Exit HESI Test Banks (over 3000 Q's and Answers ) spring 2023 / Exit HESI Prep Distinction Level Assignment Has everything.

Comprehensive Exam
133- Cyclobenzaprine (Flexeril) is prescribed to a client with multiple sclerosis for the treatment of
muscle spasms. For which common side effect of this medication does the nurse monitor the client?
A. Diarrhea
B. Drowsiness Correct
C. Abdominal pain
D. Increased salivation
134 – A nurse administers nitroglycerin sublingually to a client with angina pectoris who complains of
chest pain. The medication is ineffective, so the nurse prepares to administer a second dose. Before
administering the nitroglycerin, which action does the nurse make a priority?
A. Checking the client’s blood pressure Correct
B. Obtaining blood levels of cardiac enzymes
C. Asking the client whether he has a headache
D. Obtaining a 12-lead electrocardiogram (ECG)
135- Ciprofloxacin hydrochloride (Cipro) is prescribed to a client with a urinary tract infection. The
nurse, providing instruction about the medication, tells the client that it is best to take the medication:
A. With milk
B. With an antacid
C. 2 hours after meals Correct
D. With aluminum hydroxide
136.-
A nurse provides home care instructions to a client with coronary artery disease (CAD) who is being
discharged from the hospital. Which statement by the client indicates a need for further instruction?

A. “I need to carry my nitroglycerin with me at all times.”
B. “I need to check my pulse before, during, and after exercise.”
C. “I need to avoid foods with saturated fats and foods high in cholesterol.”
D. “I need to participate in aerobic and weightlifting exercise three times a week.” Correct
137- A nurse provides information to a client who will be undergoing endoscopic retrograde
cholangiopancreatography (ERCP). The nurse tells the client that:
A. There is no need to fast (NPO status) before the procedure
B. The gallbladder is easily removed during this procedure if gallstones are found
C. The procedure is performed specifically to visualize the esophagus, stomach, and
duodenum
D. Dye may be injected during the procedure to permit visualization of the pancreatic and
biliary ducts Correct
138.ID: 383713175
A client who has undergone knee-replacement surgery will be self-administering enoxaparin sodium
(Lovenox) at home. The nurse teaches the client about the medication and tells the client to:
A. Store the medication in the refrigerator
B. Lie down to administer the subcutaneous injection Correct
C. Inject the medication in the upper outer aspect of the arm
D. Discard the medication if the solution appears pale yellow
139.ID: 383703667
An intravenous dose of adenosine (Adenocard) is prescribed for a client to treat Wolff-ParkinsonWhite syndrome. Which piece of equipment does the nurse make a priority of obtaining before
administering the medication?
A. Pulse oximeter
B. Cardiac monitor Correct

C. Blood-pressure cuff
D. Suction catheter and suction machine
140.ID: 383703619
A nurse provides information to a client with coronary artery disease (CAD) about smoking-cessation
measures. Which statement by the client indicates a need for further information?
A. “A community support group will help me quit.”
B. “I should drink a cup of coffee if I feel the urge to smoke.” Correct
C. “Relaxation exercises will help control my urge to smoke.”
D. “I can try chewing gum or sucking on hard candy if I feel the urge to smoke.”
141.ID: 383708584
Captopril (Capoten) is prescribed for a hospitalized client with heart failure. Which action is a priority
once the nurse has administered the first dose?
A. Checking the client’s apical heart rate
B. Maintaining the client on bed rest for 3 hours Correct
C. Monitoring the client for increased urine output
D. Checking the client’s breath sounds for decreased wheezing
142.ID: 383706680
A client with heart failure suddenly experiences profound dyspnea, pallor, audible wheezing, and
cyanosis, and the nurse suspects pulmonary edema. The nurse would first:
A. Obtain a pulse oximetry reading
B. Raise the head of the client’s bed Correct
C. Administer a dose of morphine sulfate

D. Obtain a specimen for an arterial blood gas determination
143.ID: 383703665
The nurse administers intravenous morphine sulfate to a client in pulmonary edema. For which
intended effect of the medication does the nurse monitor the client?
A. Relief of pain
B. Relief of anxiety Correct
C. Decreased urine output
D. Increased blood pressure
144.ID: 383702944
A nurse is providing home care instructions to a client with coronary artery disease (CAD) who will
be discharged home and will be taking 1 aspirin daily. The nurse tells the client:
A. To stop the aspirin if nausea occurs Incorrect
B. To take the aspirin on an empty stomach
C. That the aspirin is a short-term treatment and will probably be discontinued in 2
weeks
145.ID: 383713112
A client receiving parenteral nutrition (PN) suddenly experiences chest pain and dyspnea, and the
nurse suspects an air embolism. The nurse immediately places the client in a lateral Trendelenburg
position, on the left side. What action does the nurse take next?
A. Auscultating heart sounds
B. Clamping the intravenous catheter Correct
C. Checking the client’s blood pressure

HESI Exit Exam Over 700 Questions new 2019
latest 100%

Following discharge teaching, a male client with duodenal ulcer tells the nurse the he will drink
plenty of dairy products, such as milk, to help coat and protect his ulcer. What is the best followup action by the nurse.
a- Remind the client that it is also important to switch to decaffeinated coffee and tea.
b- Suggest that the client also plan to eat frequent small meals to reduce discomfort
c- Review with the client the need to avoid foods that are rich in milk and cream.
d- Reinforce this teaching by asking the client to list a dairy food that he might select.
A male client with hypertension, who received new antihypertensive prescriptions at his last visit
returns to the clinic two weeks later to evaluate his blood pressure (BP). His BP is 158/106 and he
admits that he has not been taking the prescribed medication because the drugs make him “feel
bad”. In explaining the need for hypertension control, the nurse should stress that an elevated BP
places the client at risk for which pathophysiological condition?
a- Blindness secondary to cataracts
b- Acute kidney injury due to glomerular damage
c- Stroke secondary to hemorrhage
d- Heart block due to myocardial damage
The nurse observes an unlicensed assistive personnel (UAP) positioning a newly admitted client
who has a seizure disorder. The client is supine and the UAP is placing soft pillows along the side
rails. What action should the nurse implement?
a. Ensure that the UAP has placed the pillows effectively to protect the client.
b. Instruct the UAP to obtain soft blankets to secure to the side rails instead of pillows.
b. Assume responsibility for placing the pillows while the UAP completes another task.
c. Ask the UAP to use some of the pillows to prop the client in a side lying position.
An adolescent with major depressive disorder has been taking duloxetine (Cymbalta) for the past
12 days. Which assessment finding requires immediate follow-up?
a- Describes life without purpose
b- Complains of nausea and loss of appetite
c- States is often fatigued and drowsy
d- Exhibits an increase in sweating.
A 60-year-old female client with a positive family history of ovarian cancer has developed an
abdominal mass and is being evaluated for possible ovarian cancer. Her Papanicolau (Pap) smear
results are negative. What information should the nurse include in the client’s teaching plan?

a- Further evaluation involving surgery may be needed
b- A pelvic exam is also needed before cancer is ruled out
c- Pap smear evaluation should be continued every six month
d- One additional negative pap smear in six months is needed.

A client who recently underwear a tracheostomy is being prepared for discharge to home. Which
instructions is most important for the nurse to include in the discharge plan?
a- Explain how to use communication tools.
b- Teach tracheal suctioning techniques
c- Encourage self-care and independence.
d- Demonstrate how to clean tracheostomy site.
In assessing an adult client with a partial rebreather mask, the nurse notes that the oxygen
reservoir bag does not deflate completely during inspiration and the client’s respiratory rate is 14
breaths / minute. What action should the nurse implement?
a- Encourage the client to take deep breaths
b- Remove the mask to deflate the bag
c- Increase the liter flow of oxygen
d- Document the assessment data
During a home visit, the nurse observed an elderly client with diabetes slip and fall. What action
should the nurse take first?
a- Give the client 4 ounces of orange juice
b- Call 911 to summon emergency assistance
c- Check the client for lacerations or fractures
d- Asses clients blood sugar level
At 0600 while admitting a woman for a schedule repeat cesarean section (C-Section), the client
tells the nurse that she drank a cup a coffee at 0400 because she wanted to avoid getting a
headache. Which action should the nurse take first?
a- Ensure preoperative lab results are available
b- Start prescribed IV with lactated Ringer’s
c- Inform the anesthesia care provider
d- Contact the client’s obstetrician.
After placing a stethoscope as seen in the picture, the nurse auscultates S1 and S2 heart sounds.
To determine if an S3 heart sound is present, what action should the nurse take first?
a- Side the stethoscope across the sternum.
b- Move the stethoscope to the mitral site
c- Listen with the bell at the same location
d- Observe the cardiac telemetry monitor
A 66-year-old woman is retiring and will no longer have a health insurance through her place of
employment. Which agency should the client be referred to by the employee health nurse for

health insurance needs?
a- Woman, Infant, and Children program
b- Medicaid
c- Medicare
d- Consolidated Omnibus Budget Reconciliation Act provision.

A client who is taking an oral dose of a tetracycline complains of gastrointestinal upset. What
snack should the nurse instruct the client to take with the tetracycline?
a- Fruit-flavored yogurt.
b- Cheese and crackers.
c- Cold cereal with skim milk.
d- Toasted wheat bread and jelly
Following a lumbar puncture, a client voices several complaints. What complaint indicated to the
nurse that the client is experiencing a complication?
a- “I am having pain in my lower back when I move my legs”
b- “My throat hurts when I swallow”
c- “I feel sick to my stomach and am going to throw up”
d- I have a headache that gets worse when I sit up”
An elderly client seems confused and reports the onset of nausea, dysuria, and urgency with
incontinence. Which action should the nurse implement?
a- Auscultate for renal bruits
b- Obtain a clean catch mid-stream specimen
c- Use a dipstick to measure for urinary ketone
d- Begin to strain the client’s urine.
The nurse is assisting the mother of a child with phenylketonuria (PKU) to select foods that are in
keeping with the child’s dietary restrictions. Which foods are contraindicated for this child?
a- Wheat products
b- Foods sweetened with aspartame.
c- High fat foods
d- High calories foods.
Before preparing a client for the first surgical case of the day, a part-time scrub nurse asks the
circulating nurse if a 3-minute surgical hand scrub is adequate preparation for this client. Which
response should the circulating nurse provide?
a- Ask a more experience nurse to perform that scrub since it is the first time of the day
b- Validate the nurse is implementing the OR policy for surgical hand scrub
c- Inform the nurse that hand scrubs should be 3 minutes between cases.
d- Direct the nurse to continue the surgical hand scrub for a 5-minute duration.
Which breakfast selection indicates that the client understands the nurse’s instructions about the

dietary management of osteoporosis?
a- Egg whites, toast and coffee.
b- Bran muffin, mixed fruits, and orange juice.
c- Granola and grapefruit juice
d- Bagel with jelly and skim milk.

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 34-year -old admitted today after an emergency appendendectomy who has a peripheral
intravenous catheter and a Foley catheter.
b- A 48-year-old marathon runner with a central venous catheter who is experiencing nausea and
vomiting due to electrolyte disturbance following a race.
c- A 63-year-old chain smoker admitted with chronic bronchitis who is receiving oxygen via nasal
cannula and has a saline-locked peripheral intravenous catheter.
d- An 82-year-old client with Alzheimer’s disease newly-fractures femur who has a Foley catheter
and soft wrist restrains applied
Z
a- Cleanse the foot with soap and water and apply an antibiotic ointment
b- Provide teaching about the need for a tetanus booster within the next 72 hours.
c- have the mother check the child’s temperature q4h for the next 24 hours
d- transfer the child to the emergency department to receive a gamma globulin injection
The mother of an adolescent tells the clinic nurse, “My son has athlete’s foot, I have been
applying triple antibiotic ointment for two days, but there has been no improvement.” What
instruction should the nurse provide?
a- Antibiotics take two weeks to become effective against infections such as athlete’s foot.
b- Continue using the ointment for a full week, even after the symptoms disappear.
c- Applying too much ointment can deter its effectiveness. Apply a thin layer to prevent maceration.
d- Stop using the ointment and encourage complete drying of the feet and wearing clean socks.
A 26-year-old female client is admitted to the hospital for treatment of a simple goiter, and
levothyroxine sodium (Synthroid) is prescribed. Which symptoms indicate to the nurse that the
prescribed dosage is too high for this client? The client experiences
a- Palpitations and shortness of breath
b- Bradycardia and constipation
c- Lethargy and lack of appetite
d- Muscle cramping and dry, flushed skin
A client with a history of heart failure presents to the clinic with a nausea, vomiting, yellow vision
and palpitations. Which finding is most important for the nurse to assess to the client?
a- Determine the client’s level of orientation and cognition
b- Assess distal pulses and signs of peripheral edema
c- Obtain a list of medications taken for cardiac history.
d- Ask the client about exposure to environmental heat.

HESI Exit RN Exam Over 700 Questions,
Answers Rationale New 2019/2020 latest
100%

Following discharge teaching, a male client with duodenal ulcer
tells the nurse the he will drink plenty of dairy products, such as
milk, to help coat and protect his ulcer. What is the best follow-up
action by the nurse?
a- Remind the client that it is also important to switch to decaffeinated
coffee and tea.
b- Suggest that the client also plan to eat frequent small meals to
reduce discomfort
c- Review with the client the need to avoid foods that are rich in
milk and cream.
d- Reinforce this teaching by asking the client to list a dairy food that he
might select.
Rationale: Diets rich in milk and cream stimulate gastric acid secretion
and should be avoided.
A male client with hypertension, who received new
antihypertensive prescriptions at his last visit returns to the clinic
two weeks later to evaluate his blood pressure (BP). His BP is
158/106 and he admits that he has not been taking the prescribed
medication because the drugs make him “feel bad”. In explaining
the need for hypertension control, the nurse should stress that an
elevated BP places the client at risk for which pathophysiological
condition?
a- Blindness secondary to cataracts
b- Acute kidney injury due to glomerular damage

c- Stroke secondary to hemorrhage
d- Heart block due to myocardial damage
Rationale: Stroke related to cerebral hemorrhage is major risk for
uncontrolled hypertension.

The nurse observes an unlicensed assistive personnel (UAP)
positioning a newly admitted client who has a seizure disorder.
The client is supine and the UAP is placing soft pillows along the
side rails. What action should the nurse implement?
a- Ensure that the UAP has placed the pillows effectively to protect the
client.
b- Instruct the UAP to obtain soft blankets to secure to the side rails
instead of pillows.
a- Assume responsibility for placing the pillows while the UAP
completes another task.
b- Ask the UAP to use some of the pillows to prop the client in a side
lying position.
Rationale: The nurse should instruct the UAP to pad the side rails with
soft blankest because the use of pillows could result in suffocation and
would need to be removed at the onset of the seizure. The nurse can
delegate paddling the side rails to the UAP
An adolescent with major depressive disorder has been taking
duloxetine (Cymbalta) for the past 12 days. Which assessment
finding requires immediate follow-up?
a- Describes life without purpose
b- Complains of nausea and loss of appetite

c- States is often fatigued and drowsy
d- Exhibits an increase in sweating.
Rationale: Cymbalta is a selective serotonin and norepinephrine
reuptake inhibitor that is known to increase the risk of suicidal
thinking in adolescents and young adults with major depressive
disorder. B, C and D are side effects

A 60-year-old female client with a positive family history of
ovarian cancer has developed an abdominal mass and is being
evaluated for possible ovarian cancer. Her Papanicolau (Pap)
smear results are negative. What information should the nurse
include in the client’s teaching plan?
a- Further evaluation involving surgery may be needed
b- A pelvic exam is also needed before cancer is ruled out
c- Pap smear evaluation should be continued every six month
d- One additional negative pap smear in six months is needed.
Rationale: An abdominal mass in a client with a family history for
ovarian cancer should be evaluated carefully
A client who recently underwear a tracheostomy is being
prepared for discharge to home. Which instructions is most
important for the nurse to include in the discharge plan?
a- Explain how to use communication tools.
b- Teach tracheal suctioning techniques
c- Encourage self-care and independence.
d- Demonstrate how to clean tracheostomy site.

Rationale: Suctioning helps to clear secretions and maintain an open
airway, which is critical.

In assessing an adult client with a partial rebreather mask, the
nurse notes that the oxygen reservoir bag does not deflate
completely during inspiration and the client’s respiratory rate is
14 breaths / minute. What action should the nurse implement?
a- Encourage the client to take deep breaths
b- Remove the mask to deflate the bag
c- Increase the liter flow of oxygen
d- Document the assessment data
Rational: reservoir bag should not deflate completely during inspiration
and the client’s respiratory rate is within normal limits.
During a home visit, the nurse observed an elderly client with
diabetes slip and fall. What action should the nurse take first?
a- Give the client 4 ounces of orange juice
b- Call 911 to summon emergency assistance
c- Check the client for lacerations or fractures
d- Asses clients blood sugar level
Rationale: After the client falls, the nurse should immediately assess for
the possibility of injuries and provide first aid as needed
At 0600 while admitting a woman for a schedule repeat cesarean
section (C-Section), the client tells the nurse that she drank a cup
a coffee at 0400 because she wanted to avoid getting a headache.
Which action should the nurse take first?
a- Ensure preoperative lab results are available

ATI med surg EXIT EXAM

Following discharge teaching, a male client with duodenal ulcer tells the nurse the he will
drink plenty of dairy products, such as milk, to help coat and protect his ulcer. What is
the best follow-up action by the nurse?
 Review with the client the need to avoid foods that are rich in milk and cream
A male client with hypertension, who received new antihypertensive prescriptions at his
last visit returns to the clinic two weeks later to evaluate his blood pressure (BP). His BP
is 158/106 and he admits that he has not been taking the prescribed medication because
the drugs make him “feel bad”. In explaining the need for hypertension control, the nurse
should stress that an elevated BP places the client at risk for which pathophysiological
condition?
 Stroke secondary to hemorrhage
The nurse observes an unlicensed assistive personnel (UAP) positioning a newly
admitted client who has a seizure disorder. The client is supine and the UAP is placing
soft pillows along the side rails. What action should the nurse implement?
 Instruct the UAP to obtain soft blankets to secure to the side rails instead of
pillows.
An adolescent with major depressive disorder has been taking duloxetine (Cymbalta) for
the past 12 days. Which assessment finding requires immediate follow-up?
 Describes life without purpose
A 60-year-old female client with a positive family history of ovarian cancer has
developed an abdominal mass and is being evaluated for possible ovarian cancer. Her
Papanicolau (Pap) smear results are negative. What information should the nurse include
in the client’s teaching plan?
 Further evaluation involving surgery may be needed
A client who recently underwear a tracheostomy is being prepared for discharge to home.
Which instructions is most important for the nurse to include in the discharge plan?
 Teach tracheal suctioning techniques
In assessing an adult client with a partial rebreather mask, the nurse notes that the oxygen
reservoir bag does not deflate completely during inspiration and the client’s respiratory
rate is 14 breaths / minute. What action should the nurse implement?
 Document the assessment data
 Rational: reservoir bag should not deflate completely during inspiration and the
client’s respiratory rate is within normal limits.
During shift report, the central electrocardiogram (EKG) monitoring system alarms.
Which client alarm should the nurse investigate firs?
 Respiratory apnea of 30 seconds
During a home visit, the nurse observed an elderly client with diabetes slip and fall. What
action should the nurse take first?
 Check the client for lacerations or fractures
At 0600 while admitting a woman for a schedule repeat cesarean section (C-Section), the

client tells the nurse that she drank a cup a coffee at 0400 because she wanted to avoid
getting a headache. Which action should the nurse take first?
 Inform the anesthesia care provider

After placing a stethoscope as seen in the picture, the nurse auscultates S1 and S2 heart
sounds. To determine if an S3 heart sound is present, what action should the nurse take
first?
 Listen with the bell at the same location
A 66-year-old woman is retiring and will no longer have a health insurance through her
place of employment. Which agency should the client be referred to by the employee
health nurse for health insurance needs?
 Medicare
A client who is taking an oral dose of a tetracycline complains of gastrointestinal upset.
What snack should the nurse instruct the client to take with the tetracycline?
 Toasted wheat bread and jelly
Following a lumbar puncture, a client voices several complaints. What complaint
indicated to the nurse that the client is experiencing a complication?
 “I have a headache that gets worse when I sit up”
 “I am having pain in my lower back when I move my legs”
 “My throat hurts when I swallow”
 “I feel sick to my stomach and am going to throw up”
An elderly client seems confused and reports the onset of nausea, dysuria, and urgency
with incontinence. Which action should the nurse implement?
 Obtain a clean catch mid-stream specimen
The nurse is assisting the mother of a child with phenylketonuria (PKU) to select foods
that are in keeping with the child’s dietary restrictions. Which foods are contraindicated
for this child?
 Foods sweetened with aspartame
Before preparing a client for the first surgical case of the day, a part-time scrub nurse
asks the circulating nurse if a 3 minute surgical hand scrub is adequate preparation for
this client. Which response should the circulating nurse provide?
 Direct the nurse to continue the surgical hand scrub for a 5 minute duration
Which breakfast selection indicates that the client understands the nurse’s instructions
about the dietary management of osteoporosis?
 Bagel with jelly and skim milk
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)?
 An 82-year-old client with Alzheimer’s disease newly-fractures femur who has a
Foley catheter and soft wrist restrains applied
A mother brings her 6-year-old child, who has just stepped on a rusty nail, to the
pediatrician’s office. Upon inspection, the nurse notes that the nail went through the shoe
and pierced the bottom of the child’s foot. Which action should the nurse implement
first?
 Cleanse the foot with soap and water and apply an antibiotic ointment
 Provide teaching about the need for a tetanus booster within the next 72 hours.
 have the mother check the child’s temperature q4h for the next 24 hours
 transfer the child to the emergency department to receive a gamma globulin
injection
The mother of an adolescent tells the clinic nurse, “My son has athlete’s foot, I have been
applying triple antibiotic ointment for two days, but there has been no improvement.”
What instruction should the nurse provide?
 Stop using the ointment and encourage complete drying of the feet and wearing
clean socks.
A 26-year-old female client is admitted to the hospital for treatment of a simple goiter,
and levothyroxine sodium (Synthroid) is prescribed. Which symptoms indicate to the
nurse that the prescribed dosage is too high for this client? The client experiences
 Bradycardia and constipation
 Lethargy and lack of appetite
 Muscle cramping and dry, flushed skin
 Palpitations and shortness of breath
A client with a history of heart failure presents to the clinic with a nausea, vomiting,
yellow vision and palpitations. Which finding is most important for the nurse to assess to
the client?
 Obtain a list of medications taken for cardiac history
The healthcare provider prescribes an IV solution of isoproterenol (Isuprel) 1 mg in 250
ml of D5W at 300 mcg/hour. The nurse should program the infusion pump to deliver how
many ml/hour? (Enter numeric value only.)
 75
 Rationale: Convert mg to mcg and use the formula D/H x Q. 300 mcg/hour /
1,000 mcg x 250 ml = 3/1 x 25 = 75 ml/hour
The pathophysiological mechanism are responsible for ascites related to liver failure?
(Select all that apply)
 Fluid shifts from intravascular to interstitial area due to decreased serum protein
 Increased hydrostatic pressure in portal circulation increases fluid shifts into
abdomen
 Increased circulating aldosterone levels that increase sodium and water retention
The nurse is auscultating a client’s heart sounds. Which description should the nurse use
to document this sound? (Please listen to the audio first to select the option that applies)
 Murmur
 Rationale: A murmur is auscultated as a swishing sound that is associated with the
blood turbulence created by the heart or valvular defect.
The healthcare provider prescribes celtazidime (Fortax) 35 mg every 8 hours IM for an
infant. The 500 mg vial is labeled with the instruction to add 5.3 ml diluent to provide a
concentration of 100 mg/ml. How many ml should the nurse administered for each dose?
(Enter numeric value only. If rounding is required, round to the nearest tenth)
 0.4
 rationale: 35mg/100mg x 1 = 0.35 = 0.4 ml
The nurse notes that a client has been receiving hydromorphone (Dilaudid) every six
hours for four days. What assessment is most important for the nurse to complete?
 Auscultate the client’s bowel sounds
 Observe for edema around the ankles
 Measure the client’s capillary glucose level
 Count the apical and radial pulses simultaneously
 Rationale: hydromorphone is a potent opioid analgesic that slows peristalsis and
frequently causes constipation, so it is most important to Auscultate the client’s
bowel sounds
A female client is admitted with end stage pulmonary disease is alert, oriented, and
complaining of shortness of breath. The client tells the nurse that she wants “no heroic
measures” taken if she stops breathing, and she asks the nurse to document this in her
medical record. What action should the nurse implement?
 Ask the client to discuss “do not resuscitate” with her healthcare provider
A client is receiving a full strength continuous enteral tube feeding at 50 ml/hour and has
developed diarrhea. The client has a new prescription to change the feeding to half
strength. What intervention should the nurse implement?
 Add equal amounts of water and feeding to a feeding bag and infuse at 50ml/hour
A female client reports that her hair is becoming coarse and breaking off, that the outer
part of her eyebrows have disappeared, and that her eyes are all puffy. Which follow-up
question is best for the nurse to ask?
 Have you noticed any changes in your fingernails?
 Rationale: The pattern of reported manifestations is suggestive of hypothyroidism
After a third hospitalization 6 months ago, a client is admitted to the hospital with ascites
and malnutrition. The client is drowsy but responding to verbal stimuli and reports
recently spitting up blood. What assessment finding warrants immediate intervention by
the nurse?
 Capillary refill of 8 seconds
 bruises on arms and legs
 round and tight abdomen
 pitting edema in lower legs
After the nurse witnesses a preoperative client sign the surgical consent form, the nurse
signs the form as a witness. What are the legal implications of the nurse’s signature on
the client’s surgical consent form? (Select all that apply)
 The client voluntarily grants permission for the procedure to be done
 The client is competent to sign the consent without impairment of judgment
 The client understands the risks and benefits associated with the procedure
Following surgery, a male client with antisocial personality disorder frequently requests

HESI 68 TEST BANK MID LPN RN
2020 KEY WORDS & ANSWER(S)

Chinese-American patient going in for emergency surgery within 24 hours – interpreter
Infant with normal vitals, axillary temp low – place under warmer
Baby – protect the sac and place on abdomen
Osteoarthritis – vitamin C?
DM pump – pt needs to know how to calibrate and work bolus
Mother gives pt iron with 2 oz. orange juice – tell mother she did it correctly
Increased BMI – waist circumference
PTSD – put pt in a room away from stimulus
PTSD – show pt where the quiet room is when they first arrive
Antabuse – no alcohol for 12 hours prior to beginning the medication
Which wound would nurse assess first – laceration
Pt crying about miscarriage – give tissue let her sit quietly
Pt in employee health for routine hypertension, states he wants to kill coworker – see if pt
has a weapon
Women pregnant and smoking – go to help group for emotional support
NMS – check vital signs
Left heart failure – fatigue
To determine if pt is on one-to-one – if they’re going into other pt’s rooms
Pt on steroids asks why they need sliding scale – steroids and infection increase sugars
Lasix – check electrolytes
Glomerulonephritis – reduce sodium intake and no excess water consumption
Bulk laxative – drink additional water after taking medication
Pt ambulating in hallway – HR stable before and after
“Activity intolerance” outcome – pt ambulates without discomfort
HR increased 20 at 2 hour checks – look for cause of increased HR
Unilateral knee replacement pain – PCA pump
SATA iron – spinach option, beans option
Pregnancy women priority dx – r/o injury r/t uterine atony
Pitocin after delivery – promote uterine contractions
Diabetes with shiny legs – check pedal pulse
Evisceration – sterile saline and gauze
Isotonic solution – clean without tissue damage
NG tube with intermittent low suction – damp cotton swab in pt’s mouth
Broca’s area – give pt extra time for expression
Pt with HIV value indicates likely to develop infection – CD4+
Palpating BP – inflate to 120 (+30 from where pulse stop)
RLQ with N/V, what do you do last – palpate
Subjective response for pt with orthopnea – sleeps on 3 pillows at night
Anorexic pt wants to work in cafeteria – recommend they work as receptionist
Math – 1.7

Pharmacology Exit HESI
Nurse should observe most closely for drug toxicity when a client
receives med that has what characteristic
Narrow therapeutic index
Nurse is conducting DC teaching about anti-anxiety drug diazepam
(valium)
Evaluate the ingredients of all over-the-counter drugs for alcohol
content
Nursing instruction most important for patient on Zyloprim
Increase fluid intake
Client getting Tofranil (Imipramine)
Give medication at night
Magnesium antidote
Calcium gluconate
Patient with hyperthyroidism taking inderal (propanalol)
Decreases pulse rate
Medication dosing-heparin 25000 units at 7ml/hr doctor changed rate to
900 units what is the
Mls/hr
Med was ordered 100mg in 4 divided doses in 24 hours available in
25mg, how many will you give every 6 hours
1
Patient on benzos
Answer is not narcan

Patient Dx with bipolar-how to know if meds are effective
Family states patient is doing better with manic phases
Patient on Heparin going for surgery in a.m.,-priority
Assess patient for bleeds
Best time to give patient Abx (I think)
Time was like 1000, 1400, 1200, and 0400…best to give around the
clock
Medication calculation-patient weighs equal to 16kg-order for Tamiflu
45mg BID
Must round up-answer is 3.8ml
Peptic ulcer med-what action
Histamine 2 agonist
Patient on folliculitis medication-what to teach
Drink with full glass of water

Vasopressin
Vasoconstrictor
Know why Digoxin and Lasix are used together
Tamoxifen Citrate use and therapeutic outcome
Fosomax for osteoarthritis patient teaching
Rifampin for TB
Rusty-orange/red colored urine and body fluids
Pyridium for bladder infection
Orange/red/pink urine
Stay in bed for 3 hours post first Ace Inhibitor dose
Avoid grapefruit juice with CCB
Lipitor (statins) in PM only-no grapefruit juice
Trough draw
30 minutes before scheduled dose
Peak draw
30-60 minutes after administration
Potassium sparing diuretic need to watch for hyperkalemia
Aldactone (spirinolactone)
Using bronchodilators before steroids for asthma teaching
Exhale completely, inhale deeply, hold breath for 10 seconds
Insulin can be kept at room temp
28 days
Drawing insulin
Clear (regular) first then cloudy (NPH)
Know the insulins and their peak/onset (there are several Qs about this
in different formats)

HESI EXIT EXAM PN 2019 TEST BANK

a male client admitted the morning of his scheduled surgery tells the PN that he drank water last
night. What intervention will the PN implement first? Determine the amount of water and
exact time it was taken
A client receives ondansetron prior to chemotherapy treatment.How should the PN evaluate
this medication? Monitor the client for nausea or vomiting following the treatment
The PN is caring for an older adult client who is confused and spends…factor contributes to an
increased risk for impaired skin integrity for this client? Has increasing episodes of urinary
incontinence
The pn determines that a client with cirrhosis is experiencing peripheral….take? Protect the
clients feet from injury
A client is admitted to the postoperative surgical unit after a left lobectomy with two chest
tubes……observes the water-sealed chambers, set and prescribed suction of 20cm water…what
action should the PN implement? Maintain system integrity and to promote lung
reexpansion
photo of chest and locating apical HR just below the left nipple
At the end of a 12-hour shift the PN observes the urine in a clients drainage..what action should
the PN take next? note the most recent white blood count
Thirty minutes after receiving IV morphine, a postoperative male client continue to rate his
pain…what action should the PN implement first? implement complementary pain relief
methods
A male client has been diagnosed with schizophrenia is withdrawn, isolates himself in….with one
or two word responses. the morning the PN observes that he…Which intervention is most
important for the PN to implement? Measure appropriate vital signs
The PN is assisting a female client to obtain a voided specimen for uri…meatus. Which
intervention is performed next? initiate the urine stream?
An 8-year old is placed in 90-90 traction for a fractured femur that resulted from…further action
by the PN? weights are touching the foot of the bed
The PN is reviewing diet instructions with a female client who has hyper…she has increased her
intakes of protein and calories. What action should the PN take?Encourage the client to
continue the dietary changes she has made
The PN reviews the procedure for measuring fluid intake and output …glomerulonephritis and is
preparing for discharge from the hospital. What… -why the fluid measurements need to
be recoded
-which food types are included when measuring fluid take
-what container to use for the most accurate measurement
… request return visit for examination after her period when hormones are lowest
A mother brings her 5-year old child to the clinic for school physical examinations. Which
assessment… PN that intergenerational violence may be occurring in the home? -The 6-year old
son hits his younger sister during the interview
-the 10-year old daughter has circular burns on her trunk and legs
-the 3-year old has multiple bruises on the chest and both legs
A client has a prescription to discontinue intravenous therapy when the liter that is infusing at
150 mL per hour is…1200 the PN notes that there are 750 ml of solution remaining.At what time
should the nurse expect to discontinue the intravenous therapy? 1700
the PN is caring for a client who had a total laryngectomy, left radical neck dissection… client is
receiving nasogastric tube feedings via an internal pump. today the rate of the feeding was
increased…ml/hr. What parameter should the PN use to evaluate the clients tolerate to the rate
of the feeding? gastric residual volumes
A new mother is breastfeeding her newborn for the first time after delivery and complains of
nipple pain…Based on the client complaint, what action should the PN take? Ensure that all
the areolar tissue of the nipple is in the infants mouth.
Which site should the PN use when administering an injection of Rho (D) Immune negative
postpartum client? deltoid
Before inserting medication into a clients vagina, what instructions should the pn… urinate
until bladder is empty
An 18-year old female client with pelvic inflammatory disease (PID0 asks the pn..Which
information is best for the PN to provide? A history of untreated gonnorhea can lead to
PID
A new mother is bottle feeding instead of breastfeeding her newborn, The PN…most effectively
deal with breast engorgement and discomfort? Wear a supportive bra at all times
A young adult male tells the PN he has declared to change his hours at work so that he can…his
community. Which stage of Maslow’s development is this young adult attempting to achieve?
Self-actualiztion
A female client arrives to the clinic for an annal physical examination. when reviewing…the PN
that she takes herbs for high blood pressure instead of the prescribed..important for the PN to
reinforce with the client? Explain risks associated with using herbs instead of the
prescribed antihypertensives.
A female Native American client who is receiving chemotherapy places a native artifact…the
health care provider removes the medicine wheel and tells the client “this type..hospital” what
intervention should the PN implement ?Act as the clients advocate when discussing the issue
with the HCP
The PN is caring for a client receiving chemotherapy who has thrombocytopenia..important to
include in the nursing care plan? watch the client for abnormal bleeding
… “it is better to obtain children acetaminophen to prevent possible side effects from the
aspirin “
A client is transferred to the surgical unit from the intensive care unit after evacuation of
bilateral..primary observation should the PN monitor? neuro-vital signs related to bleeding
and intracranial pressure
The PN is working the day shift in a long term facility and is preparing..delegate to the UAP to
perform during the change of.. total the clients PO intake, fill the water pitchers, empty urinals
and catheter bags.
While taking the vital signs of a older male client who takes psychotropic
medication…uncontrollable hand movements ad is excessively blinking his eyes, which
information…. screening for tardive dyskinesia

2020 PN HESI
Exit V1
Question 1
A school-age client with diabetes is placed on an intermediateacting insulin and regular insulin before breakfast and before
dinner. She will receive a snack of milk and cereal at bedtime.
What does the nurse tell the client the snack is intended to do?
You Selected:

Prevent late night hypoglycemia.
Correct response:
Prevent late night hypoglycemia.
Question 2
A well-known public official of a small community is admitted to
the emergency department following an episode of chest pain.
Several nurses from the medical unit are aware of the admission and
access the official’s electronic medical record to obtain a status
update. What is the best response for the nurse manager to make to
the nurses regarding this situation?
You Selected:
“Assessing the official’s medical record is a breach of
confidentiality.”
Correct response:
“Assessing the official’s medical record is a breach of
confidentiality.”
Question 3
A four-year-old child is diagnosed as having acute lymphocytic

leukemia. The white blood cell (WBC) count, especially the
neutrophil count, is low. What is the most important intervention the

nurse should teach the parents?
You Selected:

Protect your child from infections because his resistance to
infection is decreased
Correct response:
Protect your child from infections because his resistance to
infection is decreased
Question 4
The nurse is caring for a client with influenza. The most effective
way to decrease the spread of microorganisms is:
You Selected:
placing the client in isolation.
Correct response:
washing the hands frequently.
Question 5
A client with a history of hypertension has been prescribed a new
antihypertensive medication and is reporting dizziness. Which is
the best way for the nurse to assess blood pressure?
You Selected:
in the supine, sitting, and standing positions
Correct response:
in the supine, sitting, and standing positions
Question 6
A client has a soft wrist-safety device. Which assessment finding
should the nurse investigate further?
You Selected:
cool, pale fingers
Correct response:
cool, pale fingers
Question 7
A nurse is caring for a female client before surgery. The client states
that she is glad that she will not be going through menopause as a
result of her surgery and is only having her uterus removed. The
nurse reviews the consent form and notes that the surgery is for a
total abdominal hysterectomy with a salpingo-oophorectomy. What
should the nurse do in this situation?
You Selected:
Contact the surgeon to explain that the client needs further
clarification regarding surgery.
Correct response:
Contact the surgeon to explain that the client needs further
clarification regarding surgery.
Question 8
A young client diagnosed with schizophrenia is talking with the
nurse and says, “You know, when I thought everyone was out to get
me, I was staying in my apartment all the time. Now, I would like to
get out and do things again.” What is the best initial response by the
nurse?
You Selected:
“What activities did you enjoy in the past?”
Correct response:
“What activities did you enjoy in the past?”

Leadership/Management Exit HESI
Finding a client sitting on the floor, nurse calls for help from UAP
Get a BP cuff
Assigning a UAP to assist client with personal care
Prescribed activity level
The ICU is full and short staffed, so nursing super informs charge nurse in the med dept that one nurse
must float to the ICU
Staff nurse who was cross-trained to work in the critical care dept
Charge nurse developing guidelines for a coronary care unit
The scope of standards of practice from the American nurses association
Which patient should be assigned to a nurse that is floated from maternity unit
Post op hysterectomy
There has been a major disaster. Triage nurse should give which patient priority
Cut over eye
Delegate to LPN
Dressing change
Move which patient to medical surgical unit
Patient with ABNL liver levels
One open bed in ICU but reserved for patient coming from PACU with respiratory problems, what to do
Take patient to ICU and arrange for respiratory patient to stay in PACU
UAP giving complete bath-which patient is more concern
Patient with dyspnea (SOB when lying flat)
Which one shows nurse manager being _ (means no team work)
?
ER nurse getting moved to L&D, what patient should leader assign
Patient with episiotomy infection
DNR
Notify the family
Against medical Advice (AMA)with and IV
RN removes IV, sign the document AMA form
Prescriptions-telephone
repeat order back to doctor to make sure it is correct
Assign UAP
hygiene, feeding, ADLS, ROM, ambulation

Confidentiality-emergency department
don’t give out information about patient, don’t talk about patients condition in front of people, keep
records safe
Malpractice
negligence by professional personnel
Ex: buring client with hot heating pad, ignoring s/s of bleeding, giving wrong medication
Patient bill of rights
show pt there bill of rights, they have the right to see their chart and anything regarding their care
Assign PN-scope of practice
No assessments, teaching (newly DX’d), IV’s, blood transfusions, no suicide patients, no critical
patients
Assignments-new grad
graduate nurse supervised by RN, what pt to give? Infusing antibiotic or choosing catheter port
Unsafe nurse
after nurse goes through rehab she can do her job regularly
Brain death-organ donation
if person is organ donor and is brain dead, organs can be donated
Critical lab value
high levels or low levels (know levels) potassium is a priority lab value
Fibromyalgia assistance
provide uninterrupted sleep and refer to pain specialist
RN role-assess
RN’s assess not LPN or UAP
Med error- action
assess pt, incident report, notify doctor, document amt prescribed, and dosage given
MRSA room assigned
private room, contact isolation
Restraints
standards of care
Cultural
Native American POC
Know rules for Immunization permission
Priority care
Management
Ethical
Assign least care to UAP

ALL HESI EXIT Questions and Answers
Test Bank; A+ Rated Guide (2022)

A client receives a new prescription for simvastatin (Zocor) 5 mg PO daily at
bedtime. What action should the nurse take?
(correct Answer- Administer the medication as prescribed with a glass of water
Which client should the nurse assess frequently because of the risk for
overflow incontinence?
A client Who is confused and frequently forgets to go to the bathroom
While monitoring a client during a seizure, which interventions should the
nurse implement? (Select all that apply)
(correct AnswerMove obstacle away from client
Monitor physical movements
Observe for a patent airway
Record the duration of the seizure
A male client with a long history of alcoholism is admitted because of mild
confusion and fine motor tremors. He reports that he quit drinking alcohol and
stopped smoking cigarettes one month ago after his brother died of lung cancer.

Which intervention is most important for the nurses to include in the client’s plan
of care?
(correct Answer- Observe for changes in level of consciousness.

An older adult female admitted to the intensive care unit (ICU) with a
possible stroke is intubated with ventilator setting of tidal volume 600, PlO2 40%,
and respiratory rate of 12 breaths/minute. The arterial blood gas (ABG) results
after intubation are PH 7.31. PaCO2 60, PaO2 104, SPO2 98%, HCO3 23. To
normalize the client’s ABG finding, which action is required?
correct Answer- Increase ventilator rate.
The mother of the 12- month-old with cystic fibrosis reports that her child is
experiencing increasing congestion despite the use of chest physical therapy (CPT)
twice a day, and has also experiences a loss of appetite. What instruction should
the nurse provide?
(correct Answer- CPT should be performed more frequently, but at least an hour
before meals.
The nurse is evaluating the diet teaching of a client with hypertension. What
dinner selection indicates that the client understands the dietary recommendation
for hypertension?
(correct Answer- Baked pork chop, applesauce, corn on the cob, 2% milk, and keylime pie
A client with type 2 diabetes mellitus is admitted for frequent hyperglycemic
episodes and a glycosylated hemoglobin (HbA1c) of 10%. Insulin glargine 10 units
subcutaneously once a day at bedtime and a sliding scale with insulin aspart q6h
are prescribed. What action should the nurse include in this client’s plan of care?
(correct Answer- Fingerstick glucose assessment q6h with meals
Review with the client proper foot care and prevention of injury
Coordinate carbohydrate controlled meals at consistent times and intervals
Teach subcutaneous injection technique, site rotation and insulin management
Which problem reported by a client taking lovastatin requires the most
immediate fallow up by the nurse?

(correct Answer- Muscle pain

While assessing a client’s chest tube (CT), the nurse discovers bubbling in the
water seal chamber of the chest tube collection device. The client’s vital signs are:
blood pressure of 80/40 mmHg, heart rate 120 beats/minutes, respiratory rate 32
breaths/minutes, oxygen saturation 88%. Which interventions should the nurse
implement?
(correct Answer- Provide supplemental oxygen
Auscultate bilateral lung fields
Reinforce occlusive CT dressing
Before leaving the room of a confused client, the nurse notes that a half bow
knot was used to attach the client’s wrist restraints to the movable portion of the
client’s bed frame. What action should the nurse take before leaving the room?
(correct Answer- Ensure that the knot can be quickly released.
Oral antibiotics are prescribed for an 18-month-old toddler with severe otitis
media. An antipyrine and benzocaine-otic also prescribed for pain and
inflammation. What instruction should the nurse emphasize concerning the
installation of the antipyrine/benzocaine otic solution?
(correct Answer- Have the child lie with the ear up for one to two minute after
installation.
An older adult male is admitted with complications related to chronic
obstructive pulmonary disease (COPD). He reports progressive dyspnea that
worsens on exertion and his weakness has increased over the past month. The
nurse notes that he has dependent edema in both lower legs. Based on these
assessment findings, which dietary instruction should the nurse provide?
(correct Answer- Restrict daily fluid intake.
The nurse inserts an indwelling urinary catheter as seen in the video what
action should the nurse take next?
(correct Answer- Leave the catheter in place and obtain a sterile catheter.
A client with coronary artery disease who is experiencing syncopal episodes
is admitted for an electrophysiology study (EPS) and possible cardiac ablation
therapy. Which intervention should the nurse delegate to the unlicensed assistive
personnel (UAP)?
(correct Answer- Prepare the skin for procedure.
Fallowing an outbreak of measles involving 5 students in an elementary
school, which action is most important for the school nurse to take? (correct
Answer- Restrict unvaccinated children from attending school until measles
outbreak is resolved.
A preeclamptic client who delivered 24h ago remains in the labor and
delivery recovery room. She continues to receive magnesium sulfate at 2 grams per
hour. Her total input is limited to 125 ml per hour, and her urinary output for the
last hour was 850 ml. What intervention should the nurse implement?
(correct Answer- Continue with the plan of care for this client
The nurse is planning care for a client who admits having suicidal thoughts.
Which client behavior indicates the highest risk for the client acting on these
suicidal thoughts?
(correct Answer- Begin to show signs of improvement in affect
When assessing a multigravida the first postpartum day, the nurse finds a
moderate amount of lochia rubra, with the uterus firm, and three fingerbreadths
above the umbilicus. What action should the nurse implement first?
(correct Answer- Check for a destined bladder
A 12 year old client who had an appendectomy two days ago is receiving
0.9% normal saline at 50 ml/hour. The client’s urine specific gravity is 1.035. What
action should the nurse implement?
(correct Answer- Encourage popsicles and fluids of choice
An older male client arrives at the clinic complaining that his bladder always
feels full. He complains of weak urine flow, frequent dribbling after voiding, and

Exit HESI (Actual hesi hints), EXIT HESI 2
what is considered a postpartum infection?
(correct ANS) – a fever on 2 consecutive days for the first 10 days postpartum not
including the first day
wound infections
mastitis
endometritis
UTIs
respiratory tract infections
what do you suspect in a child with an irregular pulse?
(correct ANS) – Kawasaki disease
what do you screen for on a newborn baby?
(correct ANS) – hypothyroidism
check T4 level (decreased)
what is an expected side effect of Solu-Medrol?
(correct ANS) – bleeding, bruising
what does Pilocarpine treat?
(correct ANS) – glaucoma
antidote is atropine sulfate
may get a dry mouth
TPN
(correct ANS) – central venous catheter
check for cloudiness
refrigerate- warm before administration
monitor electrolytes everyday
monitor for hyperglycemia and infection
change tubing with each new bag
nothing else goes through this line
what drug would you give is extravasation has occurred?
(correct ANS) – phentolamine (Regitine)- it’s a vasodilator and will increase blood
flow to the area to prevent necrosis

what diet would be chosen for a pt with CKD?
(correct ANS) – bread & cream of wheat
pt receiving a blood transfusion develops fluid volume excess and dyspnea, what
do you do?
(correct ANS) – increase O2
what should you be monitoring in a client who has had a nephrectomy?
(correct ANS) – UOP
it is more important than drainage
what is important when caring for pt in skeletal traction?
(correct ANS) – pin care; sterile technique; remove crust; serous drainage is ok
how do you deal with a rude doctor that is avoided by the nurses?
(correct ANS) – staff meeting
what is confrontation?
(correct ANS) – calling attention to inconsistent behaviors
what is reflecting?
(correct ANS) – paraphrasing or repeating what client said
what client would most likely be experiencing delirium?
(correct ANS) – a client with constant pain or insomnia
what is the priority for a depressed client who has not slept?
(correct ANS) – sleep
a client who is bipolar is going home for the weekend to adjust for discharge. what
do you tell the family?
(correct ANS) – continue normal daily activities
if a client has a pulse with absent breath sounds on the left side what do you do?
(correct ANS) – prepare to reposition ETT
what do you monitor for in adrenal insufficiency (no steroids)?
(correct ANS) – shock
hyperkalemia
increase sodium in diet

if a client suddenly withdraws from steroids what do you do?
(correct ANS) – check VS
what do you teach a client taking prednisone?
(correct ANS) – monitor for hyperglycemia
take in morning
you are caring for a client with AIDS and you accidentally stick yourself with a
sterile needle. what do you do?
(correct ANS) – go get a new needle- no need to report
what do you teach a pt taking an antipyretic for and increased temp?
(correct ANS) – give with fluids because fever can cause dehydration
what is suspected if there is an increase in serosanguineous drainage?
(correct ANS) – dehiscence
what would you expect in a client with an epidural hematoma?
(correct ANS) – temporary loss of consciousness, followed by a lucid period, and
then gradually leading to coma
for maximum effectiveness, what should older clients use for dry skin?
(correct ANS) – petroleum based ointment
what are signs of pain in an infant?
(correct ANS) – grimacing
tachycardia
restlessness
irritability
difficulty feeding/sleeping
increased RR
diaphoresis
decreased O2 levels
what is priority for a client with renal lithiasis?
(correct ANS) – address pain- these pts get pain meds immediately (don’t teach
important of straining urine- that’s RNs job)
what do you do for a pt on Amph B?

(correct ANS) – monitor UOP- it’s nephrotoxic
what is the priority assessment in a client who has lost a tooth and has an eye
injury?
(correct ANS) – check pupils
where should the level of water be in the water seal chamber?
(correct ANS) – at 2cm
where should the level of water be in the suction control chamber?
(correct ANS) – at 20cm
how does a client present with DM2?
(correct ANS) – usually come back to doctor for wounds that won’t heal or vaginal
infections
don’t have enough insulin
insulin doesn’t work
a client in hypovolemic shock would present with what?
(correct ANS) – weak thready pulse
how would you teach someone to use an inhaler?
(correct ANS) – shake well for 5 seconds (if MDI)
exhale completely
press canister once and inhale deeply and slowly
hold breath for 10 seconds
wait 1 min between each puff
if using MDI- rinse mouth & gargle after each use
nebulizers are better for peds and clients with severe asthma because it allows you
to breath normally
what is the appropriate action for a burn client in the emergent phase whose UOP
and BP are dropping?
(correct ANS) – immediately call the HCP
what do you monitor for in a client with HHS and DKA with insulin drip?
(correct ANS) – hypokalemia
U wave
what is priority discharge teaching for a client with HHS?

Exit HESI Test Bank (answered) spring 2022.

A nurse is providing information to a group of pregnant clients and their partners
about the psychosocial development of an infant. Using Erikson’s theory of
psychosocial development, what should the nurse tell the group about the
infants?
A. Rely on the fact that their needs will be met
B. Need to tolerate a great deal of frustration and discomfort to develop a
healthy personality
C. Must have needs ignored for short periods to develop a healthy
personality
D. Need to experience frustration, so it is best to allow an infant to cry for a
while before meeting his or her needs – A. Rely on the fact that their needs
will be met
A nurse is weighing a breastfed 6-month-old infant who has been brought to the
pediatrician’s office for a scheduled visit. The infant’s weight at birth was 6 lb 8
oz. The nurse notes that the infant now weighs 13 lb. Which action should the
nurse take?
A. Tell the mother that the infant’s weight is increasing as expected
B. Tell the mother to decrease the daily number of feedings because the
weight gain is excessive
C. Tell the mother that semisolid foods should not be introduced until the
infant’s weight stabilizes
D. Tell the mother that the infant should be switched from breast milk to
formula because the weight gain is inadequate – A. Tell the mother that
the infant’s weight is increasing as expected
A nurse performing a physical assessment of a 12-month-old infant notes that
the infant’s head circumference is the same as the chest circumference. Based
on this finding, what should the nurse do?
A. Suspect the presence of hydrocephalus
B. Suggest to the pediatrician that a skull x-ray be performed
C. Tell the mother that the infant is growing faster than expected
D. Document these measurements in the infant’s health-care record – D.
Document these measurements in the infant’s health-care record
A new mother asks the nurse, “I was told that my infant received my antibodies
during pregnancy. Does that mean that my infant is protected against infections?”
Which statement should the nurse make in response to the mother?
A. “Yes, your infant is protected from all infections.”
B. “If you breastfeed, your infant is protected from infection.”

C. “The transfer of your antibodies protects your infant until the infant is 12
months old.”
D. “The immune system of an infant is immature, and the infant is at risk for
infection.” – D. “The immune system of an infant is immature, and the
infant is at risk for infection.”

A nurse is assessing the language development of a 9-month-old infant. Which
developmental milestone does the nurse expect to note in an infant of this age?
A. The infant babbles.
B. The infant says “Mama.”
C. The infant smiles and coos.
D .The infant babbles single consonants. – B. The infant says “Mama.”
The mother of a 9-month-old infant calls the nurse at the pediatrician’s office, tells
the nurse that her infant is teething, and asks what can be done to relieve the
infant’s discomfort. What should the nurse instruct the mother to do?
A. Schedule an appointment with a dentist for a dental evaluation
B. Rub the infant’s gums with baby aspirin that has been dissolved in water
C. Obtain an over-the-counter (OTC) topical medication for gum-pain relief
D. Give the infant cool liquids or a Popsicle and hard foods such as dry toast

D. Give the infant cool liquids or a Popsicle and hard foods such as dry
toast

A nurse is teaching the mother of an 11-month-old infant how to clean the infant’s
teeth. What should the nurse tell the mother to do?
A. Use water and a cotton swab and rub the teeth
B. Use diluted fluoride and rub the teeth with a soft washcloth
C. Use a small amount of toothpaste and a soft-bristle toothbrush
D. Dip the infant’s pacifier in maple syrup so that the infant will suck – A. Use
water and a cotton swab and rub the teeth
A nurse provides information about feeding to the mother of a 6-month-old infant.
Which statement by the mother indicates an understanding of the information?
A. “I can mix the food in the my infant’s bottle if he won’t eat it.”
B. “Fluoride supplementation is not necessary until permanent teeth come
in.”
C. “Egg white should not be given to my infant because of the risk for an
allergy.”
10.D “Meats are really important for iron, and I should start feeding meats to my
infant right away.” – C. “Egg white should not be given to my infant because of
the risk for an allergy.”

11.A nurse provides instructions to a mother of a newborn infant who weighs 7 lb 2
oz about car safety. What should the nurse tell the mother?
A. To secure the infant in the middle of the back seat in a rear-facing infant
safety seat
B. To place the infant in a booster seat in the front seat of the car with the
shoulder and lap belts secured around the infant
C. That it is acceptable to place the infant in the front seat in a rear-facing
infant safety seat as long as the car has passenger-side air bags
D. That because of the infant’s weight it is acceptable to hold the infant as
long as the mother and infant are sitting in the middle of the back seat of
the car – A. To secure the infant in the middle of the back seat in a rearfacing infant safety seat
12.A nurse provides instructions to a mother about crib safety for her infant. Which
statement by the mother indicates a need for further instructions?
A. “I need to keep large toys out of the crib.”
B. “The drop side needs to be impossible for my infant to release.”
C. “Wood surfaces on the crib need to be free of splinters and cracks.”
D. “The distance between the slats needs to be no more than 4 inches wide
to prevent entrapment of my infant’s head or body.” – D. “The distance
between the slats needs to be no more than 4 inches wide to prevent
entrapment of my infant’s head or body.”
13.The mother of a 2-year-old tells the nurse that she is very concerned about her
child because he has developed “a will of his own” and “acts as if he can control
others.” The nurse provides information to the mother to alleviate her concern,
recalling that, according to Erikson, a toddler is confronting which developmental
task?
A. Initiative versus guilt
B. Trust versus mistrust
C. Industry versus inferiority
D. Autonomy versus doubt and shame – D. Autonomy versus doubt and
shame
14.A nurse is planning care for a hospitalized toddler. To best maintain the toddler’s
sense of control and security and ease feelings of helplessness and fear, which
action should the nurse take?
A. Spend as much time as possible with the toddler
B. Keep hospital routines as similar as possible to those at home
C. Allow the toddler to play with other children in the nursing unit playroom

D. Allow the toddler to select toys from the nursing unit playroom that can be
brought into the toddler’s hospital room – B. Keep hospital routines as
similar as possible to those at home
15.A nurse in a daycare setting is planning play activities for 2- and 3-year-old
children. Which toy is most appropriate for these activities?
A. Blocks and push-pull toys
B. Finger paints and card games
C. Simple board games and puzzles
D. Videos and cutting-and-pasting toys – A. Blocks and push-pull toys
16.A mother of twin toddlers tells the nurse that she is concerned because she
found her children involved in sex play and didn’t know what to do. What should
the nurse tell the mother?
A. To separate her children during playtime
B. That if the behavior continues, she will need to bring her children to a child
psychologist
C. That if she notes the behavior again she should casually tell her children
to dress and to direct them to another activity
D. To tell her children that what they are doing is bad and that they will be
punished if they are caught doing it again – C. That if she notes the
behavior again she should casually tell her children to dress and to direct
them to another activity
17.A nurse is assessing the motor development of a 24-month-old child. Which
activities would the nurse expect the mother to report that the child can perform?
Select all that apply.
A. Put on and tie his shoes
B. Align two or more blocks
C. Dress himself appropriately
D. Go to the bathroom without help
E. Turn the pages of a book one at a time – B. Align two or more blocks
F. Turn the pages of a book one at a time
18.A nurse is assessing language development in a toddler from a bilingual family.
What should the nurse expect about the child’s language development?
A. Is slower than expected
B. Is developing as expected
C. Is more advanced than expected
D. Will require assistance from a speech therapist – A. Is slower than
expected

Exit HESI Test Banks (over 3000 Q’s and Answers ) spring 2023 / Exit HESI Prep Distinction Level Assignment Has everything.

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