HESI 366 Study Guide

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Sample questions from HESI 366 Study Guide

This material has 18 questions with answers and rationales. Here are the first 5.

1. 1.The RN receives handoff on four adult clients. Which client should the RN assess first?

   • A.A client with diabetes whose premeal glucose is 198 mg/dL and who is ready to eat
   • B.A client with pneumonia who has new confusion, a respiratory rate of 30/min, and blood pressure of 86/48 mm Hg
   • C.A client with chronic heart failure who has unchanged ankle edema and is awaiting discharge teaching
   • D.A client who is 1 day postoperative and reports incisional pain of 6/10 with stable vital signs

   Rationale: A is correct because new confusion, tachypnea, and hypotension suggest acute organ dysfunction and possible septic shock. B describes a stable chronic finding that can wait. C requires analgesia and assessment but does not show immediate instability. D may need prescribed insulin, but the glucose value does not outweigh the first client's life-threatening changes.

2. 2.A client with suspected acute coronary syndrome has oxygen saturation of 97% on room air and blood pressure of 104/66 mm Hg. The client reports taking sildenafil 8 hours earlier. Which prescription should the nurse question?

   • A.Administer sublingual nitroglycerin
   • B.Initiate continuous cardiac monitoring
   • C.Obtain a 12-lead ECG
   • D.Administer chewable aspirin if no contraindication exists

   Rationale: B is correct because sildenafil within the preceding 24 hours is a contraindication to nitrate administration due to the risk of profound hypotension. A supports rapid identification of ischemia. C is appropriate when not contraindicated. D helps detect dysrhythmias. Normal oxygenation does not remove the need for the cardiac evaluation.

3. 3.A client with an acute asthma exacerbation initially has loud wheezing. Thirty minutes later, the client is drowsy, speaks only one word at a time, and has markedly diminished breath sounds. What is the nurse's priority action?

   • A.Delay reassessment until the next scheduled bronchodilator treatment
   • B.Document improvement because the wheezing is quieter
   • C.Offer oral fluids to loosen secretions
   • D.Activate emergency assistance and prepare to support ventilation

   Rationale: C is correct because diminished airflow with drowsiness and limited speech suggests impending respiratory failure. A mistakes reduced airflow for improvement. B is unsafe when respiratory distress compromises swallowing and does not address ventilation. D delays treatment of a life-threatening deterioration.

4. 4.An inpatient suddenly develops facial droop, slurred speech, and right arm weakness. A bedside glucose result is 48 mg/dL. The client is drowsy and cannot safely swallow. Which action is most appropriate?

   • A.Administer aspirin before brain imaging
   • B.Give orange juice and reassess in 1 hour
   • C.Administer intravenous dextrose per protocol while continuing urgent neurologic evaluation
   • D.Wait for the laboratory glucose result before intervening

   Answer and rationale are in the full material.

5. 5.A client with diabetic ketoacidosis has an initial potassium of 3.2 mEq/L. An intravenous insulin infusion is prescribed. Which action should the nurse take?

   • A.Begin insulin immediately because the potassium will rise as glucose decreases
   • B.Administer intravenous calcium to replace the missing potassium
   • C.Clarify the insulin start and anticipate potassium replacement before insulin according to protocol
   • D.Restrict all fluids until the potassium returns to normal

   Answer and rationale are in the full material.