HESI RN EXIT NURSING CARE SCENARIOS ACTUAL EXAM 2025|
200 QUESTIONS WITH VERIFIED ACCURATE SOLUTIONS
1. How does nonorganic failure-to-thrive (NOFTT) typically affect an infant's
behavior and development?
A) Infants with NOFTT often show normal developmental
milestones.
B) NOFTT leads to increased activity levels and engagement
with their environment.
C) Infants with NOFTT may appear lethargic and exhibit poor
interaction with caregivers.
D) NOFTT results in a heightened sense of curiosity and exploration.
2. What is the maximum duration for which suction should be applied
during the suctioning of a tracheostomy to prevent unnecessary
hypoxia?
5 seconds
10 seconds
15 seconds
20 seconds
3. A nurse is preparing to suction a patient with a tracheostomy who has
shown signs of respiratory distress. Considering the need to prevent
hypoxia, which action should the nurse prioritize during the procedure?
Suction for 15 seconds to clear the airway effectively
Ensure the patient is in a supine position for easier access
Apply suction for no more than 10 seconds and monitor
oxygen saturation
Use a larger catheter size to increase airflow
,4. At what age do infants typically begin to imitate sounds as part of
their vocal development?
3 months
6 months
8 months
12 months
5. Why is it important for infants to continue receiving iron fortified
formula rather than switching to whole milk before one year of age?
Whole milk contains more calories.
Iron fortified formula provides essential nutrients for growth.
Infants prefer the taste of formula.
Whole milk is more expensive.
6. What is the primary reason a patient may experience difficulty voiding
after surgery?
Increased fluid intake
Anesthesia effects
Infection
Dehydration
7. Which of these findings would the RN more closely associate with anemia
in a 10-month-old infant?
Hgb 12 g/dL
Pale mucosa of eyelids & lips
Hypoactivity
HR 140-160 bpm
,8. What is the expected weight change for a 12 month-old child compared to
their birth weight?
Increased 10% in height
Tripled the birth weight
Gained 50% of birth weight
Doubled the birth weight
9. In a scenario where a 3-year-old child refuses to take a prescribed
medication, which of the following strategies would best demonstrate
effective nursing intervention?
Administer the medication forcefully to ensure
compliance Engage the child in a game that involves
taking medicine
Ask the parents to administer the medication without the
nurse's involvement
Provide the child with a choice of flavors for the medication
10. Explain why a pulse oximetry reading of 88% would be concerning for a
patient with an endotracheal tube.
It indicates the patient is receiving adequate oxygenation.
It suggests the patient may be experiencing
hypoxemia. It shows that the endotracheal tube is
functioning properly. It means the patient is in a stable
condition.
11. Why is it important for a nurse to implement precautions with
position changes for a client in the late stage of multiple myeloma?
To prevent skin breakdown due to immobility
To reduce the risk of falls and injury
To ensure adequate hydration during care
, To facilitate communication with the patient
12. A Hispanic patient in the postpartum period refuses the hospital food
because it's "cold." The best initial action by the RN is to:
Have a UAP reheat the food if the patient wishes
Ask the patient what foods are acceptable or bad
Encourage her to eat for healing and strength
Schedule the dietician to meet with the patient ASAP
13. A nurse is caring for a post-operative patient who is experiencing dry
mouth and discomfort after being extubated. Which intervention
should the nurse prioritize to enhance the patient's comfort based on
the
principles of post-ventilator care?
Encourage the patient to drink water frequently
Provide a humidifier in the room
Perform oral care with a tooth sponge regularly
Administer an oral analgesic for pain relief
14. What is a common symptom of pyloric stenosis in infants that
parents might report?
Frequent crying during feedings
Projectile vomiting after meals
Excessive sleepiness throughout the day
Difficulty breathing during sleep
15. A client has been admitted to the detoxification unit after binge drinking.
Even though the client is not currently intoxicated, the client is combative
and exhibits altered thought processes. Which nursing diagnosis would
be the priority?
risk for injury related to effects of alcohol abuse
200 QUESTIONS WITH VERIFIED ACCURATE SOLUTIONS
1. How does nonorganic failure-to-thrive (NOFTT) typically affect an infant's
behavior and development?
A) Infants with NOFTT often show normal developmental
milestones.
B) NOFTT leads to increased activity levels and engagement
with their environment.
C) Infants with NOFTT may appear lethargic and exhibit poor
interaction with caregivers.
D) NOFTT results in a heightened sense of curiosity and exploration.
2. What is the maximum duration for which suction should be applied
during the suctioning of a tracheostomy to prevent unnecessary
hypoxia?
5 seconds
10 seconds
15 seconds
20 seconds
3. A nurse is preparing to suction a patient with a tracheostomy who has
shown signs of respiratory distress. Considering the need to prevent
hypoxia, which action should the nurse prioritize during the procedure?
Suction for 15 seconds to clear the airway effectively
Ensure the patient is in a supine position for easier access
Apply suction for no more than 10 seconds and monitor
oxygen saturation
Use a larger catheter size to increase airflow
,4. At what age do infants typically begin to imitate sounds as part of
their vocal development?
3 months
6 months
8 months
12 months
5. Why is it important for infants to continue receiving iron fortified
formula rather than switching to whole milk before one year of age?
Whole milk contains more calories.
Iron fortified formula provides essential nutrients for growth.
Infants prefer the taste of formula.
Whole milk is more expensive.
6. What is the primary reason a patient may experience difficulty voiding
after surgery?
Increased fluid intake
Anesthesia effects
Infection
Dehydration
7. Which of these findings would the RN more closely associate with anemia
in a 10-month-old infant?
Hgb 12 g/dL
Pale mucosa of eyelids & lips
Hypoactivity
HR 140-160 bpm
,8. What is the expected weight change for a 12 month-old child compared to
their birth weight?
Increased 10% in height
Tripled the birth weight
Gained 50% of birth weight
Doubled the birth weight
9. In a scenario where a 3-year-old child refuses to take a prescribed
medication, which of the following strategies would best demonstrate
effective nursing intervention?
Administer the medication forcefully to ensure
compliance Engage the child in a game that involves
taking medicine
Ask the parents to administer the medication without the
nurse's involvement
Provide the child with a choice of flavors for the medication
10. Explain why a pulse oximetry reading of 88% would be concerning for a
patient with an endotracheal tube.
It indicates the patient is receiving adequate oxygenation.
It suggests the patient may be experiencing
hypoxemia. It shows that the endotracheal tube is
functioning properly. It means the patient is in a stable
condition.
11. Why is it important for a nurse to implement precautions with
position changes for a client in the late stage of multiple myeloma?
To prevent skin breakdown due to immobility
To reduce the risk of falls and injury
To ensure adequate hydration during care
, To facilitate communication with the patient
12. A Hispanic patient in the postpartum period refuses the hospital food
because it's "cold." The best initial action by the RN is to:
Have a UAP reheat the food if the patient wishes
Ask the patient what foods are acceptable or bad
Encourage her to eat for healing and strength
Schedule the dietician to meet with the patient ASAP
13. A nurse is caring for a post-operative patient who is experiencing dry
mouth and discomfort after being extubated. Which intervention
should the nurse prioritize to enhance the patient's comfort based on
the
principles of post-ventilator care?
Encourage the patient to drink water frequently
Provide a humidifier in the room
Perform oral care with a tooth sponge regularly
Administer an oral analgesic for pain relief
14. What is a common symptom of pyloric stenosis in infants that
parents might report?
Frequent crying during feedings
Projectile vomiting after meals
Excessive sleepiness throughout the day
Difficulty breathing during sleep
15. A client has been admitted to the detoxification unit after binge drinking.
Even though the client is not currently intoxicated, the client is combative
and exhibits altered thought processes. Which nursing diagnosis would
be the priority?
risk for injury related to effects of alcohol abuse
