2024 RN HESI EXIT Exam V2 WITH QUESTION AND VERIFIED ANSWERS
GRADED A+
1. The nurse assumes care of a postoperative adult client with type 2 diabetes
mellitus and learns that the client has a current blood glucose level of 720
mg/dL. When assessing the client, what is the priority?
A. Assess for signs of fluid volume deficit
B. Observe wound drainage characteristics
C. Measure the level of acute pain
D. Determine when the client last ate: A. Assess for signs of fluid volume deficit
2. A male client tells the nurse that he is concerned that he may have a stomach
ulcer, because he is experiencing heartburn and dull gnawing pain that is
relieved when he eats. Which is the best response by the nurse?
A. Encourage the client to obtain a complete physical exam, since these
symptoms are consistent with an ulcer
B. Assure the client that his symptoms may only reflect reflux, since ulcer pain
is not relieved with food
C. Instruct the client that these mild symptoms can generally be controlled
with changes in his diet
D. Advise the client that he needs to seek immediate medical evaluation
and treatment of these symptoms: A. Encourage the client to obtain a complete
physical exam, since these symptoms are consistent with an ulcer
3. A male client with stomach cancer returns to the unit following a total
,gastrectomy. He has a nasogastric tube to suction and is receiving Lactated
Ringer's solution at 75 mL/hr IV. One hour after admission to the unit, the nurse
notes 300mL of blood in the suction canister, the client's heart rate is 155
beats/minute, and his blood pressure is 78/48 mmHg. In addition to reporting
the findings to the surgeon, which action should the nurse implement first?
A. Measure and document the client's urinary output
B. Request the client's reserved unit of packed red blood cells
C. Prepare for placement of a central venous catheter
D. Increase the infusion rate of Lactated Ringer's solution: D. Increase the
infusion rate of Lactated Ringer's solution
4. A heparin infusion is prescribed for a client who weighs 220 pounds. After
administering a bolus dose of 80 units/kg, the nurse calculates the infusion
rate for the heparin solution as 18 units/kg/hour. The available solution is He-
parin Sodium 25,000 Units in 5% Dextrose Injection 250 mL. The nurse should
program the infusion pump to deliver how many mL/hour?: -1st: calculate the
weight = 220/2.2= 100kg
-Then calculate total dose in units = 18units x 100kg = 1800 units/hr
- 25000 units - in 250
,1800 units ---in X ml
x = 1800 x 250/25000 =18 mL/hr
5. An adult male who fell 20 feet from the roof of his home has multiple injuries,
including a right pneumothorax. Chest tubes were inserted in the emergency
department prior to his transfer to the intensive care unit (ICU). The nurse
notes that the suction control chamber is bubbling at the -10cm H2O mark,
which fluctuation in the water seal, and over the past hour 75 mL of bright red
blood is measured in the collection chamber. Which intervention should the
nurse implement?
A. Add sterile water to the suction control chamber
B. Give blood from the collection chamber as autotransfusion
C. Manipulate blood in tubing to drain into chamber
D. Increase wall suction to eliminate fluctuation in water seal: A. Add sterile
water to the suction control chamber
6. An adult male was diagnosed with stage IV lung cancer three weeks ago.
His wife approaches the nurse and asks how she will know that her husband's
death is imminent because their two adult children want to be there when he
dies. Which is the best response by the nurse?
A. Gather information regarding how long it will take for the children to arrive
B. Explain that the client will start to lose consciousness and the body sys-
tems will slow down
C. Reassure the spouse that the healthcare provider will notify when to call the
children
D. Offer to discuss the client's health status with each of the adult children: B.
Explain that the client will start to lose consciousness and the body systems will
, slow down
7. The charge nurse of a critical care unit is informed at the beginning of the
shift that less than the optimal number of registered nurses will be working
that shift. In planning assignments, which client should receive the most care
hours by a registered nurse (RN)?
A. A 48-year-old marathon runner with a central venous catheter who is
experiencing nausea and vomiting due to electrolyte disturbance following a
race
B. A 34-year-old admitted today after an emergency appendectomy who has a
peripheral intravenous catheter and a Foley catheter
C. A 63-year-old chain smoker admitted with chronic bronchitis who is receiv-
ing oxygen via nasal cannula and has a saline-locked peripheral intravenous
catheter
D. An 82-year-old client with Alzheimer's disease and a newly-fractured femur
GRADED A+
1. The nurse assumes care of a postoperative adult client with type 2 diabetes
mellitus and learns that the client has a current blood glucose level of 720
mg/dL. When assessing the client, what is the priority?
A. Assess for signs of fluid volume deficit
B. Observe wound drainage characteristics
C. Measure the level of acute pain
D. Determine when the client last ate: A. Assess for signs of fluid volume deficit
2. A male client tells the nurse that he is concerned that he may have a stomach
ulcer, because he is experiencing heartburn and dull gnawing pain that is
relieved when he eats. Which is the best response by the nurse?
A. Encourage the client to obtain a complete physical exam, since these
symptoms are consistent with an ulcer
B. Assure the client that his symptoms may only reflect reflux, since ulcer pain
is not relieved with food
C. Instruct the client that these mild symptoms can generally be controlled
with changes in his diet
D. Advise the client that he needs to seek immediate medical evaluation
and treatment of these symptoms: A. Encourage the client to obtain a complete
physical exam, since these symptoms are consistent with an ulcer
3. A male client with stomach cancer returns to the unit following a total
,gastrectomy. He has a nasogastric tube to suction and is receiving Lactated
Ringer's solution at 75 mL/hr IV. One hour after admission to the unit, the nurse
notes 300mL of blood in the suction canister, the client's heart rate is 155
beats/minute, and his blood pressure is 78/48 mmHg. In addition to reporting
the findings to the surgeon, which action should the nurse implement first?
A. Measure and document the client's urinary output
B. Request the client's reserved unit of packed red blood cells
C. Prepare for placement of a central venous catheter
D. Increase the infusion rate of Lactated Ringer's solution: D. Increase the
infusion rate of Lactated Ringer's solution
4. A heparin infusion is prescribed for a client who weighs 220 pounds. After
administering a bolus dose of 80 units/kg, the nurse calculates the infusion
rate for the heparin solution as 18 units/kg/hour. The available solution is He-
parin Sodium 25,000 Units in 5% Dextrose Injection 250 mL. The nurse should
program the infusion pump to deliver how many mL/hour?: -1st: calculate the
weight = 220/2.2= 100kg
-Then calculate total dose in units = 18units x 100kg = 1800 units/hr
- 25000 units - in 250
,1800 units ---in X ml
x = 1800 x 250/25000 =18 mL/hr
5. An adult male who fell 20 feet from the roof of his home has multiple injuries,
including a right pneumothorax. Chest tubes were inserted in the emergency
department prior to his transfer to the intensive care unit (ICU). The nurse
notes that the suction control chamber is bubbling at the -10cm H2O mark,
which fluctuation in the water seal, and over the past hour 75 mL of bright red
blood is measured in the collection chamber. Which intervention should the
nurse implement?
A. Add sterile water to the suction control chamber
B. Give blood from the collection chamber as autotransfusion
C. Manipulate blood in tubing to drain into chamber
D. Increase wall suction to eliminate fluctuation in water seal: A. Add sterile
water to the suction control chamber
6. An adult male was diagnosed with stage IV lung cancer three weeks ago.
His wife approaches the nurse and asks how she will know that her husband's
death is imminent because their two adult children want to be there when he
dies. Which is the best response by the nurse?
A. Gather information regarding how long it will take for the children to arrive
B. Explain that the client will start to lose consciousness and the body sys-
tems will slow down
C. Reassure the spouse that the healthcare provider will notify when to call the
children
D. Offer to discuss the client's health status with each of the adult children: B.
Explain that the client will start to lose consciousness and the body systems will
, slow down
7. The charge nurse of a critical care unit is informed at the beginning of the
shift that less than the optimal number of registered nurses will be working
that shift. In planning assignments, which client should receive the most care
hours by a registered nurse (RN)?
A. A 48-year-old marathon runner with a central venous catheter who is
experiencing nausea and vomiting due to electrolyte disturbance following a
race
B. A 34-year-old admitted today after an emergency appendectomy who has a
peripheral intravenous catheter and a Foley catheter
C. A 63-year-old chain smoker admitted with chronic bronchitis who is receiv-
ing oxygen via nasal cannula and has a saline-locked peripheral intravenous
catheter
D. An 82-year-old client with Alzheimer's disease and a newly-fractured femur
