HESI 4 EXAM LATEST UPDATE 2022/2023
(expert solved)
The nurse assumes care of a postoperative adult client with type 2 dia-
betes mellitus and learns that the client has a current blood glucose level
of720 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
Heparin 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
systems 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
who has a Foley catheter and soft wrist restraints applied: D. An 82-year-old
client with Alzheimer's disease and a newly-fractured femur who has a Foley
catheter and soft wrist restraints applied
8. The nurse is preparing a dose of 60 mcg of teriparatide. The medication
is labeled "750 mcg/2.4mL". How many mL should the nurse administer?
Round to nearest tenth.: 0.2 mL
9. In caring for a client with Cushing's Syndrome, which serum laboratory
value is most important for the nurse to monitor?
A. Creatinine
B. Lactate
C. Glucose
D. Hemoglobin: C. Glucose
Impaired glucose metabolism is prevalent in Cushing's syndrome. Cushing's syn-
drome causes a significant reduction in insulin sensitivity and glucose disappear-
ance (peripheral uptake of glucose).
10. A client who received hemodialysis yesterday is experiencing a blood
pressure of 200/100 mmHg, heart rate 110 beats/minute, and respiratory rate
36 breaths/minute. The client is manifesting shortness of breath, bilateral 2+
pedal edema, and an oxygen saturation on room air of 89%. Which action
should the nurse take first?
A. Elevate the foot of the bed
B. Restrict the client's fluids
C. Begin supplemental oxygen
D. Prepare client for hemodialysis: C. Begin supplemental oxygen
11. When caring for a client with full thickness burns to both lower extremi-
ties, which assessment findings warrant immediate intervention? Select all
that apply
A. Sloughing tissue around wound edges
B. Complaint of increased pain and pressure
C. Change in the quality of the peripheral pulses
D. Loss of sensation to the left lower extremity
E. Weeping serosanguineous fluid from wounds: B. Complaint of increased
pain and pressure
C. Change in the quality of the peripheral pulses
D. Loss of sensation to the left lower extremity
(expert solved)
The nurse assumes care of a postoperative adult client with type 2 dia-
betes mellitus and learns that the client has a current blood glucose level
of720 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
Heparin 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
systems 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
who has a Foley catheter and soft wrist restraints applied: D. An 82-year-old
client with Alzheimer's disease and a newly-fractured femur who has a Foley
catheter and soft wrist restraints applied
8. The nurse is preparing a dose of 60 mcg of teriparatide. The medication
is labeled "750 mcg/2.4mL". How many mL should the nurse administer?
Round to nearest tenth.: 0.2 mL
9. In caring for a client with Cushing's Syndrome, which serum laboratory
value is most important for the nurse to monitor?
A. Creatinine
B. Lactate
C. Glucose
D. Hemoglobin: C. Glucose
Impaired glucose metabolism is prevalent in Cushing's syndrome. Cushing's syn-
drome causes a significant reduction in insulin sensitivity and glucose disappear-
ance (peripheral uptake of glucose).
10. A client who received hemodialysis yesterday is experiencing a blood
pressure of 200/100 mmHg, heart rate 110 beats/minute, and respiratory rate
36 breaths/minute. The client is manifesting shortness of breath, bilateral 2+
pedal edema, and an oxygen saturation on room air of 89%. Which action
should the nurse take first?
A. Elevate the foot of the bed
B. Restrict the client's fluids
C. Begin supplemental oxygen
D. Prepare client for hemodialysis: C. Begin supplemental oxygen
11. When caring for a client with full thickness burns to both lower extremi-
ties, which assessment findings warrant immediate intervention? Select all
that apply
A. Sloughing tissue around wound edges
B. Complaint of increased pain and pressure
C. Change in the quality of the peripheral pulses
D. Loss of sensation to the left lower extremity
E. Weeping serosanguineous fluid from wounds: B. Complaint of increased
pain and pressure
C. Change in the quality of the peripheral pulses
D. Loss of sensation to the left lower extremity
