HESI Exist a

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Sample questions from HESI Exist a

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

1. 1.A 68-year-old client is in the emergency department with crushing chest pain, diaphoresis, and nausea. Blood pressure is 86/54 mm Hg, heart rate is 112/min, and oxygen saturation is 94% on room air. The electrocardiogram shows ST-segment elevation in leads II, III, and aVF. Which action should the nurse take first?

   • A.Administer prescribed sublingual nitroglycerin
   • B.Establish intravenous access and prepare for emergency reperfusion
   • C.Obtain a detailed history of the client's cardiac risk factors
   • D.Give the client oral aspirin with a glass of water

   Rationale: Inferior ST elevation with hypotension may indicate right ventricular involvement, and rapid reperfusion with intravenous access is the priority. Nitroglycerin can further lower blood pressure and is unsafe at 86/54 mm Hg. A risk-factor history does not address the immediate threat. Aspirin is important in acute coronary syndrome, but oral administration should not delay urgent stabilization and reperfusion.

2. 2.A 74-year-old client is admitted to a medical unit with pneumonia and has a temperature of 39.2 C, heart rate of 128/min, respiratory rate of 30/min, blood pressure of 82/48 mm Hg, and lactate of 4.1 mmol/L. The client is confused and has urine output of 15 mL/hr. Which action is the priority?

   • A.Obtain a urine specimen before starting any treatment
   • B.Administer the prescribed broad-spectrum antibiotic immediately
   • C.Initiate the prescribed isotonic crystalloid bolus and sepsis protocol
   • D.Apply a cooling blanket and reassess the temperature in 30 minutes

   Rationale: Hypotension, elevated lactate, altered mentation, and oliguria indicate septic shock requiring prompt perfusion support and sepsis care. A urine specimen may be useful but should not delay resuscitation. Antibiotics are urgent, but circulation support is an immediate priority in this unstable client. Cooling may reduce temperature but does not correct shock.

3. 3.A 56-year-old client with type 1 diabetes is admitted to the emergency department with vomiting and abdominal pain. The client is drowsy, has deep respirations, glucose of 584 mg/dL, potassium of 5.6 mEq/L, and arterial pH of 7.18. Which prescription should the nurse implement first?

   • A.Begin an isotonic intravenous fluid bolus
   • B.Administer intravenous regular insulin
   • C.Give intravenous sodium bicarbonate
   • D.Administer a potassium supplement

   Rationale: The client has diabetic ketoacidosis with significant volume depletion, so isotonic fluid replacement is the first priority. Insulin is needed after initial fluid resuscitation and with careful potassium monitoring. Bicarbonate is not routinely indicated at this pH and can cause complications. Potassium is elevated, so supplementation is unsafe at this time.

4. 4.A 72-year-old client with chronic obstructive pulmonary disease is admitted with increased dyspnea and productive cough. The client is alert, has an oxygen saturation of 84% on room air, respiratory rate of 28/min, and arterial blood gas results of pH 7.36, PaCO2 58 mm Hg, and HCO3 32 mEq/L. Which action is appropriate?

   • A.Withhold oxygen because the client has chronic carbon dioxide retention
   • B.Apply oxygen to achieve a saturation of approximately 88% to 92%
   • C.Apply a nonrebreather mask at 15 L/min and target 100% saturation
   • D.Ask the client to breathe into a paper bag

   Answer and rationale are in the full material.

5. 5.A 31-year-old client arrives at the emergency department 45 minutes after sudden onset of right-sided weakness and difficulty speaking. Blood pressure is 178/96 mm Hg, oxygen saturation is 97%, and blood glucose is 112 mg/dL. Which action is the priority?

   • A.Administer aspirin immediately
   • B.Lower the blood pressure with an intravenous antihypertensive
   • C.Prepare the client for an urgent noncontrast head CT
   • D.Offer oral fluids to assess swallowing

   Answer and rationale are in the full material.