Nightingale 246 HESI

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Sample questions from Nightingale 246 HESI

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.At change of shift on a medical-surgical unit, a 68-year-old client is 2 hours postoperative after abdominal surgery and has a BP of 88/54 mm Hg, HR 122/min, RR 24/min, and SpO2 94% on room air. Which client should the nurse assess first?

   • A.A client with chronic obstructive pulmonary disease whose SpO2 is 90%, consistent with the documented baseline
   • B.A client with a new colostomy who needs assistance learning pouch care
   • C.A client with diabetes whose premeal blood glucose is 186 mg/dL and who is awaiting lunch
   • D.The postoperative client with hypotension and tachycardia

   Rationale: The postoperative client's hypotension and tachycardia may indicate hemorrhage or another cause of impaired perfusion and require immediate assessment. The client with a baseline SpO2 of 90% is not showing a new change, while ostomy teaching can wait. A glucose of 186 mg/dL should be addressed according to the care plan but is not as urgent as possible acute circulatory compromise.

2. 2.Refer to the client's chart. An 81-year-old client is being cared for on a medical unit. Which actions should the charge nurse take in response to the change in the client's condition? Select all that apply.

   • A.Ask another nurse to bring the prescribed oxygen and emergency equipment to the bedside.
   • B.Delegate an unlicensed assistive personnel to assess the client's lung sounds while the nurse calls the provider.
   • C.Wait for the next scheduled vital signs before contacting the provider because the client is already receiving antibiotics.
   • D.Communicate the changes in mental status, blood pressure, oxygen saturation, and urine output using a structured handoff.
   • E.Immediately assess the client and activate the rapid response process according to facility criteria.

   Rationale: The chart shows worsening confusion, hypotension, hypoxemia, and declining urine output, which together suggest acute deterioration and require prompt nursing assessment and escalation. Bringing oxygen and emergency equipment supports timely stabilization, and a structured handoff helps communicate the trend and relevant findings. An unlicensed assistive personnel cannot assess lung sounds, and waiting for routine vital signs would dangerously delay intervention.

3. 3.During a home visit, a 47-year-old client with a new prescription for warfarin says, "I take an herbal supplement every morning, but I did not mention it at my appointment." Which action should the home health nurse take first?

   • A.Ask the client to identify the supplement and notify the prescribing clinician or pharmacist before the next dose.
   • B.Advise the client to continue the supplement because herbal products do not affect prescription medications.
   • C.Tell the client to stop all prescribed medications until the next clinic appointment.
   • D.Document the supplement and wait until the next routine visit to discuss possible interactions.

   Rationale: The nurse should identify the supplement and promptly communicate it to the prescriber or pharmacist because some herbal products increase bleeding risk or alter warfarin effects. Stopping all prescribed medications is unsafe and exceeds the nurse's role. Assuming the supplement is harmless or delaying communication leaves a potentially significant interaction unaddressed.

4. 4.A provider asks a 34-year-old client in the preoperative area to sign a consent form for surgery. The client says, "I still do not understand the risks." The procedure is scheduled in 30 minutes. What should the nurse do?

   • A.Witness the client's signature and document that the client had questions.
   • B.Ask the provider to return and explain the risks before the client signs.
   • C.Ask a family member to explain the risks so the procedure is not delayed.
   • D.Explain the surgical risks in detail and obtain the client's signature.

   Answer and rationale are in the full material.

5. 5.In a pediatric clinic, a 6-year-old client with a temperature of 38.2 C is scheduled for routine immunizations and has a mild runny nose. The parent asks whether the vaccines should be postponed. Which response by the nurse is best?

   • A.All vaccines must be postponed until the child has been symptom-free for 7 days.
   • B.The parent should decide whether to skip the vaccines without a clinical assessment.
   • C.The mild illness alone usually does not require delaying routine vaccines; the clinician should assess the child before administration.
   • D.The vaccines should be administered immediately without checking the child's condition or the product guidance.

   Answer and rationale are in the full material.