HESI PN EXIT V1 NEWEST 2024-2025 ACTUAL EXAM ALL 180
AND CORRECT DETAILED ANSWERS WITH RATIONALES
(VERIFIED ANSWERS) |ALREADY GRADED A+
A young adult male who is being seen at the employee health care clinic for an annual assessment tells
the nurse that his mother was diagnosed with schizophrenia when she was his age and that life with a
schizophrenic mother was difficult indeed. Which response is best for the nurse to provide? A.
Encourage the client to seek genetic counseling to determine his risk for mental illness
B. Inform the client that his mother's schizophrenia has affected his psychological development
C. Tell the client that mental illness has a familial predisposition so he should see a psychiatrist
D. Ask the client if he is worried about becoming schizophrenic at the age his mother was diagnosed -
ANSWER-D. Ask the client if he is worried about becoming schizophrenic at the age his mother was
diagnosed
Which laboratory finding for an adult client is most critical for the nurse to report to the healthcare
provider?
A. Serum sodium 142mEq/L
B. Serum potassium 3.9mEq/L
C. Serum glucose 62 mg/dL
D. Blood urea nitrogen 18 mg/dL - ANSWER-C. Serum glucose 62 mg/dL
When conducting diet teaching for a client who was diagnosed with a myocardial infarction, which snack
foods should the nurse encourage the client to eat? (Select all that apply)
A. Fresh vegetables with mayonnaise dip
B. Fresh turkey slices and berries
C. Chicken bouillon soup and toast
D. Soda crackers and peanut butter
E. Raw unsalted almonds and apples - ANSWER-B. Fresh turkey slices and berries
C. Chicken bouillon soup and toast
E. Raw unsalted almonds and apples
A client with a lower respiratory tract infection receives a prescription for ciprofloxacin 500mg PO every
12 hours. When the client requests an afternoon snack, which dietary choice should the nurse provide?
,A. Cinnamon applesauce
B. Vanilla-flavored yogurt
C. Calcium-fortified juice
D. Low-fat chocolate milk - ANSWER-A. Cinnamon applesauce
When admitting a client with a diagnosis of transient ischemic attack (TIA), which intervention is most
important for the nurse to include in this client's plan of care?
A. Assess bilateral breath sounds
B. Review client's daily medications
C. Initiate neurological monitoring every 2 hours
D. Palpate suprapubic region for urinary retention - ANSWER-C. Initiate neurological monitoring every
2 hours
An older client's daughter calls the home health nurse and reports that her mother has become forgetful
and is very confused at night. The daughter stated that her mother's behavior changed suddenly a few
days ago and is now getting worse. Which actions should the nurse take?
A. Encourage increased intake of high protein foods
B. Instruct the daughter to check her mother's temperature
C. Review the client's current food and medication allergies
D. Ask if the mother is experiencing any pain with urination
E. Determine if the mother has recently experienced a fall. - ANSWER-A. Encourage increased intake
of high protein foods
B. Instruct the daughter to check her mother's temperature
D. Ask if the mother is experiencing any pain with urination
The nurse who works in labor and delivery is reassigned to the cardiac care unit for the day because of a
low census in labor and delivery. Which assignment is best for the charge nurse to give this nurse?
A. Assist cardiac nurses with their assignments
B. Monitor the central telemetry
C. Perform the admission of a new client
,D. Transfer a client to another unit - ANSWER-A. Assist cardiac nurses with their assignments
A client with Type 1 diabetes mellitus and a large draining ulcer of the right foot is admitted with a
suspected Staphylococcus aureus infection. Which interventions should the nurse implement? (Select all
that apply)
A. Monitor the client's white blood cell count
B. Explain the purpose of a low bacteria diet
C. Send wound drainage for culture and sensitivity
D. Institute contact precautions for staff and visitors
E. Use standard precautions and wear a mask - ANSWER-A. Monitor the client's white blood cell count
C. Send wound drainage for culture and sensitivity
D. Institute contact precautions for staff and visitors
The nurse is managing 4 clients in the intensive care unit who are mechanically ventilated. After
performing a quick visual assessment, the nurse should prioritize care for the client who is exhibiting
which finding?
A. An audible voice when client is trying to communicate
B. High pressure alarm sounds when client is coughing
C. Restrained and restless with a low volume alarm sounding
D. Diminished breath sounds in the right posterior base - ANSWER-C. Restrained and restless with a
low volume alarm sounding
A male client tells the nurse that he is concerned that he may have a stomach ulcer, because he is
experiencing heartburn and a dull gnawing pain that is relieved when he eats. Which is the best
response by the nurse?
A. Instruct the client that these mild symptoms can generally be controlled with changes in his diet
B. Advise the client that he needs to seek immediate medical evaluation and treatment of these
symptoms
C. Encourage the client to obtain a complete physical exam, since these symptoms are consistent with an
ulcer
, D. Assure the client that his symptoms may only reflect reflux, since ulcer pain is not relieved with food -
ANSWER-C. Encourage the client to obtain a complete physical exam, since these symptoms are
consistent with an ulcer
The nurse is evaluating the diet teaching of a client with hypertension. What dinner selection indicates
that the client understands the dietary recommendations for hypertension?
A. Grilled steak, baked potato with sour cream, green beans, coffee, and raisin cream pie
B. Baked pork chops, applesauce, corn on the cob, 1% milk, and key-lime pie
C. Tomato soup, grilled cheese sandwich, pickles, skim milk, and lemon meringue pie
D. Beef stir fry, fried rice, egg drop soup, diet soda, and pumpkin pie - ANSWER-B. Baked pork chops,
applesauce, corn on the cob, 1% milk, and key-lime pie
A client is admitted with a diagnosis of urolithiasis. Which finding is most important for the nurse to
report to the healthcare provider?
A. Volume of each voiding is more than 300mL
B. Serum potassium that is elevated
C. Relief of flank pain that radiated into the groin
D. Hematuria that is beginning to turn pink - ANSWER-D. Hematuria that is beginning to turn pink
Three days after initiating parenteral fluids for a newborn with a ventricular septal defect (VSD), the
nurse assesses an increase in heart rate and blood pressure. Which intervention is most important for
the nurse to implement?
A. View the graph of daily weights
B. Restrict intake of oral fluids
C. Assess bilateral lung sounds
D. Decrease IV flow rate - ANSWER-B. Restrict intake of oral fluids
During an admission assessment, a client reports currently using heroin. Which information is most
important for the nurse to consider in the plan of care?
A. History of suicide attempts
B. Feelings of disorientation
AND CORRECT DETAILED ANSWERS WITH RATIONALES
(VERIFIED ANSWERS) |ALREADY GRADED A+
A young adult male who is being seen at the employee health care clinic for an annual assessment tells
the nurse that his mother was diagnosed with schizophrenia when she was his age and that life with a
schizophrenic mother was difficult indeed. Which response is best for the nurse to provide? A.
Encourage the client to seek genetic counseling to determine his risk for mental illness
B. Inform the client that his mother's schizophrenia has affected his psychological development
C. Tell the client that mental illness has a familial predisposition so he should see a psychiatrist
D. Ask the client if he is worried about becoming schizophrenic at the age his mother was diagnosed -
ANSWER-D. Ask the client if he is worried about becoming schizophrenic at the age his mother was
diagnosed
Which laboratory finding for an adult client is most critical for the nurse to report to the healthcare
provider?
A. Serum sodium 142mEq/L
B. Serum potassium 3.9mEq/L
C. Serum glucose 62 mg/dL
D. Blood urea nitrogen 18 mg/dL - ANSWER-C. Serum glucose 62 mg/dL
When conducting diet teaching for a client who was diagnosed with a myocardial infarction, which snack
foods should the nurse encourage the client to eat? (Select all that apply)
A. Fresh vegetables with mayonnaise dip
B. Fresh turkey slices and berries
C. Chicken bouillon soup and toast
D. Soda crackers and peanut butter
E. Raw unsalted almonds and apples - ANSWER-B. Fresh turkey slices and berries
C. Chicken bouillon soup and toast
E. Raw unsalted almonds and apples
A client with a lower respiratory tract infection receives a prescription for ciprofloxacin 500mg PO every
12 hours. When the client requests an afternoon snack, which dietary choice should the nurse provide?
,A. Cinnamon applesauce
B. Vanilla-flavored yogurt
C. Calcium-fortified juice
D. Low-fat chocolate milk - ANSWER-A. Cinnamon applesauce
When admitting a client with a diagnosis of transient ischemic attack (TIA), which intervention is most
important for the nurse to include in this client's plan of care?
A. Assess bilateral breath sounds
B. Review client's daily medications
C. Initiate neurological monitoring every 2 hours
D. Palpate suprapubic region for urinary retention - ANSWER-C. Initiate neurological monitoring every
2 hours
An older client's daughter calls the home health nurse and reports that her mother has become forgetful
and is very confused at night. The daughter stated that her mother's behavior changed suddenly a few
days ago and is now getting worse. Which actions should the nurse take?
A. Encourage increased intake of high protein foods
B. Instruct the daughter to check her mother's temperature
C. Review the client's current food and medication allergies
D. Ask if the mother is experiencing any pain with urination
E. Determine if the mother has recently experienced a fall. - ANSWER-A. Encourage increased intake
of high protein foods
B. Instruct the daughter to check her mother's temperature
D. Ask if the mother is experiencing any pain with urination
The nurse who works in labor and delivery is reassigned to the cardiac care unit for the day because of a
low census in labor and delivery. Which assignment is best for the charge nurse to give this nurse?
A. Assist cardiac nurses with their assignments
B. Monitor the central telemetry
C. Perform the admission of a new client
,D. Transfer a client to another unit - ANSWER-A. Assist cardiac nurses with their assignments
A client with Type 1 diabetes mellitus and a large draining ulcer of the right foot is admitted with a
suspected Staphylococcus aureus infection. Which interventions should the nurse implement? (Select all
that apply)
A. Monitor the client's white blood cell count
B. Explain the purpose of a low bacteria diet
C. Send wound drainage for culture and sensitivity
D. Institute contact precautions for staff and visitors
E. Use standard precautions and wear a mask - ANSWER-A. Monitor the client's white blood cell count
C. Send wound drainage for culture and sensitivity
D. Institute contact precautions for staff and visitors
The nurse is managing 4 clients in the intensive care unit who are mechanically ventilated. After
performing a quick visual assessment, the nurse should prioritize care for the client who is exhibiting
which finding?
A. An audible voice when client is trying to communicate
B. High pressure alarm sounds when client is coughing
C. Restrained and restless with a low volume alarm sounding
D. Diminished breath sounds in the right posterior base - ANSWER-C. Restrained and restless with a
low volume alarm sounding
A male client tells the nurse that he is concerned that he may have a stomach ulcer, because he is
experiencing heartburn and a dull gnawing pain that is relieved when he eats. Which is the best
response by the nurse?
A. Instruct the client that these mild symptoms can generally be controlled with changes in his diet
B. Advise the client that he needs to seek immediate medical evaluation and treatment of these
symptoms
C. Encourage the client to obtain a complete physical exam, since these symptoms are consistent with an
ulcer
, D. Assure the client that his symptoms may only reflect reflux, since ulcer pain is not relieved with food -
ANSWER-C. Encourage the client to obtain a complete physical exam, since these symptoms are
consistent with an ulcer
The nurse is evaluating the diet teaching of a client with hypertension. What dinner selection indicates
that the client understands the dietary recommendations for hypertension?
A. Grilled steak, baked potato with sour cream, green beans, coffee, and raisin cream pie
B. Baked pork chops, applesauce, corn on the cob, 1% milk, and key-lime pie
C. Tomato soup, grilled cheese sandwich, pickles, skim milk, and lemon meringue pie
D. Beef stir fry, fried rice, egg drop soup, diet soda, and pumpkin pie - ANSWER-B. Baked pork chops,
applesauce, corn on the cob, 1% milk, and key-lime pie
A client is admitted with a diagnosis of urolithiasis. Which finding is most important for the nurse to
report to the healthcare provider?
A. Volume of each voiding is more than 300mL
B. Serum potassium that is elevated
C. Relief of flank pain that radiated into the groin
D. Hematuria that is beginning to turn pink - ANSWER-D. Hematuria that is beginning to turn pink
Three days after initiating parenteral fluids for a newborn with a ventricular septal defect (VSD), the
nurse assesses an increase in heart rate and blood pressure. Which intervention is most important for
the nurse to implement?
A. View the graph of daily weights
B. Restrict intake of oral fluids
C. Assess bilateral lung sounds
D. Decrease IV flow rate - ANSWER-B. Restrict intake of oral fluids
During an admission assessment, a client reports currently using heroin. Which information is most
important for the nurse to consider in the plan of care?
A. History of suicide attempts
B. Feelings of disorientation
