HESI Exit RN V4 LATEST VERSION WITH
WELL ELABORATED QUESTIONS AND
A+VERIFIED ACCURATE ANSWERS
1. A client is discharged following hospitalization for congestive heart failure. The nurse
teaching the family suggests they encourage the client to rest frequently in which of the
following positions?
A) High Fowler's
B) Supine
C) Left lateral
D) Low Fowler's - CORRECT ANSWER A: High Fowler’s
2. A nurse who is evaluating a mentally retarded 2 year-olds in a clinic should stress
which goal when talking to the child's mother?
A) Teaching the child self-care skills
B) Preparing for independent toileting
C) Promoting the child's optimal development
D) Helping the family decide on long term care - CORRECT ANSWER C: Promoting
the child''s optimal development
3. The nurse is caring for a client with trigeminal neuralgia (ticdouloureaux). To assist
the client with nutrition needs, the nurse should
A) Offer small meals of high calorie soft food
B) Assist the client to sit in a chair for meals
C) Provide additional servings of fruits and raw vegetables
D) Encourage the client to eat fish, liver and chicken - CORRECT ANSWER A: Offer
small meals of high calorie soft food
4. The nurse is assessing a 2-year-old client with a possible diagnosis of congenital
heart disease. Which of these is most likely to be seen with this diagnosis?
A) Several otitis media episodes in the last year
B) Weight and height in 10th percentile since birth
C) Takes frequent rest periods while playing
D) Changing food preferences and dislikes - CORRECT ANSWER C: Takes frequent
rest periods while playing
5. The nurse is caring for a 10 year-old on admission to the burn unit. One assessment
parameter that will indicate that the child has adequate fluid replacement is
,A) Urinary output of 30 ml per hour
B) No complaints of thirst
C) Increased hematocrit
D) Good skin turgor around burn - CORRECT ANSWER A: Urinary output of 30 ml
per hour
6. Upon examining the mouth of a 3-year-old child, the nurse discovers that the teeth
have chalky white-to-yellowish staining with pitting of the enamel. Which of the following
conditions would most likely explain these findings?
A) Ingestion of tetracycline
B) Excessive fluoride intake
C) Oral iron therapy
D) Poor dental hygiene - CORRECT ANSWER B: Excessive fluoride intake
7. The nurse is reassigned to work at the Poison Control Center telephone hotline. In
which of these cases of childhood poisoning would the nurse suggest that parents have
the child drink orange juice?
A) An 18 month-old who ate an undetermined amount of crystal drain cleaner
B) A 14 month-old who chewed 2 leaves of a philodendron plant
C) A 20 month-old who is found sitting on the bathroom floor beside an empty bottle of
diazepam (Valium)
D) A 30 month-old who has swallowed a mouthful of charcoal lighter fluid - CORRECT
ANSWER A: An 18 month-old who ate an undetermined amount of crystal drain
cleaner
8. Which of these is an example of a variation in the newborn resulting from the
presence of maternal hormones?
A) Engorgement of the breasts
B) Mongolian spots
C) Edema of the scrotum
D) Lanugo - CORRECT ANSWER A: Engorgement of the breasts
9. A 2 month-old child has had a cleft lip repair. The selection of which restraint would
require no further action by the charge nurse?
A) Elbow
B) Mummy
C) Jacket
D) Clove hitch - CORRECT ANSWER A: Elbow
,10. A client treated for depression tells the nurse at the mental health clinic that he
recently purchased a handgun because he is thinking about suicide. The first nursing
action should be to
A) Notify the health care provider immediately
B) Suggest in-patient psychiatric care
C) Respect the client's confidential disclosure
D) Phone the family to warn them of the risk - CORRECT ANSWER A: Notify the
health care provider immediately
11. A client has just been admitted with portal hypertension. Which nursing diagnosis
would be a priority in planning care?
A) Altered nutrition: less than body requirements
B) Potential complication hemorrhage
C) Ineffective individual coping
D) Fluid volume excess - CORRECT ANSWER B: Potential complication
hemorrhage
12. While planning care for a 2 year-old hospitalized child, which situation would the
nurse expect to most likely affect the behavior?
A) Strange bed and surroundings
B) Separation from parents
C) Presence of other toddlers
D) Unfamiliar toys and games - CORRECT ANSWER B: Separation from parents
13. Which of the following should the nurse teach the client to avoid when taking
chlorpromazine HCL (Thomasine)?
A) Direct sunlight
B) Foods containing tyramine
C) Foods fermented with yeast
D) Canned citrus fruit drinks - CORRECT ANSWER A: Avoid direct sunlight
14. The initial response by the nurse to a delusional client who refuses to eat because
of a belief that the food is poisoned is
A) "You think that someone wants to poison you?"
B) "Why do you think the food is poisoned?"
C) "These feelings are a symptom of your illness."
D) "You're safe here. I won't let anyone poison you." - CORRECT ANSWER A: "You
think that someone wants to poison you?"
15. The nurse is caring for a client with cirrhosis of the liver with ascites. When
instructing nursing assistants in the care of the client, the nurse should emphasize that
, A) The client should remain on bed rest in a semi-Fowler's position
B) The client should alternate ambulation with bed rest with legs elevated
C) The client may ambulate and sit in chair as tolerated
D) The client may ambulate as tolerated and remain in semi-Fowler position in bed -
CORRECT ANSWER B: The client should alternate ambulation with bed rest with
legs elevated
16. The nurse is performing physical assessments on adolescents. When would the
nurse anticipate that females experience growth spurts?
A) About 2 years earlier than males
B) About the same time as males
C) Just prior to the onset of puberty
D) That increase height by 4 inches each year - CORRECT ANSWER A: About 2
years earlier than males
17. The nurse is caring for a pre-adolescent client in skeletal Dunlop traction. Which
nursing intervention is appropriate for this child?
A) Make certain the child is maintained in correct body alignment.
B) Be sure the traction weights touch the end of the bed.
C) Adjust the head and foot of the bed for the child's comfort
D) Release the traction for 15-20 minutes every 6 hours PRN. - CORRECT ANSWER
A: Make certain the child is maintained in correct body alignment.
18. The nurse is assessing a healthy child at the 2 year checkup. Which of the following
should the nurse report immediately to the health care provider?
A) Height and weight percentiles vary widely
B) Growth pattern appears to have slowed
C) Recumbent and standing height are different
D) Short term weight changes are uneven - CORRECT ANSWER A: Height and
weight percentiles vary widely
19. The parents of a 2-year-old child report that he has been holding his breath
whenever he has temper tantrums. What is the best action by the nurse?
A) Teach the parents how to perform cardiopulmonary resuscitation
B) Recommend that the parents give in when he holds his breath to prevent anoxia
C) Advise the parents to ignore breath holding because breathing will begin as a reflex
D) Instruct the parents on how to reason with the child about possible harmful effects -
CORRECT ANSWER C: Advise the parents to ignore breath holding because
breathing will begin as a reflex
20. The nurse is assessing a client in the emergency room. Which statement suggests
that the problem is acute angina?
WELL ELABORATED QUESTIONS AND
A+VERIFIED ACCURATE ANSWERS
1. A client is discharged following hospitalization for congestive heart failure. The nurse
teaching the family suggests they encourage the client to rest frequently in which of the
following positions?
A) High Fowler's
B) Supine
C) Left lateral
D) Low Fowler's - CORRECT ANSWER A: High Fowler’s
2. A nurse who is evaluating a mentally retarded 2 year-olds in a clinic should stress
which goal when talking to the child's mother?
A) Teaching the child self-care skills
B) Preparing for independent toileting
C) Promoting the child's optimal development
D) Helping the family decide on long term care - CORRECT ANSWER C: Promoting
the child''s optimal development
3. The nurse is caring for a client with trigeminal neuralgia (ticdouloureaux). To assist
the client with nutrition needs, the nurse should
A) Offer small meals of high calorie soft food
B) Assist the client to sit in a chair for meals
C) Provide additional servings of fruits and raw vegetables
D) Encourage the client to eat fish, liver and chicken - CORRECT ANSWER A: Offer
small meals of high calorie soft food
4. The nurse is assessing a 2-year-old client with a possible diagnosis of congenital
heart disease. Which of these is most likely to be seen with this diagnosis?
A) Several otitis media episodes in the last year
B) Weight and height in 10th percentile since birth
C) Takes frequent rest periods while playing
D) Changing food preferences and dislikes - CORRECT ANSWER C: Takes frequent
rest periods while playing
5. The nurse is caring for a 10 year-old on admission to the burn unit. One assessment
parameter that will indicate that the child has adequate fluid replacement is
,A) Urinary output of 30 ml per hour
B) No complaints of thirst
C) Increased hematocrit
D) Good skin turgor around burn - CORRECT ANSWER A: Urinary output of 30 ml
per hour
6. Upon examining the mouth of a 3-year-old child, the nurse discovers that the teeth
have chalky white-to-yellowish staining with pitting of the enamel. Which of the following
conditions would most likely explain these findings?
A) Ingestion of tetracycline
B) Excessive fluoride intake
C) Oral iron therapy
D) Poor dental hygiene - CORRECT ANSWER B: Excessive fluoride intake
7. The nurse is reassigned to work at the Poison Control Center telephone hotline. In
which of these cases of childhood poisoning would the nurse suggest that parents have
the child drink orange juice?
A) An 18 month-old who ate an undetermined amount of crystal drain cleaner
B) A 14 month-old who chewed 2 leaves of a philodendron plant
C) A 20 month-old who is found sitting on the bathroom floor beside an empty bottle of
diazepam (Valium)
D) A 30 month-old who has swallowed a mouthful of charcoal lighter fluid - CORRECT
ANSWER A: An 18 month-old who ate an undetermined amount of crystal drain
cleaner
8. Which of these is an example of a variation in the newborn resulting from the
presence of maternal hormones?
A) Engorgement of the breasts
B) Mongolian spots
C) Edema of the scrotum
D) Lanugo - CORRECT ANSWER A: Engorgement of the breasts
9. A 2 month-old child has had a cleft lip repair. The selection of which restraint would
require no further action by the charge nurse?
A) Elbow
B) Mummy
C) Jacket
D) Clove hitch - CORRECT ANSWER A: Elbow
,10. A client treated for depression tells the nurse at the mental health clinic that he
recently purchased a handgun because he is thinking about suicide. The first nursing
action should be to
A) Notify the health care provider immediately
B) Suggest in-patient psychiatric care
C) Respect the client's confidential disclosure
D) Phone the family to warn them of the risk - CORRECT ANSWER A: Notify the
health care provider immediately
11. A client has just been admitted with portal hypertension. Which nursing diagnosis
would be a priority in planning care?
A) Altered nutrition: less than body requirements
B) Potential complication hemorrhage
C) Ineffective individual coping
D) Fluid volume excess - CORRECT ANSWER B: Potential complication
hemorrhage
12. While planning care for a 2 year-old hospitalized child, which situation would the
nurse expect to most likely affect the behavior?
A) Strange bed and surroundings
B) Separation from parents
C) Presence of other toddlers
D) Unfamiliar toys and games - CORRECT ANSWER B: Separation from parents
13. Which of the following should the nurse teach the client to avoid when taking
chlorpromazine HCL (Thomasine)?
A) Direct sunlight
B) Foods containing tyramine
C) Foods fermented with yeast
D) Canned citrus fruit drinks - CORRECT ANSWER A: Avoid direct sunlight
14. The initial response by the nurse to a delusional client who refuses to eat because
of a belief that the food is poisoned is
A) "You think that someone wants to poison you?"
B) "Why do you think the food is poisoned?"
C) "These feelings are a symptom of your illness."
D) "You're safe here. I won't let anyone poison you." - CORRECT ANSWER A: "You
think that someone wants to poison you?"
15. The nurse is caring for a client with cirrhosis of the liver with ascites. When
instructing nursing assistants in the care of the client, the nurse should emphasize that
, A) The client should remain on bed rest in a semi-Fowler's position
B) The client should alternate ambulation with bed rest with legs elevated
C) The client may ambulate and sit in chair as tolerated
D) The client may ambulate as tolerated and remain in semi-Fowler position in bed -
CORRECT ANSWER B: The client should alternate ambulation with bed rest with
legs elevated
16. The nurse is performing physical assessments on adolescents. When would the
nurse anticipate that females experience growth spurts?
A) About 2 years earlier than males
B) About the same time as males
C) Just prior to the onset of puberty
D) That increase height by 4 inches each year - CORRECT ANSWER A: About 2
years earlier than males
17. The nurse is caring for a pre-adolescent client in skeletal Dunlop traction. Which
nursing intervention is appropriate for this child?
A) Make certain the child is maintained in correct body alignment.
B) Be sure the traction weights touch the end of the bed.
C) Adjust the head and foot of the bed for the child's comfort
D) Release the traction for 15-20 minutes every 6 hours PRN. - CORRECT ANSWER
A: Make certain the child is maintained in correct body alignment.
18. The nurse is assessing a healthy child at the 2 year checkup. Which of the following
should the nurse report immediately to the health care provider?
A) Height and weight percentiles vary widely
B) Growth pattern appears to have slowed
C) Recumbent and standing height are different
D) Short term weight changes are uneven - CORRECT ANSWER A: Height and
weight percentiles vary widely
19. The parents of a 2-year-old child report that he has been holding his breath
whenever he has temper tantrums. What is the best action by the nurse?
A) Teach the parents how to perform cardiopulmonary resuscitation
B) Recommend that the parents give in when he holds his breath to prevent anoxia
C) Advise the parents to ignore breath holding because breathing will begin as a reflex
D) Instruct the parents on how to reason with the child about possible harmful effects -
CORRECT ANSWER C: Advise the parents to ignore breath holding because
breathing will begin as a reflex
20. The nurse is assessing a client in the emergency room. Which statement suggests
that the problem is acute angina?
