HESI RN EXIT EXAM VERSION 4 TEST BANK
HESI RN EXIT EXAM VERSION 4 TEST BANK FEATURING UPDATED
QUESTIONS AND VERIFIED ANSWERS ALIGNED WITH CURRENT NCLEX-
RN STANDARDS AND CLINICAL PRACTICE GUIDELINES.
While the nurse is conducting an admission assessment of a female client with bipolar disorder,
the client suddenly begins to take off her clothes and throw them about the room. Which action
should the nurse take first?
a. State it is unacceptable to undress during interview
b. Change to less anxiety promoting questions
c. Leave the client's room so she can act out her anxiety
d. Ignore the client's inappropriate behavior - ANSWER-a. State it is unacceptable to undress
during interview
The nurse is planning care for a client who has a fourth-degree midline laceration that occurred
during vaginal delivery of an 8 pound 10 ounce infant. Which intervention has the highest
priority for this client?
a. Administer prescribed PRN sleep medications
b. Administer prescribed stool softener
c. Encourage use of prescribed analgesic perennial sprays
d. Encourage breastfeeding to promote uterine involution - ANSWER-b. Administer prescribed
stool softener
An older adult male reporting abdominal pain is admitted to the hospital from a long term care
facility. It has been seven days since his last bowel movement, and his abdomen is distended,
and he just vomited 150 milliliters of dark brown emesis. In what order should the nurse
implement these interventions?
a. Elevate the head of bed
b. Complete focus assessment
c. Offer PRN pain medication
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, HESI RN EXIT EXAM VERSION 4 TEST BANK
d. Send emesis sample to the lab - ANSWER-a. Elevate the head of bed
c. Offer PRN pain medication
b. Complete focus assessment
d. Send emesis sample to the lab
What is the primary purpose for initiating nursing interventions that promote good nutrition,
rest and exercise, and stress reduction for clients diagnosed with and HIV infection?
a. Increase ability to carry out activities of daily living
b. Promote a feeling of general well-being
c. Prevent spread of infection to others
d. Improve function of the immune system - ANSWER-d. Improve function of the immune
system
A nurse who works in the nursery is attending the vaginal delivery of a term infant. What action
should the nurse complete prior to leaving the delivery room?
a. Obtain the infants vital signs
b. Observe the instant latching on to the breast
c. Place the ID bands on the infant and mother
d. Administer vitamin K injection - ANSWER-c. Place the ID bands on the infant and mother
The nurse is preparing a client with an acoustic neuroma for a magnetic resonance image (MRI).
Which client complaint is life threatening and should be reported to the health care provider
immediately?
a. Difficulty with balance
b. Intensifying headache
c. Right ear hearing loss
d. Facial numbness - ANSWER-b. Intensifying headache
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, HESI RN EXIT EXAM VERSION 4 TEST BANK
A client with chronic kidney disease (CKD) is discharged with a prescription for epoetin alpha
subcutaneously. In teaching the client about the medication, the nurse should emphasize the
benefit of increasing which food product in the diet?
a. Iron rich foods
b. High fiber foods
c. Citrus fruits and vegetables
d. Dairy products - ANSWER-a. Iron rich foods
An adult client is admitted to the psychiatric unit with a diagnosis of major depression. After
two weeks of antidepressant medication therapy, the nurse notices the client has more energy,
is giving personal belongings away to visitors, and is in a better mood. Which intervention is
best for the nurse to implement?
a. Tell the client to keep one's belongings because they will be needed at discharge
b. Support the client by validating the progress that has been made
c. Reassure the client that the antidepressant drugs are apparently effective
d. Ask the client if there are any recent thoughts of harming self - ANSWER-d. Ask the client if
there are any recent thoughts of harming self
While changing the clients postoperative dressing, the nurse observes are red and swollen
wound with a moderate amount of yellow and green drainage and a foul odor. Before reporting
this finding to the health care provider, the nurse should evaluate which of the client's
laboratory values?
a. C reactive protein level
b. Serum albumin
c. Neutrophil count
d. Creatinine level - ANSWER-c. Neutrophil count
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, HESI RN EXIT EXAM VERSION 4 TEST BANK
A client with cancer is admitted to the oncology unit and tells the nurse that he is in the hospital
for palliative care measures. The nurse notes that the client's admission prescriptions include
radiation therapy. What action should the nurse implement?
A. Notify the radiation department to withhold the treatments for now
B. Determine if the client wishes to cancel further radiation treatments
C. Ask the client about his expected goals for this hospitalization
D. Explain that palliative care measures can be provided at home - ANSWER-C. Ask the client
about his expected goals for this hospitalization
The home care nurse provided self-care instructions for a client with chronic venous
insufficiency caused by deep vein thrombosis. Which instruction should the nurse include in the
clients discharge teaching plan? Select all that apply.
a. Use recliner for long periods of sitting
b. Continue wearing compression stockings
c. Avoid prolonged standing or sitting
d. Crossed legs at knee but not at ankle
e. Maintain the bed flat while sleeping - ANSWER-a. Use recliner for long periods of sitting
b. Continue wearing compression stockings
c. Avoid prolonged standing or sitting
While a child is hospitalized with acute glomerulonephritis, the parents ask why blood pressure
readings are being taken so often. Which response by the nurse is most accurate?
a. Hypertension leading to sudden shock can develop at any time
b. Blood pressure fluctuations means that the condition has become chronic
c. Sodium intake with meals and snacks affects the blood pressure
d. Elevated blood pressure must be anticipated and identified quickly - ANSWER-d. Elevated
blood pressure must be anticipated and identified quickly
4|Page
HESI RN EXIT EXAM VERSION 4 TEST BANK FEATURING UPDATED
QUESTIONS AND VERIFIED ANSWERS ALIGNED WITH CURRENT NCLEX-
RN STANDARDS AND CLINICAL PRACTICE GUIDELINES.
While the nurse is conducting an admission assessment of a female client with bipolar disorder,
the client suddenly begins to take off her clothes and throw them about the room. Which action
should the nurse take first?
a. State it is unacceptable to undress during interview
b. Change to less anxiety promoting questions
c. Leave the client's room so she can act out her anxiety
d. Ignore the client's inappropriate behavior - ANSWER-a. State it is unacceptable to undress
during interview
The nurse is planning care for a client who has a fourth-degree midline laceration that occurred
during vaginal delivery of an 8 pound 10 ounce infant. Which intervention has the highest
priority for this client?
a. Administer prescribed PRN sleep medications
b. Administer prescribed stool softener
c. Encourage use of prescribed analgesic perennial sprays
d. Encourage breastfeeding to promote uterine involution - ANSWER-b. Administer prescribed
stool softener
An older adult male reporting abdominal pain is admitted to the hospital from a long term care
facility. It has been seven days since his last bowel movement, and his abdomen is distended,
and he just vomited 150 milliliters of dark brown emesis. In what order should the nurse
implement these interventions?
a. Elevate the head of bed
b. Complete focus assessment
c. Offer PRN pain medication
1|Page
, HESI RN EXIT EXAM VERSION 4 TEST BANK
d. Send emesis sample to the lab - ANSWER-a. Elevate the head of bed
c. Offer PRN pain medication
b. Complete focus assessment
d. Send emesis sample to the lab
What is the primary purpose for initiating nursing interventions that promote good nutrition,
rest and exercise, and stress reduction for clients diagnosed with and HIV infection?
a. Increase ability to carry out activities of daily living
b. Promote a feeling of general well-being
c. Prevent spread of infection to others
d. Improve function of the immune system - ANSWER-d. Improve function of the immune
system
A nurse who works in the nursery is attending the vaginal delivery of a term infant. What action
should the nurse complete prior to leaving the delivery room?
a. Obtain the infants vital signs
b. Observe the instant latching on to the breast
c. Place the ID bands on the infant and mother
d. Administer vitamin K injection - ANSWER-c. Place the ID bands on the infant and mother
The nurse is preparing a client with an acoustic neuroma for a magnetic resonance image (MRI).
Which client complaint is life threatening and should be reported to the health care provider
immediately?
a. Difficulty with balance
b. Intensifying headache
c. Right ear hearing loss
d. Facial numbness - ANSWER-b. Intensifying headache
2|Page
, HESI RN EXIT EXAM VERSION 4 TEST BANK
A client with chronic kidney disease (CKD) is discharged with a prescription for epoetin alpha
subcutaneously. In teaching the client about the medication, the nurse should emphasize the
benefit of increasing which food product in the diet?
a. Iron rich foods
b. High fiber foods
c. Citrus fruits and vegetables
d. Dairy products - ANSWER-a. Iron rich foods
An adult client is admitted to the psychiatric unit with a diagnosis of major depression. After
two weeks of antidepressant medication therapy, the nurse notices the client has more energy,
is giving personal belongings away to visitors, and is in a better mood. Which intervention is
best for the nurse to implement?
a. Tell the client to keep one's belongings because they will be needed at discharge
b. Support the client by validating the progress that has been made
c. Reassure the client that the antidepressant drugs are apparently effective
d. Ask the client if there are any recent thoughts of harming self - ANSWER-d. Ask the client if
there are any recent thoughts of harming self
While changing the clients postoperative dressing, the nurse observes are red and swollen
wound with a moderate amount of yellow and green drainage and a foul odor. Before reporting
this finding to the health care provider, the nurse should evaluate which of the client's
laboratory values?
a. C reactive protein level
b. Serum albumin
c. Neutrophil count
d. Creatinine level - ANSWER-c. Neutrophil count
3|Page
, HESI RN EXIT EXAM VERSION 4 TEST BANK
A client with cancer is admitted to the oncology unit and tells the nurse that he is in the hospital
for palliative care measures. The nurse notes that the client's admission prescriptions include
radiation therapy. What action should the nurse implement?
A. Notify the radiation department to withhold the treatments for now
B. Determine if the client wishes to cancel further radiation treatments
C. Ask the client about his expected goals for this hospitalization
D. Explain that palliative care measures can be provided at home - ANSWER-C. Ask the client
about his expected goals for this hospitalization
The home care nurse provided self-care instructions for a client with chronic venous
insufficiency caused by deep vein thrombosis. Which instruction should the nurse include in the
clients discharge teaching plan? Select all that apply.
a. Use recliner for long periods of sitting
b. Continue wearing compression stockings
c. Avoid prolonged standing or sitting
d. Crossed legs at knee but not at ankle
e. Maintain the bed flat while sleeping - ANSWER-a. Use recliner for long periods of sitting
b. Continue wearing compression stockings
c. Avoid prolonged standing or sitting
While a child is hospitalized with acute glomerulonephritis, the parents ask why blood pressure
readings are being taken so often. Which response by the nurse is most accurate?
a. Hypertension leading to sudden shock can develop at any time
b. Blood pressure fluctuations means that the condition has become chronic
c. Sodium intake with meals and snacks affects the blood pressure
d. Elevated blood pressure must be anticipated and identified quickly - ANSWER-d. Elevated
blood pressure must be anticipated and identified quickly
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