HESI PN EXIT V1 AND V2 NEWEST 2024 ACTUAL EXAM
ALL 320 AND CORRECT DETAILED ANSWERS WITH
RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED
A+
The home health practical nurse is visiting with a client who has a
history of second degree heart block and pacemaker placement
six months ago. Which symptom compliant by the client would be
indicative of pacemaker failure?
A. Facial flushing
B. Nausea
C. Pounding headache
D. Feelings of dizziness - ANSWER-D. Feelings of dizziness
Rationale: Feelings of dizziness may occur as the result of a
decreased heart rate, leading to decreased cardiac output as
a result of pacemaker failure.
A client diagnosed with emphysema that is oxygen-dependent
lives alone at home and manages self-care with no difficulty.
Which finding should prompt the home health practical nurse to
consult the registered nurse case manager?
A. A pulse oximetry reading of 91% on oxygen at 2/lpm.
B. A weight loss of five pounds since the last monthly home visit
, HESI PN EXIT V1 AND V2 NEWEST 2024 ACTUAL EXAM
ALL 320 AND CORRECT DETAILED ANSWERS WITH
RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED
A+
C. The client states the need to increase their oxygen at night
when lying down.
D. Upon entering the home, the PN noticed dirty dishes and
clothing scattered around the home. - ANSWER-B. A weight loss
of five pounds since the last monthly home visit
Rationale: A weight loss of five pounds in 1 month is a
concern. Clients with COPD need additional calorie intake
because they are using up a lot from the energy they are
using to breath. The practical nurse needs to consult with the
registered nurse case manager for a Nutrition Consult.
A client is diagnosed with acute myocardial infarction (MI). Which
diagnostic laboratory value should the practical nurse (PN)
anticipate to be the first to elevate to establish a diagnosis of an
acute myocardial infarction (MI)?
A. Elevated troponin
B. Elevated creatine kinase-MB (CK-MB) level
C. Prolonged prothrombin time (PT)
D. Elevated serum blood urea nitrogen (BUN) and creatinin -
ANSWER-A. Elevated troponin
, HESI PN EXIT V1 AND V2 NEWEST 2024 ACTUAL EXAM
ALL 320 AND CORRECT DETAILED ANSWERS WITH
RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED
A+
Rationale: Tissue damage in the myocardium causes the
release of cardiac enzymes into the blood system. According
the American College of Cardiology (ACS) and the European
Society of cardiology (ESC), an elevation of the troponin will
occur within 2 to 3 hours of an MI and is use to establish the
diagnosis. It takes the CK-MB level 6 to 9 hours or longer to
elevate.
A client sustained a burn injury greater than 25% of total body
surface with majority of it lower extremities during a house fire.
During the acute phase of care, which intervention is MOST
important for the practical nurse to implement?
A. Administer 0.5 mL of tetanus toxoid IM.
B. Offer high-protein supplemental feedings.
C. Perform active range-of-motion exercises.
D. Application of compression stockings and ambulation. -
ANSWER-A. Administer 0.5 mL of tetanus toxoid IM
Q: Which intervention is MOST important to implement during the
acute care phase? Eliminate incorrect choices, D then decide
which choices apply to acute care phase.
, HESI PN EXIT V1 AND V2 NEWEST 2024 ACTUAL EXAM
ALL 320 AND CORRECT DETAILED ANSWERS WITH
RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED
A+
Rationale: Prevention of infection from Clostridium tetani by
administering tetanus toxoid has the highest priority for care
of a client in the acute phase of burn care.
An elderly client with a history of cardiac disease is admitted to
the hospital. Since admission, the client has been confused and
complaining about muscle cramps and has vomited twice. The
client's vital signs are BP 130/70, P-47, and R-18. Which
medication in the client's HISTORY should the practical nurse
(PN) be MOST concerned?
A. Warfarin
B. Ibuprofen
C. Nitroglycerine
D. Digitalis - ANSWER-D. Digitalis
Rationale: Elderly clients are particularly susceptible to the
accumulation and toxicity of cardiac glycosides, such as
digoxin or digitoxin (digitalis derivatives). Toxicity can cause
anorexia, nausea, vomiting, diarrhea, headache, muscle
cramps, and fatigue.
ALL 320 AND CORRECT DETAILED ANSWERS WITH
RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED
A+
The home health practical nurse is visiting with a client who has a
history of second degree heart block and pacemaker placement
six months ago. Which symptom compliant by the client would be
indicative of pacemaker failure?
A. Facial flushing
B. Nausea
C. Pounding headache
D. Feelings of dizziness - ANSWER-D. Feelings of dizziness
Rationale: Feelings of dizziness may occur as the result of a
decreased heart rate, leading to decreased cardiac output as
a result of pacemaker failure.
A client diagnosed with emphysema that is oxygen-dependent
lives alone at home and manages self-care with no difficulty.
Which finding should prompt the home health practical nurse to
consult the registered nurse case manager?
A. A pulse oximetry reading of 91% on oxygen at 2/lpm.
B. A weight loss of five pounds since the last monthly home visit
, HESI PN EXIT V1 AND V2 NEWEST 2024 ACTUAL EXAM
ALL 320 AND CORRECT DETAILED ANSWERS WITH
RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED
A+
C. The client states the need to increase their oxygen at night
when lying down.
D. Upon entering the home, the PN noticed dirty dishes and
clothing scattered around the home. - ANSWER-B. A weight loss
of five pounds since the last monthly home visit
Rationale: A weight loss of five pounds in 1 month is a
concern. Clients with COPD need additional calorie intake
because they are using up a lot from the energy they are
using to breath. The practical nurse needs to consult with the
registered nurse case manager for a Nutrition Consult.
A client is diagnosed with acute myocardial infarction (MI). Which
diagnostic laboratory value should the practical nurse (PN)
anticipate to be the first to elevate to establish a diagnosis of an
acute myocardial infarction (MI)?
A. Elevated troponin
B. Elevated creatine kinase-MB (CK-MB) level
C. Prolonged prothrombin time (PT)
D. Elevated serum blood urea nitrogen (BUN) and creatinin -
ANSWER-A. Elevated troponin
, HESI PN EXIT V1 AND V2 NEWEST 2024 ACTUAL EXAM
ALL 320 AND CORRECT DETAILED ANSWERS WITH
RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED
A+
Rationale: Tissue damage in the myocardium causes the
release of cardiac enzymes into the blood system. According
the American College of Cardiology (ACS) and the European
Society of cardiology (ESC), an elevation of the troponin will
occur within 2 to 3 hours of an MI and is use to establish the
diagnosis. It takes the CK-MB level 6 to 9 hours or longer to
elevate.
A client sustained a burn injury greater than 25% of total body
surface with majority of it lower extremities during a house fire.
During the acute phase of care, which intervention is MOST
important for the practical nurse to implement?
A. Administer 0.5 mL of tetanus toxoid IM.
B. Offer high-protein supplemental feedings.
C. Perform active range-of-motion exercises.
D. Application of compression stockings and ambulation. -
ANSWER-A. Administer 0.5 mL of tetanus toxoid IM
Q: Which intervention is MOST important to implement during the
acute care phase? Eliminate incorrect choices, D then decide
which choices apply to acute care phase.
, HESI PN EXIT V1 AND V2 NEWEST 2024 ACTUAL EXAM
ALL 320 AND CORRECT DETAILED ANSWERS WITH
RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED
A+
Rationale: Prevention of infection from Clostridium tetani by
administering tetanus toxoid has the highest priority for care
of a client in the acute phase of burn care.
An elderly client with a history of cardiac disease is admitted to
the hospital. Since admission, the client has been confused and
complaining about muscle cramps and has vomited twice. The
client's vital signs are BP 130/70, P-47, and R-18. Which
medication in the client's HISTORY should the practical nurse
(PN) be MOST concerned?
A. Warfarin
B. Ibuprofen
C. Nitroglycerine
D. Digitalis - ANSWER-D. Digitalis
Rationale: Elderly clients are particularly susceptible to the
accumulation and toxicity of cardiac glycosides, such as
digoxin or digitoxin (digitalis derivatives). Toxicity can cause
anorexia, nausea, vomiting, diarrhea, headache, muscle
cramps, and fatigue.
