and cream stimulate gastric acid secretion and should be avoided.
QUESTION 2
Pathophysiological mechanisms responsible for ascites related to liver failure? (Select all
that apply)
ANSWER
Fluid shifts from intravascular to interstitial area due to decreased serum
protein
Increased hydrostatic pressure in portal circulation
Increased circulating aldosterone levels that increase sodium and water
retention
RATIONALE / EXPLANATION
Reduced albumin allows fluid shift into interstitial space. Portal pressure increases fluid shifts.
Failing liver cannot inactivate aldosterone causing retention.
QUESTION 3
Client receiving hydromorphone (Dilaudid) every six hours for four days. Most important
assessment?
ANSWER
Page 1 of 33
,Auscultate the client's bowel sounds
RATIONALE / EXPLANATION
Hydromorphone is a potent opioid analgesic that slows peristalsis and frequently causes
constipation.
QUESTION 4
Client has not had bowel movement for 3 days, but now defecating frequent small amounts
of liquid stool. Action?
ANSWER
Digitally check the client for a fecal impaction
RATIONALE / EXPLANATION
Small amounts of liquid stool around an impaction (paradoxical diarrhea) indicates fecal
impaction requiring digital removal.
QUESTION 5
Client with intestinal obstruction has NG tube to suction, IV LR at 100 mL/hr. Most important
finding to report?
ANSWER
Serum potassium level of 3.1 mEq/L
RATIONALE / EXPLANATION
Normal potassium is 3.5-5.0 mEq/L. NG suctioning causes potassium loss. Hypokalemia can
cause cardiac arrhythmias.
Page 2 of 33
, SECTION 2: CARDIOVASCULAR
QUESTION 6
Client with hypertension not taking meds because they make him 'feel bad'. What risk should
nurse stress?
ANSWER
Stroke secondary to hemorrhage
RATIONALE / EXPLANATION
Stroke related to cerebral hemorrhage is a major risk for uncontrolled hypertension.
QUESTION 7
Client with heart failure history presents with nausea, vomiting, yellow vision, palpitations.
Most important assessment?
ANSWER
Obtain a list of medications taken for cardiac history
RATIONALE / EXPLANATION
Client is presenting with signs of digitalis toxicity. Medication list will likely show digoxin - validate
toxicity with serum levels >2 mg/mL.
QUESTION 8
After placing stethoscope and hearing S1 and S2, how to determine if S3 heart sound is
present?
ANSWER
Listen with the bell at the same location
RATIONALE / EXPLANATION
The bell of the stethoscope is used to hear low-pitched sounds such as S3 and S4.
QUESTION 9
Page 3 of 33
, Client received multiple antihypertensive medications and has syncope with BP 70/40.
Rationale for holding meds?
ANSWER
The additive effect of multiple medications has caused the blood pressure to
drop too low
RATIONALE / EXPLANATION
When medications with similar action are administered, an additive effect occurs that is the sum
of each medication's effect.
QUESTION 10
Client admitted 2 hours ago with chest pain, EKG shows bradycardia, ST depression. Now
reports 'elephant on chest', Q waves and ST elevation. Intervention?
ANSWER
Administer prescribed morphine sulfate IV and provide oxygen at 2 L/min per
nasal cannula
RATIONALE / EXPLANATION
Morphine sulfate increases oxygen supply - priority for acute MI symptoms. Supplement with
nitroglycerin and aspirin.
QUESTION 11
Development of atherosclerosis - arrange events in order:
ANSWER
1. Arterial endothelium injury causes inflammation
2. Macrophages consume LDL, creating foam cells
3. Foam cells release growth factors for smooth muscle cells
4. Smooth muscle grows over fatty streaks creating fibrous plaques
5. Vessel narrowing results in ischemia
RATIONALE / EXPLANATION
Sequential progression from initial injury through inflammation, lipid accumulation, smooth
muscle proliferation, to vessel narrowing.
Page 4 of 33
