HESI RN EXIT PRACTICE TEST 1
COMPREHENSIVE STUDY GUIDE
SECTION 1: MATERNITY & OB
QUESTION 1
Pregnant woman with hyperemesis gravidarum, hypokalemia (K+ 3.0). What other
abnormalities to expect? (Select all)
ANSWER
Increased serum bicarbonate
Decreased serum chloride
RATIONALE / EXPLANATION
Excessive vomiting causes loss of potassium, chloride, and acid → hypokalemic, hypochloremic
metabolic alkalosis. Expect elevated bicarbonate and low chloride. NOT peaked T waves (that's
hyperkalemia). PCO2 will be increased (hypoventilating to compensate).
QUESTION 2
Client 12 weeks pregnant admitted for hyperemesis gravidarum. Appropriate nursing
interventions? (Select all)
ANSWER
Place on nothing-by-mouth status
Initiate IV fluids and electrolytes
Provide vitamin B6 supplement
RATIONALE / EXPLANATION
Initial treatment: NPO until vomiting stopped for 48 hours, IV fluids/electrolytes, vitamin B6
(pyridoxine), and antiemetics. DO NOT start small frequent meals or involve client in food
selection until vomiting subsides for 48+ hours.
Page 1 of 24
, SECTION 2: GASTROINTESTINAL
QUESTION 3
Clear liquid diet ordered for colonoscopy. Which foods indicate teaching effective? (Select
all)
ANSWER
Gelatin
Tea with honey
Broth
RATIONALE / EXPLANATION
Clear liquid diet = only clear liquids. NO pulp (avoid OJ with pulp), NO milk (avoid cappuccino).
Can have: gelatin, clear juices (apple, grape), dark coffee without milk, tea with honey, broth.
QUESTION 4
Client with small bowel obstruction, NG tube on suction, IV NS, muscle cramping. Labs show
metabolic alkalosis. What interventions? (Select all)
ANSWER
Obtain electrocardiogram (ECG)
Increase normal saline infusion rate
RATIONALE / EXPLANATION
Client has hypochloremic, hypokalemic metabolic alkalosis. Get ECG for cardiac effects of
hypokalemia. Increase NS to dilute high bicarbonate. DON'T use D5W for K+ replacement
(increases insulin → worsens hypokalemia). DON'T increase suction (worsens electrolyte loss).
DON'T give bicarb (worsens alkalosis).
QUESTION 5
School-age client with celiac disease has frequent abdominal cramping after meals.
Instruction?
ANSWER
Increase intake of eggs, lean dairy, and rice
RATIONALE / EXPLANATION
Page 2 of 24
, Celiac disease = gluten intolerance. Avoid wheat, barley, rye, oats. Eggs, dairy, and rice are
gluten-free. Whole wheat and spelt contain gluten. Soy sauce contains gluten. Barley has gluten
(beans are OK).
Page 3 of 24
COMPREHENSIVE STUDY GUIDE
SECTION 1: MATERNITY & OB
QUESTION 1
Pregnant woman with hyperemesis gravidarum, hypokalemia (K+ 3.0). What other
abnormalities to expect? (Select all)
ANSWER
Increased serum bicarbonate
Decreased serum chloride
RATIONALE / EXPLANATION
Excessive vomiting causes loss of potassium, chloride, and acid → hypokalemic, hypochloremic
metabolic alkalosis. Expect elevated bicarbonate and low chloride. NOT peaked T waves (that's
hyperkalemia). PCO2 will be increased (hypoventilating to compensate).
QUESTION 2
Client 12 weeks pregnant admitted for hyperemesis gravidarum. Appropriate nursing
interventions? (Select all)
ANSWER
Place on nothing-by-mouth status
Initiate IV fluids and electrolytes
Provide vitamin B6 supplement
RATIONALE / EXPLANATION
Initial treatment: NPO until vomiting stopped for 48 hours, IV fluids/electrolytes, vitamin B6
(pyridoxine), and antiemetics. DO NOT start small frequent meals or involve client in food
selection until vomiting subsides for 48+ hours.
Page 1 of 24
, SECTION 2: GASTROINTESTINAL
QUESTION 3
Clear liquid diet ordered for colonoscopy. Which foods indicate teaching effective? (Select
all)
ANSWER
Gelatin
Tea with honey
Broth
RATIONALE / EXPLANATION
Clear liquid diet = only clear liquids. NO pulp (avoid OJ with pulp), NO milk (avoid cappuccino).
Can have: gelatin, clear juices (apple, grape), dark coffee without milk, tea with honey, broth.
QUESTION 4
Client with small bowel obstruction, NG tube on suction, IV NS, muscle cramping. Labs show
metabolic alkalosis. What interventions? (Select all)
ANSWER
Obtain electrocardiogram (ECG)
Increase normal saline infusion rate
RATIONALE / EXPLANATION
Client has hypochloremic, hypokalemic metabolic alkalosis. Get ECG for cardiac effects of
hypokalemia. Increase NS to dilute high bicarbonate. DON'T use D5W for K+ replacement
(increases insulin → worsens hypokalemia). DON'T increase suction (worsens electrolyte loss).
DON'T give bicarb (worsens alkalosis).
QUESTION 5
School-age client with celiac disease has frequent abdominal cramping after meals.
Instruction?
ANSWER
Increase intake of eggs, lean dairy, and rice
RATIONALE / EXPLANATION
Page 2 of 24
, Celiac disease = gluten intolerance. Avoid wheat, barley, rye, oats. Eggs, dairy, and rice are
gluten-free. Whole wheat and spelt contain gluten. Soy sauce contains gluten. Barley has gluten
(beans are OK).
Page 3 of 24
