Psychiatry and Mental Health HESI Exams, Med-Surg HESI Exams, Trends HESI and Exit Exams

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Sample questions from Psychiatry and Mental Health HESI Exams, Med-Surg HESI Exams, Trends HESI and Exit Exams

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

1. 1.In the emergency department, a client with COPD who uses oxygen at home becomes increasingly drowsy. The client is receiving oxygen at 4 L/min by nasal cannula; SpO2 is 95%, respiratory rate is 10/min, and the client is difficult to arouse. Which action should the nurse take first?

   • A.Encourage the client to use pursed-lip breathing and reassess in 30 minutes
   • B.Increase oxygen to 6 L/min to prevent further hypoxemia
   • C.Administer the prescribed PRN opioid for reported dyspnea
   • D.Titrate oxygen to maintain an SpO2 of 88% to 92% and promptly assess ventilation and notify the provider

   Rationale: The declining level of consciousness and slow respiratory rate suggest worsening ventilation, so the nurse should promptly assess airway and breathing, titrate oxygen toward the prescribed COPD target, and escalate care. Increasing oxygen without addressing hypoventilation may worsen carbon dioxide retention in a susceptible client. An opioid could further depress respirations, and waiting 30 minutes to reassess is unsafe with altered consciousness.

2. 2.Refer to the client's chart. Which actions should the nurse take now in response to the client's changing condition? Select all that apply.

   • A.Activate the rapid response process for suspected clinical deterioration
   • B.Administer the prescribed IV crystalloid bolus and reassess perfusion
   • C.Reassess blood pressure, mental status, urine output, and peripheral perfusion frequently
   • D.Delay escalation until the pending culture results identify the organism
   • E.Obtain a repeat lactate level and promptly communicate the result

   Rationale: The chart shows hypotension worsening from 104/66 to 86/50 mm Hg, rising heart rate, new confusion, oliguria, and a lactate of 3.8 mmol/L, which support urgent escalation and treatment for possible sepsis-related hypoperfusion. The prescribed crystalloid bolus and repeat lactate help address and evaluate perfusion, while frequent reassessment detects response or further decline. Waiting for cultures delays time-sensitive care; cultures identify a pathogen but are not needed before escalating treatment.

3. 3.A client with type 1 diabetes tells the clinic nurse, "I took my usual insulin, but I have been vomiting and cannot keep food down." The client is alert, glucose is 278 mg/dL, and urine ketones are moderate. Which instruction is most important?

   • A.Continue basal insulin, check glucose and ketones frequently, and seek urgent evaluation for persistent vomiting or worsening ketones
   • B.Drink only sugar-free fluids and recheck glucose the next morning
   • C.Stop all insulin until solid food can be tolerated
   • D.Take an extra full dose of rapid-acting insulin now without contacting the diabetes care team

   Rationale: During illness, a person with type 1 diabetes generally must continue basal insulin and monitor glucose and ketones because insulin omission can precipitate diabetic ketoacidosis. Persistent vomiting, moderate ketones, or worsening symptoms require prompt evaluation and individualized sick-day guidance. Stopping insulin is dangerous, waiting until morning delays care, and an unsupervised extra full dose risks hypoglycemia.

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

   • A.A client with chronic kidney disease whose potassium is 5.4 mEq/L and whose ECG is unchanged
   • B.A client receiving chemotherapy whose temperature is 37.8 C and who reports mild nausea
   • C.A client 6 hours after thyroidectomy who reports tingling around the mouth and has new hand spasms
   • D.A client with a leg cast who reports itching under the cast but has warm toes and brisk capillary refill

   Answer and rationale are in the full material.

5. 5.A client's serum lithium level is 1.6 mEq/L (therapeutic range 0.6-1.2 mEq/L). The client has new coarse hand tremors, diarrhea, and unsteady gait after several days of poor fluid intake. Which action should the nurse take?

   • A.Document the findings as expected adverse effects and recheck the level next month
   • B.Hold the lithium and notify the provider promptly
   • C.Give the next dose with food to reduce gastrointestinal effects
   • D.Encourage the client to restrict fluids until the diarrhea stops

   Answer and rationale are in the full material.