HESI 799 RN EXIT EXAM
PART 1 - 250 QUESTIONS
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 in liver failure? (Select all)
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
Decreased albumin allows fluid shift into interstitial space. Portal pressure increases fluid shifts.
Failing liver cannot inactivate aldosterone.
QUESTION 3
Client receiving hydromorphone (Dilaudid) every 6 hours for 4 days. Most important
assessment?
ANSWER
Page 1 of 35
,Auscultate the client's bowel sounds
RATIONALE / EXPLANATION
Hydromorphone is a potent opioid that slows peristalsis and frequently causes constipation.
QUESTION 4
Client no bowel movement for 3 days, now defecating frequent small amounts of liquid stool.
Action?
ANSWER
Digitally check the client for a fecal impaction
RATIONALE / EXPLANATION
Paradoxical diarrhea (small liquid stools around impaction) indicates fecal impaction.
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 K+ is 3.5-5.0 mEq/L. NG suctioning causes potassium loss. Hypokalemia can cause
cardiac arrhythmias.
Page 2 of 35
, SECTION 2: CARDIOVASCULAR
QUESTION 6
Client with HTN not taking meds because they make him 'feel bad'. What risk should nurse
stress?
ANSWER
Stroke secondary to hemorrhage
RATIONALE / EXPLANATION
Stroke from cerebral hemorrhage is a major risk for uncontrolled hypertension.
QUESTION 7
Client with heart failure has nausea, vomiting, yellow vision, palpitations. Most important
assessment?
ANSWER
Obtain a list of medications taken for cardiac history
RATIONALE / EXPLANATION
Signs of digitalis toxicity. Medication list will likely show digoxin - validate toxicity with serum
levels >2 mg/mL.
QUESTION 8
Auscultating S1 and S2 heart sounds. How to determine if S3 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
What heart sound is described as a swishing sound associated with blood turbulence?
Page 3 of 35
, ANSWER
Murmur
RATIONALE / EXPLANATION
A murmur is a swishing sound associated with blood turbulence from heart or valvular defect.
QUESTION 10
Client received multiple antihypertensives, 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
Medications with similar action produce additive effect - sum of each medication's effect.
QUESTION 11
Client admitted 2 hours ago with chest pain. 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 and oxygen are priority interventions for acute MI. Supplement with nitroglycerin and
aspirin.
QUESTION 12
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
Page 4 of 35
PART 1 - 250 QUESTIONS
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 in liver failure? (Select all)
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
Decreased albumin allows fluid shift into interstitial space. Portal pressure increases fluid shifts.
Failing liver cannot inactivate aldosterone.
QUESTION 3
Client receiving hydromorphone (Dilaudid) every 6 hours for 4 days. Most important
assessment?
ANSWER
Page 1 of 35
,Auscultate the client's bowel sounds
RATIONALE / EXPLANATION
Hydromorphone is a potent opioid that slows peristalsis and frequently causes constipation.
QUESTION 4
Client no bowel movement for 3 days, now defecating frequent small amounts of liquid stool.
Action?
ANSWER
Digitally check the client for a fecal impaction
RATIONALE / EXPLANATION
Paradoxical diarrhea (small liquid stools around impaction) indicates fecal impaction.
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 K+ is 3.5-5.0 mEq/L. NG suctioning causes potassium loss. Hypokalemia can cause
cardiac arrhythmias.
Page 2 of 35
, SECTION 2: CARDIOVASCULAR
QUESTION 6
Client with HTN not taking meds because they make him 'feel bad'. What risk should nurse
stress?
ANSWER
Stroke secondary to hemorrhage
RATIONALE / EXPLANATION
Stroke from cerebral hemorrhage is a major risk for uncontrolled hypertension.
QUESTION 7
Client with heart failure has nausea, vomiting, yellow vision, palpitations. Most important
assessment?
ANSWER
Obtain a list of medications taken for cardiac history
RATIONALE / EXPLANATION
Signs of digitalis toxicity. Medication list will likely show digoxin - validate toxicity with serum
levels >2 mg/mL.
QUESTION 8
Auscultating S1 and S2 heart sounds. How to determine if S3 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
What heart sound is described as a swishing sound associated with blood turbulence?
Page 3 of 35
, ANSWER
Murmur
RATIONALE / EXPLANATION
A murmur is a swishing sound associated with blood turbulence from heart or valvular defect.
QUESTION 10
Client received multiple antihypertensives, 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
Medications with similar action produce additive effect - sum of each medication's effect.
QUESTION 11
Client admitted 2 hours ago with chest pain. 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 and oxygen are priority interventions for acute MI. Supplement with nitroglycerin and
aspirin.
QUESTION 12
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
Page 4 of 35
