HESI Final Comprehensive Exam

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Sample questions from HESI Final Comprehensive Exam

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

1. 1.At change of shift on a medical unit, the RN receives report on four clients. Which client should the RN assess first?

   • A.A 72-year-old with heart failure who gained 1 kg overnight and has new crackles at both lung bases
   • B.A 54-year-old 6 hours after thyroidectomy who reports tingling around the mouth and has a hoarse voice
   • C.A 66-year-old with diabetes whose glucose is 58 mg/dL and who is awake, diaphoretic, and asking for juice
   • D.A 40-year-old with pneumonia whose temperature is 38.3 C and who is due for the next prescribed antibiotic

   Rationale: The client with new hoarseness after thyroidectomy may have laryngeal edema or a developing airway obstruction, so airway assessment takes priority. The hypoglycemia requires prompt treatment, but the client is awake and able to take oral glucose; the heart failure findings and fever also need timely care but are not as immediately threatening. The priority is to identify and address a potentially obstructed airway before other important but less urgent needs.

2. 2.During a home-health visit, an RN is planning care for a 9-year-old with cerebral palsy who is medically stable and receives enteral feedings. Which task is appropriate to delegate to an experienced unlicensed assistive personnel (UAP)?

   • A.Assess the child's tolerance of a newly prescribed feeding formula
   • B.Determine whether the child's new cough is related to aspiration
   • C.Measure and record the child's intake and output during the visit
   • D.Teach the parent how to respond to a clogged feeding tube

   Rationale: Measuring and recording intake and output is a predictable task that can be delegated to a trained UAP, with the RN responsible for interpreting the findings. Assessing tolerance, teaching the parent, and determining the cause of a new cough require nursing judgment and remain the RN's responsibility. The RN should give clear instructions about what to report, such as a change in respiratory status or unexpected residuals.

3. 3.Refer to the client's chart. The RN is coordinating care for the client on a pediatric unit. Which actions should the RN take now? Select all that apply.

   • A.Document the client's new symptoms and the actions taken
   • B.Ask the UAP to reassess the client in 30 minutes and report any change
   • C.Notify the provider promptly about the change in the client's condition
   • D.Verify the current infusion rate and the most recent medication administration
   • E.Stop the infusion and assess the peripheral IV site

   Rationale: The chart shows new pain, swelling, and coolness at the IV site while a potassium-containing infusion is running, so the RN should stop the infusion, assess the site, and verify the infusion and medication record. The new findings require prompt provider notification because extravasation and tissue injury are possible. The RN should document the assessment and response; assigning a UAP to reassess this acute change would delay RN assessment and exceed the appropriate use of delegation.

4. 4.In the preoperative clinic, a 45-year-old client scheduled for an elective procedure says, "I signed the form, but I still do not understand the risks, and I do not want the operation today." The surgeon is in another procedure. What should the RN do?

   • A.Notify the surgeon that the client has questions and does not wish to proceed at this time
   • B.Explain the procedure's risks in detail and obtain the client's verbal agreement
   • C.Witness the consent form and proceed with the remaining preoperative checklist
   • D.Ask the client to reconsider because the procedure is already scheduled

   Answer and rationale are in the full material.

5. 5.At a community shelter after a bus collision, an RN is assigned to triage arriving clients. Which client should receive immediate priority for treatment?

   • A.A 29-year-old with an open lower-leg fracture, controlled bleeding, and a palpable pedal pulse
   • B.A 7-year-old who is crying, has several superficial cuts, and is walking without assistance
   • C.A 34-year-old with a closed wrist deformity and capillary refill of 2 seconds
   • D.A 61-year-old with noisy respirations, facial burns, and increasing restlessness

   Answer and rationale are in the full material.