ALL HESI EXIT Questions and Answers Test
Bank; A+ Rated Guide (2022)
. A client is receiving a continuous half strength tube feeding at 50ml/hour.
To prepare enough of the solution for eight hours, how many ml of full
strength feeding will the nurse need? (Enter numeric value only.)
200ml . 25 ml of full strength feeding mixed with 25ml of water provided
50ml of half strength. 25ml × 8 hours= 200ml
An elderly male client is experiencing urinary incontinence. What is the best
initial nursing action?
Apply an external condom catheter
3. A male Muslim client with pneumonia is scheduled to receive a dose of
an intravenous antibiotic but refuses to allow the nurse to begin the
medication, stating he cannot allow fluids to enter his body once he is
cleansed for prayer. What action should the nurse implement?
Reschedule administration of the antibiotic until after he completes his
prayers
UAP using a hand sanitzers that is alcohol for 2 minutes
tell that hand sanitizer use is less > 2min
5.A child is to receive vancomycin (Vancocin) 40 mg/kg IV one hour before
a scheduled procedure. The child weighs 44 pounds. How many mg of the
medication should the nurse administer
Answer: 800 Rationale: First, convert the child's weight to kg: 44 pounds
divided by
2.2pound/kg = 20 kg. Next calculate the mg/kg/dose, 40 mg x 20 kg =
800mg
6. While assisting a postpartum client with perineal care, the nurse notes
that her vaginal bleeding spurts rather than trickles from the vagina. The
uterine fundus is firm and the client's vital signs are pulse 88 beats/minute;
respiratory rate, 21 breaths/minute; and blood pressure, 104/68 mmHg.
What action should the nurse take next?
Compare current vital signs with previous vital signs
,A 6-year old boy was hit with a bat while playing at school. He has a
splinter of wood imbedded in his eye. Which action should the school nurse
take?
Have the parent take the child for emergency help
Within four weeks of childbirth, a client is admitted to the hospital for
disorganized speech bizarre behavior, and strange thoughts about her
infant being possessed by demons. The nurse identifies a nursing
diagnosis of "Altered thought processes, secondary to" what condition?
Postpartum psychosis
The nurse identifies a priority diagnosis of, "Altered comfort related to
menstrual cramps" for a 25-year-old female client. Which self-care activity
should the nurse emphasize in the client's teaching plan?
Regular aerobic exercise.
Psych/Alcohol/Tylenol overdose antidote
Give Mucomyst
Medical Surgical/Laxative abuses
Patient -taking Milk of Magnesium
Spiritual/Documentation
Native American - Allow pt's family to stay in the room
Leadership- Interpreter informed consent
Pt should sign the consent
Geriatrics/Emergency Rib fractures fall
Pulmonary embolism
A client diagnosed with major depression is being allowed a weekend pass
from the psychiatric unit. Which instruction should the nurse provide to the
client's family?
Involve the client in usual at home activities
Upon assessment, the nurse discovers that a postpartum client has
persistent red lochia.
Which of the following does this assessment finding suggest to the nurse?
Coagulation disorders
The healthcare provider performs peritoneal dialysis on a client, after which
2 liters of fluid is drained. What action should the nurse complete first?
Assess vital signs.
After administering a medication through a nasogastric tube connected to
suction, what action should the nurse take first?
Clamp the tube
The nurse is caring for four clients: Client A 94% o2 saturation, Client B,
hemoglobin of 8.;
,Client C, potassium level of 3.8 and Client D appendectomy who has a
white blood cell count of 15,000. What
should the nurse implement?
Determine if Client B has two units of packed cells available in the blood
bank.
Triage question with a train wreck The psychiatric nurse is called to a train
derailment that was likely caused by a terrorist bomb. In triaging those in
need of immediate care, what is the priority ranking for these cases?
(arrange these cases in order or priority with the top item requiring the most
immediate care and the bottom item requiring the least priority care)
A mother and father have just arrived on the .
A crying child being held by another passenger. A woman sitting on the
ground with a blanket.
A middle-aged man who is wandering around
(arrange in order) = middle age woman bleeding- woman w/ blanket- child
crying- mother and father. (Mine didn't have a middle age woman bleeding,
instead it had an old man wandering and
correct order is: wandering old man, woman w/blanket, man holding baby,
and mother & father)
The nurse in the emergency department is using the simple triage and
rapid transport (START) system to assess victims of a hurricane. Which
statement correctly describes a yellow disaster tag?
A yellow disaster tag means critical injuries and require immediate
intervention.
What makes a baby frontal bulge or rises
crying
Which of the following is a nursing intervention for a 3-year-old client who is
going in for sugery in 8 hours
that has an order for fluid restriction?
Do not allow the child to drink fluids
The ear, where do u pull to give a ear drop
it a picture so look it up online (KNOW CHILD & ADULT) (pull the pinnae
top side of ear; u can look at a picture to see exactly where pinnae is)
(Mine had a picture of ear and put it on the lobule of the pinnae it is the ear
lobe). The eye picture asked to find the macula or the fovea centralis (there
are 2 prominent spots on the eye - choose the DARK spot to the left not the
spot where the light is)
Know your serum levels?
, K- 3.5-5.1,
Na - 135-145,
Ca 9-11,
BUN - 10-20
When to use drug for motion sickness drug question
Take Zofran 4 hours before going on trip via sea.
Pt with DM
she states that she has to eat lunch rite after the gets her insulin to prevent
going to hypoglycemia
Electrical burn pt
put him in a cardiac telemetry monitor
Which discharge instruction has the greatest priority for the mother of a 6-
year-old who was diagnosed with
Type 1 diabetes mellitus one week ago?
"Always carry a quick source of sugar
A nurse working on a mental health unit where a diagnosis of bulimia
nervosa is being admitted. Which of the following symptoms would the
nurse most likely NOT expect to find with this client?
severe over-or under-weight
The charge nurse is developing the nursing guidelines for a coronary care
unit. Which references is likely to be the most useful in developing these
guidelines?
The Scope of Standards of Practice from the American Nurses Association
Which assessment finding indicates a client's readiness to leave the
nursing unit for a Bronchoscopy?
On-call sedation administered.
A nurse-manager is preparing an annual budget for the unit. Nursing
salaries should be included in which component of the budget?
Operating budget
The nurse has not finished administering routine oral medication because
on e client experienced chest pain and another rectal bleeding. It is now
dinner time and two clients must be fed. The unlicensed assistive
personnel (UAP) is filling water pitchers and the practical nurse (PN) is
charting vital signs. Which change in assignments is best for the team
leader to make?
UAP feed the two clients, PN finish oral medications and RN monitor clients
with chest pain and rectal bleeding
What is manntiol drug used for?
To promote diuresis in prevention and treatment of oliguric phase of renal
failure, ICP, IOP, edema in CHF.
Bank; A+ Rated Guide (2022)
. A client is receiving a continuous half strength tube feeding at 50ml/hour.
To prepare enough of the solution for eight hours, how many ml of full
strength feeding will the nurse need? (Enter numeric value only.)
200ml . 25 ml of full strength feeding mixed with 25ml of water provided
50ml of half strength. 25ml × 8 hours= 200ml
An elderly male client is experiencing urinary incontinence. What is the best
initial nursing action?
Apply an external condom catheter
3. A male Muslim client with pneumonia is scheduled to receive a dose of
an intravenous antibiotic but refuses to allow the nurse to begin the
medication, stating he cannot allow fluids to enter his body once he is
cleansed for prayer. What action should the nurse implement?
Reschedule administration of the antibiotic until after he completes his
prayers
UAP using a hand sanitzers that is alcohol for 2 minutes
tell that hand sanitizer use is less > 2min
5.A child is to receive vancomycin (Vancocin) 40 mg/kg IV one hour before
a scheduled procedure. The child weighs 44 pounds. How many mg of the
medication should the nurse administer
Answer: 800 Rationale: First, convert the child's weight to kg: 44 pounds
divided by
2.2pound/kg = 20 kg. Next calculate the mg/kg/dose, 40 mg x 20 kg =
800mg
6. While assisting a postpartum client with perineal care, the nurse notes
that her vaginal bleeding spurts rather than trickles from the vagina. The
uterine fundus is firm and the client's vital signs are pulse 88 beats/minute;
respiratory rate, 21 breaths/minute; and blood pressure, 104/68 mmHg.
What action should the nurse take next?
Compare current vital signs with previous vital signs
,A 6-year old boy was hit with a bat while playing at school. He has a
splinter of wood imbedded in his eye. Which action should the school nurse
take?
Have the parent take the child for emergency help
Within four weeks of childbirth, a client is admitted to the hospital for
disorganized speech bizarre behavior, and strange thoughts about her
infant being possessed by demons. The nurse identifies a nursing
diagnosis of "Altered thought processes, secondary to" what condition?
Postpartum psychosis
The nurse identifies a priority diagnosis of, "Altered comfort related to
menstrual cramps" for a 25-year-old female client. Which self-care activity
should the nurse emphasize in the client's teaching plan?
Regular aerobic exercise.
Psych/Alcohol/Tylenol overdose antidote
Give Mucomyst
Medical Surgical/Laxative abuses
Patient -taking Milk of Magnesium
Spiritual/Documentation
Native American - Allow pt's family to stay in the room
Leadership- Interpreter informed consent
Pt should sign the consent
Geriatrics/Emergency Rib fractures fall
Pulmonary embolism
A client diagnosed with major depression is being allowed a weekend pass
from the psychiatric unit. Which instruction should the nurse provide to the
client's family?
Involve the client in usual at home activities
Upon assessment, the nurse discovers that a postpartum client has
persistent red lochia.
Which of the following does this assessment finding suggest to the nurse?
Coagulation disorders
The healthcare provider performs peritoneal dialysis on a client, after which
2 liters of fluid is drained. What action should the nurse complete first?
Assess vital signs.
After administering a medication through a nasogastric tube connected to
suction, what action should the nurse take first?
Clamp the tube
The nurse is caring for four clients: Client A 94% o2 saturation, Client B,
hemoglobin of 8.;
,Client C, potassium level of 3.8 and Client D appendectomy who has a
white blood cell count of 15,000. What
should the nurse implement?
Determine if Client B has two units of packed cells available in the blood
bank.
Triage question with a train wreck The psychiatric nurse is called to a train
derailment that was likely caused by a terrorist bomb. In triaging those in
need of immediate care, what is the priority ranking for these cases?
(arrange these cases in order or priority with the top item requiring the most
immediate care and the bottom item requiring the least priority care)
A mother and father have just arrived on the .
A crying child being held by another passenger. A woman sitting on the
ground with a blanket.
A middle-aged man who is wandering around
(arrange in order) = middle age woman bleeding- woman w/ blanket- child
crying- mother and father. (Mine didn't have a middle age woman bleeding,
instead it had an old man wandering and
correct order is: wandering old man, woman w/blanket, man holding baby,
and mother & father)
The nurse in the emergency department is using the simple triage and
rapid transport (START) system to assess victims of a hurricane. Which
statement correctly describes a yellow disaster tag?
A yellow disaster tag means critical injuries and require immediate
intervention.
What makes a baby frontal bulge or rises
crying
Which of the following is a nursing intervention for a 3-year-old client who is
going in for sugery in 8 hours
that has an order for fluid restriction?
Do not allow the child to drink fluids
The ear, where do u pull to give a ear drop
it a picture so look it up online (KNOW CHILD & ADULT) (pull the pinnae
top side of ear; u can look at a picture to see exactly where pinnae is)
(Mine had a picture of ear and put it on the lobule of the pinnae it is the ear
lobe). The eye picture asked to find the macula or the fovea centralis (there
are 2 prominent spots on the eye - choose the DARK spot to the left not the
spot where the light is)
Know your serum levels?
, K- 3.5-5.1,
Na - 135-145,
Ca 9-11,
BUN - 10-20
When to use drug for motion sickness drug question
Take Zofran 4 hours before going on trip via sea.
Pt with DM
she states that she has to eat lunch rite after the gets her insulin to prevent
going to hypoglycemia
Electrical burn pt
put him in a cardiac telemetry monitor
Which discharge instruction has the greatest priority for the mother of a 6-
year-old who was diagnosed with
Type 1 diabetes mellitus one week ago?
"Always carry a quick source of sugar
A nurse working on a mental health unit where a diagnosis of bulimia
nervosa is being admitted. Which of the following symptoms would the
nurse most likely NOT expect to find with this client?
severe over-or under-weight
The charge nurse is developing the nursing guidelines for a coronary care
unit. Which references is likely to be the most useful in developing these
guidelines?
The Scope of Standards of Practice from the American Nurses Association
Which assessment finding indicates a client's readiness to leave the
nursing unit for a Bronchoscopy?
On-call sedation administered.
A nurse-manager is preparing an annual budget for the unit. Nursing
salaries should be included in which component of the budget?
Operating budget
The nurse has not finished administering routine oral medication because
on e client experienced chest pain and another rectal bleeding. It is now
dinner time and two clients must be fed. The unlicensed assistive
personnel (UAP) is filling water pitchers and the practical nurse (PN) is
charting vital signs. Which change in assignments is best for the team
leader to make?
UAP feed the two clients, PN finish oral medications and RN monitor clients
with chest pain and rectal bleeding
What is manntiol drug used for?
To promote diuresis in prevention and treatment of oliguric phase of renal
failure, ICP, IOP, edema in CHF.
