HESI EXIT RN 2022
The nurse has completed the diet teaching of a client who is being discharged following treatment of a leg wound. A high
protein diet
... [Show More] is encouraged to promote wound healing. Which lunch choice by the client indicates that the teaching was
effective?
a. A peanut butter sandwich with soda and cookies.
b. A tuna fish sandwich with chips and ice cream.
c. Vegetable soup, crackers, and milk.
d. A salad with three kinds of lettuce and fruit.
3 The nurse implements a primary prevention program for sexually transmitted diseases in a nurse managed health center.
Which outcome indicates that the program was effective?
A. Average client scores improved on specific risk factor knowledge test.
B. More than half of at-risk client were diagnosed early in their process.
C. New screening protocols were developed, validated, and implemented.
D. Clients who incurred disease complications promptly received rehabilitation.
4 A young adult client is admitted to the emergency room following a motor vehicle collision. The client's head hit the
dashboard. Admission assessments include blood pressure 85/45 mm Hg, oral temperature 98.6° F (37° C), pulse 124
beats/minute, and respirations 22 breaths/minute. Based on these data, the nurse formulates the first portion of a nursing
problem as "Risk for injury". What term best expresses the "related to" portion of the nursing problem?
a. head injury.
b. infection.
c. increased intracranial pressure.
d. shock.
5 A nurse working on an endocrine unit should see which client first.
a. An adolescent male with diabetes who is arguing about his insulin dose.
b. An older client with Addison’s disease whose current blood sugar level is 62mg/dl (3.44 mmol/l).
c. An adult with a blood sugar of 384mg/dl (21.31mmol/l) and urine output of 350 ml in the last hour.
d. A client taking corticosteroids who has become disoriented in the last two hours.
6 Following a gunshot wound, an adult client has a hemoglobin level of 4 grams/dl (40 mmol/L SI). The nurse prepares to
administer a unit of blood for an emergency transfusion. The client has AB negative blood type and the blood bank sends a
unit of Type A Rh negative, reporting that there is no Type AB negative blood currently available. Which intervention
should the nurse implement?
a. Transfuse Type A negative blood until Type AB negative is available.
b. Recheck the clienfs hemoglobin, blood type, and Rh factor.
c. Obtain additional consent for administration of Type A negative blood.
d. Administer normal saline solution until Type AB negative is available.
7 An older client who lives alone in a two-story home is admitted after falling while shopping. X-rays reveal a fractured left
hip. With no immediate family in the area, the client is concerned about the pets at home. Which interventions should the
nurse implement? (Select au that apply.)
A- Evaluate pain using a standard pain scale
B- Alert social worker of client's concerns.
C- Support left leg with two pillows.
D- Palpate and mark pedal pulses.
E- Assess ability to bear weight when standing
8 Which laboratory finding for an adult client is most critical for the nurse to report to the healthcare provider? (Click on the
correct location on the chart. To change, click on a new location.)
Serum Sodio 142 mEq/L (142 mmol/L)
Postassium 3.9 mEq/L (3.9 mmol'/L)
Serum glucose 62 mg/dl (3.4 mmdl/L)
Blood urea nitrogen 18 mg/dl (6.4 mmol/L)
9 An older adult client with heart failure (HF) develops cardiac tamponade. The client has muffled, distant, heart sounds,
and is anxious and restless. After initiating oxygen therapy and IV hydration, which intervention is most important for the
nurse to implement?
a. Observe neck for jugular vein distention
b. Notify healthcare provider to prepare for pericardiocentesis
c. Asses for paradoxical blood pressure
d. Monitor oxygen saturation (Sp02) via continuous pulse oximetry
10 The parent of a child born with a cleft lip asks the nurse to explain why this happened. The parent is concerned that they
did something wrong that caused this to occur. Which response is most helpful?
a. "You didn't do anything wrong."
b. "This must be a very difficult time for you."
c. "With surgery, your baby should have a full recovery.
d. "Is there any particular reason why you think this is your fault?
11 After diagnosis and initial treatment of a 3-year-old with Cystic fibrosis, the nurse provides home care instructions to the
mother, which statement by the child's mother indicates that she understands home care treatment to promote
pulmonary functions?
a. Chest physiotherapy should be performed twice a day before a meal.
b. Administer a cough suppressant every 8 hours."
c. Energy should be conserved by scheduling minimally strenuous activities."
d. Maintain supplemental oxygen at 4 to 6 Uminute. [Show Less]