HESI EXIT RN EXAM 2022 V2 - REAL
[160 QUESTIONS AND ANSWERS]
1. 1. Before leaving the room of a confused client, the nurse notes that a
half bow knot was used to attach the client's wrist restraints to the movable portion of the client's bed
frame. What action should the nurse take before leaving the room?
a) Ensure that the restraints are snug against the client's wrists. b) Move the ties so the restraints are
secured to the side rails.
c) Ensure that the knot can be quickly released.
d) Tie the knot with a double turn or square knot.: c) Ensure that the knot can be quickly released.
2. 2. When gathering for a group therapy session at 1400 hours, a female client complains to the nurse that
a smoking break has not been allowed
all day. The nurse responds that 15 minute breaks were called over the unit intercom after breakfast and
after lunch. The nurse is using what communi- cation technique in responding to the client?
a) Doubt
b) Observation c) Confrontation
d) Reflection: d) Reflection
3. 3. The nurse is interviewing a client with schizophrenia. Which client behavior requires immediate
intervention?
a) Lip smacking and frequent eye blinking b) Shuffling gait and stooped posture
c) Rocks back and forth in the chair
d) Muscle spasms of the back and neck: d) Muscle spasms of the back and neck
4. 4. A female client with rheumatoid arthritis (RA) comes to the clinic com- plaining of joint pain and
swelling. The client has been taking prednisone (Deltasone) and ibuprofen (Motrin Extra Strength) every
day. To assist the client with self-management of her pain, which information should the nurse obtain?
a) Presence of bruising, weakness, or fatigue
b) Therapeutic exercise included in daily routine. c) Average amount of protein eaten daily
,d) Existence of gastrointestinal discomfort: b) Therapeutic exercise included in daily routine.
5. 5. The charge nurse of the Intensive Care Unit is making assignments for the permanent staff and one
RN who was floated from a medical unit. The client with which condition is the best to assign to the float
nurse?
a) Diabetic ketoacidosis and titrated IV insulin infusion
b) Emphysema extubated 3 hours ago receiving heated mist c) Subdural hematoma with an intracranial
monitoring device
d) Acute coronary syndrome treated with vasopressors: a) Diabetic ketoaci- dosis and titrated IV insulin
infusion
6. 6. A client admitted to the emergency center had inspiratory and expiratory wheezing, nasal flaring, and
thick, tenacious sputum secretions observed during the physical examination. Based on these assessment
findings, what classification of pharmacologic agents should the nurse anticipate adminis- tering?
a) Beta blockers
b) Bronchodilators c) Corticosteroids
d) Beta-adrenergics: b) Bronchodilators
7. 7. The nurse weighs a 6-month-old infant during a well-baby check-up and determines that the baby's
weight has tripled compared to the birth weight of 7 pounds 8 ounces. The mother asks if the baby is
gaining enough weight. What response should the nurse offer?
a) What food does your baby usually eat in a normal day?
b) What was the baby's weight at the last well-baby clinic visit?
c) The baby is below the normal percentile for weight gain
d) Your baby is gaining weight right on schedule: What food does your baby usually eat in a normal day?
8. 8. The home health nurse is assessing a male client who has started peritoneal dialysis (PD) 5 days ago.
Which assessment finding warrants immediate intervention by the nurse?
a) Finger stick blood glucose 120 mg/dL post exchange b) Arteriovenous (AV) graft surgical site
pulsations.
c) Anorexia and poor intake of adequate dietary protein
d) Cloudy dialysate output and rebound abdominal pain: Cloudy dialysate output and rebound abdominal
pain
,9. 9. A male client with renal cell carcinoma is returned to the unit following a radical nephrectomy.The nurse
notes that his vital signs and urine output are within normal range, his bandage is dry, and the drain from the
incision site is producing a small amount of serasanguinous drainage. Which intervention should the nurse
implement?
a) Place a pressure bandage at the drainage site
b) Document assessment findings in the electronic medical record c) Monitor urinary catheter output for
a decrease below 30 ml/hr
d) Notify surgeon of color and amount of wound drainage.: Notify surgeon of color and amount of wound
drainage
10. 10. A client with chronic obstructive lung disease, who is receiving oxy- gen at 1.5 liters/minute by
nasal cannula, is currently short of breath. What action should the nurse take?
a) Ask the client to take short, rapid breaths b) Instruct the client in pursed lip breathing c) Increase oxygen
to three liters/minute
d) Have the client breathe into a paper bag: Instruct the client in pursed lip breathing
11. 11. The nurse assesses a male client following surgery for a gunshot wound to the abdomen and
determines that his dressing is saturated with blood and petechiae are on his extremities. His current
blood pressure
is 80/40, and his heart rate is 130 beats/minute. Which laboratory finding confirms the presence of
disseminated intravascular coagulopathy (DIC)? a) Low prothrombin time
b) Elevated fibrinogen c) Positive d-Dimer
d) Normal hemoglobin: Elevated fibrinogen
12. 12. After a routine physical examination, the healthcare admits a woman with a history of Systemic
Lupus Erythematous (SLE) to the hospital be- cause she has 3+ pitting ankle edema and blood in her
urine. Which assess- ment finding warrants immediate intervention by the nurse?
a) Blood pressure 170/98 b) Joint and muscle aches c) Urine output 300 ml/hr
d) Dark, rust-colored urine: Urine output 300 ml/hr
13. 13. In evaluating the effectiveness of a postoperative client's intermittent pneumatic compression
devices, which assessment is most important for the nurse to complete?
a) Evaluate the client's ability to use an incentive spirometer b) Monitor the amount of drainage from the
client's incision c) Observe both lower extremities for redness and swelling
, d) Palpate all peripheral pulse points for volume and strength: Monitor the amount of drainage from the
client's incision
14. 14. While caring for a toddler receiving oxygen (02) via face mask, the nurse observes that the child's
lips and nares are dry and cracked. Which intervention should the nurse implement?
[160 QUESTIONS AND ANSWERS]
1. 1. Before leaving the room of a confused client, the nurse notes that a
half bow knot was used to attach the client's wrist restraints to the movable portion of the client's bed
frame. What action should the nurse take before leaving the room?
a) Ensure that the restraints are snug against the client's wrists. b) Move the ties so the restraints are
secured to the side rails.
c) Ensure that the knot can be quickly released.
d) Tie the knot with a double turn or square knot.: c) Ensure that the knot can be quickly released.
2. 2. When gathering for a group therapy session at 1400 hours, a female client complains to the nurse that
a smoking break has not been allowed
all day. The nurse responds that 15 minute breaks were called over the unit intercom after breakfast and
after lunch. The nurse is using what communi- cation technique in responding to the client?
a) Doubt
b) Observation c) Confrontation
d) Reflection: d) Reflection
3. 3. The nurse is interviewing a client with schizophrenia. Which client behavior requires immediate
intervention?
a) Lip smacking and frequent eye blinking b) Shuffling gait and stooped posture
c) Rocks back and forth in the chair
d) Muscle spasms of the back and neck: d) Muscle spasms of the back and neck
4. 4. A female client with rheumatoid arthritis (RA) comes to the clinic com- plaining of joint pain and
swelling. The client has been taking prednisone (Deltasone) and ibuprofen (Motrin Extra Strength) every
day. To assist the client with self-management of her pain, which information should the nurse obtain?
a) Presence of bruising, weakness, or fatigue
b) Therapeutic exercise included in daily routine. c) Average amount of protein eaten daily
,d) Existence of gastrointestinal discomfort: b) Therapeutic exercise included in daily routine.
5. 5. The charge nurse of the Intensive Care Unit is making assignments for the permanent staff and one
RN who was floated from a medical unit. The client with which condition is the best to assign to the float
nurse?
a) Diabetic ketoacidosis and titrated IV insulin infusion
b) Emphysema extubated 3 hours ago receiving heated mist c) Subdural hematoma with an intracranial
monitoring device
d) Acute coronary syndrome treated with vasopressors: a) Diabetic ketoaci- dosis and titrated IV insulin
infusion
6. 6. A client admitted to the emergency center had inspiratory and expiratory wheezing, nasal flaring, and
thick, tenacious sputum secretions observed during the physical examination. Based on these assessment
findings, what classification of pharmacologic agents should the nurse anticipate adminis- tering?
a) Beta blockers
b) Bronchodilators c) Corticosteroids
d) Beta-adrenergics: b) Bronchodilators
7. 7. The nurse weighs a 6-month-old infant during a well-baby check-up and determines that the baby's
weight has tripled compared to the birth weight of 7 pounds 8 ounces. The mother asks if the baby is
gaining enough weight. What response should the nurse offer?
a) What food does your baby usually eat in a normal day?
b) What was the baby's weight at the last well-baby clinic visit?
c) The baby is below the normal percentile for weight gain
d) Your baby is gaining weight right on schedule: What food does your baby usually eat in a normal day?
8. 8. The home health nurse is assessing a male client who has started peritoneal dialysis (PD) 5 days ago.
Which assessment finding warrants immediate intervention by the nurse?
a) Finger stick blood glucose 120 mg/dL post exchange b) Arteriovenous (AV) graft surgical site
pulsations.
c) Anorexia and poor intake of adequate dietary protein
d) Cloudy dialysate output and rebound abdominal pain: Cloudy dialysate output and rebound abdominal
pain
,9. 9. A male client with renal cell carcinoma is returned to the unit following a radical nephrectomy.The nurse
notes that his vital signs and urine output are within normal range, his bandage is dry, and the drain from the
incision site is producing a small amount of serasanguinous drainage. Which intervention should the nurse
implement?
a) Place a pressure bandage at the drainage site
b) Document assessment findings in the electronic medical record c) Monitor urinary catheter output for
a decrease below 30 ml/hr
d) Notify surgeon of color and amount of wound drainage.: Notify surgeon of color and amount of wound
drainage
10. 10. A client with chronic obstructive lung disease, who is receiving oxy- gen at 1.5 liters/minute by
nasal cannula, is currently short of breath. What action should the nurse take?
a) Ask the client to take short, rapid breaths b) Instruct the client in pursed lip breathing c) Increase oxygen
to three liters/minute
d) Have the client breathe into a paper bag: Instruct the client in pursed lip breathing
11. 11. The nurse assesses a male client following surgery for a gunshot wound to the abdomen and
determines that his dressing is saturated with blood and petechiae are on his extremities. His current
blood pressure
is 80/40, and his heart rate is 130 beats/minute. Which laboratory finding confirms the presence of
disseminated intravascular coagulopathy (DIC)? a) Low prothrombin time
b) Elevated fibrinogen c) Positive d-Dimer
d) Normal hemoglobin: Elevated fibrinogen
12. 12. After a routine physical examination, the healthcare admits a woman with a history of Systemic
Lupus Erythematous (SLE) to the hospital be- cause she has 3+ pitting ankle edema and blood in her
urine. Which assess- ment finding warrants immediate intervention by the nurse?
a) Blood pressure 170/98 b) Joint and muscle aches c) Urine output 300 ml/hr
d) Dark, rust-colored urine: Urine output 300 ml/hr
13. 13. In evaluating the effectiveness of a postoperative client's intermittent pneumatic compression
devices, which assessment is most important for the nurse to complete?
a) Evaluate the client's ability to use an incentive spirometer b) Monitor the amount of drainage from the
client's incision c) Observe both lower extremities for redness and swelling
, d) Palpate all peripheral pulse points for volume and strength: Monitor the amount of drainage from the
client's incision
14. 14. While caring for a toddler receiving oxygen (02) via face mask, the nurse observes that the child's
lips and nares are dry and cracked. Which intervention should the nurse implement?
