HESI Exit B Elsevier

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Sample questions from HESI Exit B Elsevier

This material has 150 questions with answers and rationales. Here are the first 5.

1. 1.In the emergency department, a client with chronic kidney disease reports new muscle weakness. The cardiac monitor shows peaked T waves, and the potassium level is 6.4 mEq/L. Which prescription should the nurse implement first?

   • A.Administer IV calcium gluconate as prescribed
   • B.Restrict dietary potassium
   • C.Prepare to administer IV regular insulin with dextrose
   • D.Give oral sodium polystyrene sulfonate

   Rationale: IV calcium gluconate stabilizes the cardiac membrane and is the immediate priority when hyperkalemia is causing ECG changes. Insulin with dextrose shifts potassium into cells but does not provide the same immediate membrane stabilization. Sodium polystyrene sulfonate and dietary restriction may help lower or prevent elevated potassium but act too slowly to address the current dysrhythmia risk.

2. 2.A client receiving chemotherapy has an absolute neutrophil count of 400/mm3 and is being discharged home. Which instructions should the nurse include to reduce infection risk? Select all that apply.

   • A.Use a rectal thermometer if an oral temperature is difficult to obtain
   • B.Report a temperature of 38.0 C (100.4 F) or higher immediately
   • C.Avoid crowds and people who are ill
   • D.Eat raw sprouts for added vitamins
   • E.Wash hands frequently and ask visitors to do the same
   • F.Perform daily oral care with a soft toothbrush

   Rationale: A temperature of 38.0 C (100.4 F) or higher can signal a life-threatening infection in a client with severe neutropenia and requires immediate reporting. Avoiding sick contacts and crowds, careful hand hygiene, and gentle daily oral care reduce exposure and mucosal injury. Rectal temperature measurement can injure mucosa and introduce infection, and raw sprouts may carry pathogens.

3. 3.A primigravida at 32 weeks with preeclampsia is receiving magnesium sulfate. The client is difficult to arouse, respirations are 10/min, and the patellar reflexes are absent. Which action should the nurse take first?

   • A.Place the client in a supine position
   • B.Increase the maintenance IV fluid rate
   • C.Document the findings and reassess in 30 minutes
   • D.Stop the magnesium sulfate infusion

   Rationale: Respiratory depression, decreased level of consciousness, and absent reflexes indicate magnesium toxicity, so the infusion must be stopped immediately. Increasing fluids does not reverse toxicity and could worsen fluid-related complications. Supine positioning can impair venous return in late pregnancy, and delaying reassessment risks respiratory arrest; the nurse should also notify the provider and prepare the prescribed antidote.

4. 4.At change of shift, the nurse receives report on four clients. Which client should the nurse assess first?

   • A.A client with a leg cast who reports itching beneath the cast and has warm toes
   • B.A client 2 hours after thyroidectomy who is restless and has noisy respirations
   • C.A client with heart failure who has gained 1 kg in 24 hours and has bilateral ankle edema
   • D.A client with diabetes whose premeal glucose is 248 mg/dL and who has no symptoms

   Answer and rationale are in the full material.

5. 5.A client with type 1 diabetes is prescribed NPH and regular insulin before breakfast. The client asks why the regular insulin is drawn into the syringe first. Which response is best?

   • A.Drawing up NPH first makes the regular insulin act more quickly
   • B.Regular insulin must be injected before NPH to prevent hypoglycemia
   • C.Drawing up regular insulin first helps prevent contaminating it with NPH insulin
   • D.NPH insulin cannot be mixed with any other insulin

   Answer and rationale are in the full material.