Exit HESI (Testing, Leadership,
Advanced Clinical Concepts, and
Medical-Surgical) Questions and
Answers 2023
Examples of negative style questions
"Which response should the nurse question?"
"Which response indicates the nurse needs to reteach the patient?"
Note: most questions on the HESI are written in positive style, not negative
How to determine priority for answers
In addition to ADPIE, ABC, and picking the least invasive intervention first, you can use Maslow's
hierarchy of needs to set priorities for what should be done first
1. Physiological: food, water, warmth, rest
2. Safety: safety and security
3. Belonging and love: intimate relationships and friends
4. Esteem: prestige, feelings of accomplishment, and self-image
5. Self-actualization: utilizing one's full potential, morality, spontaneity, creativity, etc.
Explaining procedures to clients
Remember, the nurse cannot explain it first... It needs to be the healthcare provider. The RN's
responsibility is that the informed consent form is signed, but not to ensure the patient understands. If
the patient has questions about a procedure before signing, the HCP needs to come back to further
explain
Good Samaritan Act
This protects health practitioners against malpractice claims for care provided in emergency situations
(i.e. a nurse giving CPR at the site of a car accident)
Use of restraints
Restraints of any kind may constitute false imprisonment if used incorrectly. Clients may only be
restrained in an emergency, for a limited time, or for the purpose of protecting the client from injury or
harm
What types of procedures should be assigned to a professional nurse?
Sterile or invasive procedures
,Note: the test uses the acronym UAP, meaning unlicensed assistive personnel. These would be examples
of people who are not professional nurses and could not carry out such procedures
What actions should a nurse take if he or she questions a health care provider's prescription and
believes it to be wrong?
Inform the HCP; record that the HCP was informed and what his or her response was to that
information; inform nursing supervisor; refuse to carry out prescription
UAPs
Unlicensed assistive personnel cannot be given tasks that require the use of these parts of the nursing
process: assessments (like actual assessing the patient, not vital signs), analysis, diagnosis, planning, and
evaluation. Delegated activities would fall within the "implementation" phase
More on prioritization
Which client is the most critically ill?
Which client is most likely to experience a significant change in condition?
Which client requires an assessment by an RN?
What is ARDS?
An unexpected, catastrophic pulmonary complication occurring in a person with no previous pulmonary
problems. Client are critically ill and managed in intensive care setting. Mortality rate is 50%
Prevent complications of clients on mechanical ventilation with ARDS
-Elevate HOB ≥ 30º
-Assist with sedation vacations
-Implement comprehensive oral hygiene
-Implement comprehensive mobilization program
Frequency of suctioning
Suction only when secretions are present (but assess need for suctioning q2h)
What test is done before drawing ABGs?
Allen's test for collateral circulation and arterial patency
Signs of acute respiratory failure in children
Restlessness, tachypnea, tachycardia, and diaphoresis
-A child in severe distress should be on 100% O2
Respiratory failure lab values
PCO2>45 or PO2<60 on 50% O2 signifies respiratory failure
Four common causes of respiratory failure in children
, Congenital heart disease, infection or sepsis, respiratory distress syndrome, aspiration, fluid overload, or
dehydration
Early signs of shock
Agitation and restlessness (resulting from cerebral hypoxia)
Pathophysiology of shock
Leads to widespread cellular injury and impairs the integrity of the capillary membranes. Fluid and
osmotic proteins seep into the extravascular spaces, further reducing cardiac output. If all organs are
damaged from decreased perfusion, the damage could be permanent.
Note: systemic inflammatory response syndrome (SIRS) as a result of the shock can lead to that organ
damage, also known as multiple organ dysfunction syndrome (MODS)
Cardiogenic shock with pulmonary edema
If the cardiogenic shock is from pump failure (presents with pulmonary edema), position the client in
high Fowler's to decrease further venous return to the left ventricle
Common vasopressors used in shock
Epinephrine (Bronkaid), dopamine (Intropin), dobutamine (Dobutrex), norepinephrine (Levophed), or
isoproterenol (Isuprel)
Minimum renal output per hour
30 mL/hr
When to seek emergency medical services for cardiac arrest?
Chest pain does not immediately go away with rest or is not relieved in 5 minutes after taking
nitroglycerin. Also, if the chest pain is accompanied by additional symptoms like nausea or sweating.
Someone with previously unrecognized coronary disease experiencing chest pain for 2 minutes or longer
should seek EMS
Pulseless arrest common causes (that need to be treated to fix the code)
Hypovolemia, hypoxia, hydrogen ion acidosis, hypokalemia, hyperkalemia, hypoglycemia, hypothermia,
toxins, tamponade (cardiac), tension pneumothorax, thrombosis (cardiac or pulmonary), and trauma
Potassium imbalances
Life threatening and should be corrected immediately. Usually accompanied by low magnesium,
especially when diuretics are used
BUN
BUN measures the amount of urea nitrogen in blood. Urea is formed in the liver as the end product of
protein metabolism. BUN is directly related to metabolic function of the liver and the excretory function
of the kidneys
Advanced Clinical Concepts, and
Medical-Surgical) Questions and
Answers 2023
Examples of negative style questions
"Which response should the nurse question?"
"Which response indicates the nurse needs to reteach the patient?"
Note: most questions on the HESI are written in positive style, not negative
How to determine priority for answers
In addition to ADPIE, ABC, and picking the least invasive intervention first, you can use Maslow's
hierarchy of needs to set priorities for what should be done first
1. Physiological: food, water, warmth, rest
2. Safety: safety and security
3. Belonging and love: intimate relationships and friends
4. Esteem: prestige, feelings of accomplishment, and self-image
5. Self-actualization: utilizing one's full potential, morality, spontaneity, creativity, etc.
Explaining procedures to clients
Remember, the nurse cannot explain it first... It needs to be the healthcare provider. The RN's
responsibility is that the informed consent form is signed, but not to ensure the patient understands. If
the patient has questions about a procedure before signing, the HCP needs to come back to further
explain
Good Samaritan Act
This protects health practitioners against malpractice claims for care provided in emergency situations
(i.e. a nurse giving CPR at the site of a car accident)
Use of restraints
Restraints of any kind may constitute false imprisonment if used incorrectly. Clients may only be
restrained in an emergency, for a limited time, or for the purpose of protecting the client from injury or
harm
What types of procedures should be assigned to a professional nurse?
Sterile or invasive procedures
,Note: the test uses the acronym UAP, meaning unlicensed assistive personnel. These would be examples
of people who are not professional nurses and could not carry out such procedures
What actions should a nurse take if he or she questions a health care provider's prescription and
believes it to be wrong?
Inform the HCP; record that the HCP was informed and what his or her response was to that
information; inform nursing supervisor; refuse to carry out prescription
UAPs
Unlicensed assistive personnel cannot be given tasks that require the use of these parts of the nursing
process: assessments (like actual assessing the patient, not vital signs), analysis, diagnosis, planning, and
evaluation. Delegated activities would fall within the "implementation" phase
More on prioritization
Which client is the most critically ill?
Which client is most likely to experience a significant change in condition?
Which client requires an assessment by an RN?
What is ARDS?
An unexpected, catastrophic pulmonary complication occurring in a person with no previous pulmonary
problems. Client are critically ill and managed in intensive care setting. Mortality rate is 50%
Prevent complications of clients on mechanical ventilation with ARDS
-Elevate HOB ≥ 30º
-Assist with sedation vacations
-Implement comprehensive oral hygiene
-Implement comprehensive mobilization program
Frequency of suctioning
Suction only when secretions are present (but assess need for suctioning q2h)
What test is done before drawing ABGs?
Allen's test for collateral circulation and arterial patency
Signs of acute respiratory failure in children
Restlessness, tachypnea, tachycardia, and diaphoresis
-A child in severe distress should be on 100% O2
Respiratory failure lab values
PCO2>45 or PO2<60 on 50% O2 signifies respiratory failure
Four common causes of respiratory failure in children
, Congenital heart disease, infection or sepsis, respiratory distress syndrome, aspiration, fluid overload, or
dehydration
Early signs of shock
Agitation and restlessness (resulting from cerebral hypoxia)
Pathophysiology of shock
Leads to widespread cellular injury and impairs the integrity of the capillary membranes. Fluid and
osmotic proteins seep into the extravascular spaces, further reducing cardiac output. If all organs are
damaged from decreased perfusion, the damage could be permanent.
Note: systemic inflammatory response syndrome (SIRS) as a result of the shock can lead to that organ
damage, also known as multiple organ dysfunction syndrome (MODS)
Cardiogenic shock with pulmonary edema
If the cardiogenic shock is from pump failure (presents with pulmonary edema), position the client in
high Fowler's to decrease further venous return to the left ventricle
Common vasopressors used in shock
Epinephrine (Bronkaid), dopamine (Intropin), dobutamine (Dobutrex), norepinephrine (Levophed), or
isoproterenol (Isuprel)
Minimum renal output per hour
30 mL/hr
When to seek emergency medical services for cardiac arrest?
Chest pain does not immediately go away with rest or is not relieved in 5 minutes after taking
nitroglycerin. Also, if the chest pain is accompanied by additional symptoms like nausea or sweating.
Someone with previously unrecognized coronary disease experiencing chest pain for 2 minutes or longer
should seek EMS
Pulseless arrest common causes (that need to be treated to fix the code)
Hypovolemia, hypoxia, hydrogen ion acidosis, hypokalemia, hyperkalemia, hypoglycemia, hypothermia,
toxins, tamponade (cardiac), tension pneumothorax, thrombosis (cardiac or pulmonary), and trauma
Potassium imbalances
Life threatening and should be corrected immediately. Usually accompanied by low magnesium,
especially when diuretics are used
BUN
BUN measures the amount of urea nitrogen in blood. Urea is formed in the liver as the end product of
protein metabolism. BUN is directly related to metabolic function of the liver and the excretory function
of the kidneys
