HESI D443

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Sample questions from HESI D443

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

1. 1.At change of shift on a surgical unit, care is transferred for a 72-year-old client. Refer to the client's chart. Which action has the highest priority?

   • A.Administer the prescribed oral analgesic.
   • B.Activate the rapid response team and remain with the client.
   • C.Reassess the urine output in 1 hour.
   • D.Request a routine physical therapy evaluation.

   Rationale: The blood pressure decrease to 86/48 mm Hg, heart rate increase to 124 beats/min, new confusion, and bloody drainage indicate possible hemorrhagic shock requiring immediate escalation. Oral analgesia does not address impaired perfusion and may complicate assessment. Waiting another hour risks deterioration, and physical therapy is inappropriate during hemodynamic instability. Prioritize acute threats to circulation over routine postoperative care.

2. 2.On a rehabilitation unit, a 68-year-old client recovering from a stroke has stable vital signs and an established mobility plan. Which task should the RN delegate to experienced unlicensed assistive personnel?

   • A.Evaluate whether the client's gait has improved.
   • B.Assess the client's report of new dizziness.
   • C.Assist the client to the chair using the prescribed transfer technique.
   • D.Teach the client how to use a new walker.

   Rationale: Assisting a stable client with an established transfer technique is a predictable task appropriate for trained assistive personnel. Evaluating gait and assessing new dizziness require nursing judgment. Initial teaching about a walker also remains the responsibility of a licensed professional. Delegate routine implementation, not assessment, teaching, or evaluation.

3. 3.Before an elective bronchoscopy, a 54-year-old client in the procedure suite states, 'I signed the form, but I do not understand why they need a biopsy.' No sedative has been administered. What should the nurse do next?

   • A.Explain the procedure's risks and obtain another signature.
   • B.Ask a family member to confirm the client's consent.
   • C.Proceed because the signed form documents informed consent.
   • D.Pause preparation and ask the procedural provider to clarify the biopsy.

   Rationale: The client's statement indicates that consent may not be informed, so the procedure should be paused for clarification by the responsible provider. The nurse can reinforce information but should not replace the provider's explanation of procedure-specific risks and alternatives. A family member cannot consent for a competent adult simply because the adult has questions. A signature alone does not establish informed consent.

4. 4.During discharge planning, a 61-year-old client newly prescribed insulin reports living in a car and being unable to afford testing supplies. The current glucose is 168 mg/dL. Which referral should the nurse prioritize?

   • A.Case management to coordinate supplies, medication storage, and housing resources
   • B.Physical therapy to develop an exercise program
   • C.A specialty clinic appointment scheduled in 6 months
   • D.A diabetes support group that meets monthly

   Answer and rationale are in the full material.

5. 5.During evening rounds on a medical unit, a 67-year-old client receiving anticoagulation reports a change in symptoms. Refer to the client's chart. Which actions should the nurse take? Select all that apply.

   • A.Stop the heparin infusion.
   • B.Notify the provider immediately about the bleeding findings.
   • C.Prepare to administer protamine sulfate if prescribed.
   • D.Encourage independent ambulation to assess activity tolerance.
   • E.Administer the scheduled warfarin before contacting the provider.

   Answer and rationale are in the full material.