2016 HESI EXIT V4 (NEW)
I. A client is in her third month of her first pregnancy. During the interview, she tellsthe
nurse that she has several sex partners and is unsure of the identity of the baby's father.
Which of the following nursing interventions is a priority?
A) Counsel the woman to consent to HIV screening
B) Perform tests for sexually transmitted diseases
C) Discuss her high risk for cervical cancer
D) Refer the client to a family planning clinic
II. 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
III. A nurse who is evaluating a mentally retarded 2 year-old 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
IV. The nurse is caring for a client with trigeminal neuralgia (tic douloureaux). To assistthe
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
, 2016 HESI EXIT V4 (NEW)
V. 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
VI. 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
VII. 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
VIII. 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
, 2016 HESI EXIT V4 (NEW)
IX. 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
X. 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
XI. 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
XII. 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
, 2016 HESI EXIT V4 (NEW)
XIII. 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
I. A client is in her third month of her first pregnancy. During the interview, she tellsthe
nurse that she has several sex partners and is unsure of the identity of the baby's father.
Which of the following nursing interventions is a priority?
A) Counsel the woman to consent to HIV screening
B) Perform tests for sexually transmitted diseases
C) Discuss her high risk for cervical cancer
D) Refer the client to a family planning clinic
II. 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
III. A nurse who is evaluating a mentally retarded 2 year-old 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
IV. The nurse is caring for a client with trigeminal neuralgia (tic douloureaux). To assistthe
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
, 2016 HESI EXIT V4 (NEW)
V. 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
VI. 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
VII. 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
VIII. 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
, 2016 HESI EXIT V4 (NEW)
IX. 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
X. 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
XI. 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
XII. 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
, 2016 HESI EXIT V4 (NEW)
XIII. 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
