HESI Exit Final Exam Practice for RN

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Sample questions from HESI Exit Final Exam Practice for RN

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

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

   • A.A client 6 hours after thyroidectomy who reports tingling around the mouth and has a respiratory rate of 20/min
   • B.A client with a fractured wrist who reports pain of 8 on a 0-to-10 scale after receiving analgesia 45 minutes ago
   • C.A client with pneumonia who has a temperature of 38.1 C (100.6 F) and is due for an antibiotic
   • D.A client with chronic heart failure who has bilateral ankle edema and an oxygen saturation of 94% on room air

   Rationale: Perioral tingling after thyroidectomy can signal hypocalcemia from parathyroid injury, which may progress to laryngospasm and airway compromise. The nurse should immediately assess airway status and signs of tetany, then notify the provider and prepare to administer calcium as prescribed. The other findings require follow-up, but none suggests the same immediate risk of rapid airway obstruction. Post-thyroidectomy neuromuscular symptoms are urgent even when the respiratory rate is currently normal.

2. 2.A client's potassium is 6.1 mEq/L (reference range 3.5 to 5.0 mEq/L), and the electrocardiogram shows peaked T waves. The client has chronic kidney disease and takes digoxin. Which prescription should the nurse implement first?

   • A.Administer the scheduled dose of digoxin
   • B.Restrict dietary potassium and recheck the level tomorrow
   • C.Administer oral sodium polystyrene sulfonate and reassess in 4 hours
   • D.Administer IV regular insulin with dextrose as prescribed

   Rationale: Hyperkalemia with peaked T waves is an immediate dysrhythmia risk, and IV insulin with dextrose rapidly shifts potassium into cells. The nurse should also anticipate continuous cardiac monitoring and additional prescribed treatment to remove potassium or stabilize the myocardium. Digoxin should not be given without resolving the immediate concern and reviewing the client's status; dietary restriction and a delayed recheck are too slow. Oral potassium-binding therapy may be appropriate as part of treatment, but it does not act as rapidly as the prescribed insulin and dextrose.

3. 3.A client receiving a continuous unfractionated heparin infusion for a pulmonary embolism has new bleeding from the gums. Which actions should the nurse take? Select all that apply.

   • A.Administer the next scheduled warfarin dose to avoid a gap in anticoagulation
   • B.Apply firm pressure to the gums and continue the infusion while awaiting results
   • C.Prepare to administer protamine sulfate if prescribed
   • D.Stop the infusion and notify the provider
   • E.Obtain the prescribed coagulation studies and a complete blood count

   Rationale: New bleeding during a heparin infusion requires stopping the infusion, promptly notifying the provider, and evaluating coagulation status and blood loss with prescribed studies. Protamine sulfate is the reversal agent for heparin and may be prescribed depending on the client's condition and results. Continuing the infusion despite bleeding is unsafe, even while applying pressure. Giving warfarin during active bleeding would increase anticoagulation rather than address the immediate problem.

4. 4.During a home visit, a client with diabetes says, 'I take my insulin even when I skip breakfast.' The client is prescribed morning NPH insulin and has had two episodes of sweating and confusion before lunch this week. Which action should the nurse take first?

   • A.Teach the client to avoid all carbohydrate-containing foods at breakfast
   • B.Check the client's current blood glucose and determine when the last meal and insulin dose were taken
   • C.Instruct the client to double the NPH dose on days when breakfast is skipped
   • D.Recommend that the client stop taking insulin until the next clinic appointment

   Answer and rationale are in the full material.

5. 5.A client with a new left-sided stroke has facial weakness and slurred speech. Which action is most important before the first oral medication is given?

   • A.Place the medication on the weak side of the mouth
   • B.Offer a small sip of water to determine whether the client can swallow
   • C.Request a swallow screening and keep the client NPO until the screening is completed
   • D.Crush the medication and mix it with applesauce

   Answer and rationale are in the full material.