RN HESI Exit Exam

Free preview · Original latest version

Sample questions from RN HESI Exit Exam

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

1. 1.In the emergency department, a 9-year-old with type 1 diabetes arrives with vomiting, deep rapid respirations, and abdominal pain. The glucose is 468 mg/dL, potassium is 5.4 mEq/L, and arterial pH is 7.18. Which prescription should the nurse implement first?

   • A.Begin 0.9% sodium chloride IV bolus as prescribed.
   • B.Give oral potassium replacement with sips of water.
   • C.Administer IV regular insulin as a bolus before fluids.
   • D.Administer sodium bicarbonate IV to correct the acidosis.

   Rationale: The findings indicate diabetic ketoacidosis with significant dehydration, so isotonic fluid resuscitation is the immediate priority. Insulin is essential but is generally started after initial fluid therapy and with close potassium monitoring; a bolus is not routinely indicated. Potassium is elevated, and bicarbonate is not routinely given for this pH because it can cause harmful shifts in potassium and worsen outcomes.

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

   • A.A 66-year-old with heart failure who has bilateral ankle edema and gained 1 kg over the past week.
   • B.A 58-year-old 6 hours after thyroidectomy who reports tingling around the mouth and has new inspiratory stridor.
   • C.A 46-year-old with pancreatitis who reports pain of 8 out of 10 and has a heart rate of 104/min.
   • D.A 72-year-old with chronic obstructive pulmonary disease whose oxygen saturation is 90% on the prescribed 2 L/min and who is speaking comfortably.

   Rationale: New stridor after thyroidectomy suggests airway compromise, potentially from laryngeal edema or a compressive hematoma, and requires immediate assessment and action. The COPD client's oxygen saturation may be within the prescribed target, while the pancreatitis pain and gradual heart-failure weight gain need prompt follow-up but are not as immediately life-threatening. Airway threats take priority over pain and less acute fluid-retention findings.

3. 3.Refer to the client's chart. Which actions should the nurse take now? Select all that apply.

   • A.Place the client on continuous cardiac monitoring.
   • B.Repeat the potassium level in 24 hours before taking further action.
   • C.Administer IV calcium gluconate as prescribed.
   • D.Prepare to administer IV regular insulin with dextrose as prescribed.
   • E.Encourage the client to ambulate to promote potassium excretion.
   • F.Withhold the prescribed potassium-sparing diuretic and notify the provider.

   Rationale: The potassium of 6.3 mEq/L with peaked T waves and widening QRS complexes indicates life-threatening hyperkalemia, so continuous cardiac monitoring is needed. IV calcium gluconate stabilizes the myocardium, and insulin with dextrose shifts potassium into cells; the potassium-sparing diuretic should be withheld and the provider notified. Ambulation will not correct this emergency, and waiting 24 hours to recheck potassium would dangerously delay treatment.

4. 4.A client states, "I took my warfarin like usual, but now my stool is black and I feel lightheaded." The INR is 5.8, and the blood pressure is 92/58 mm Hg. Which action should the nurse take first?

   • A.Encourage oral fluids and assist the client to walk to the bathroom.
   • B.Administer the scheduled warfarin dose and recheck the INR tomorrow.
   • C.Hold warfarin and notify the provider immediately.
   • D.Give prescribed vitamin K and discharge the client once the stool is assessed.

   Answer and rationale are in the full material.

5. 5.A client with a recent ischemic stroke coughs after a sip of water during a bedside assessment. Which action is best?

   • A.Give oral medications in applesauce because the client is alert.
   • B.Offer thickened liquids and continue the meal with close observation.
   • C.Place the client supine and repeat the water test in 30 minutes.
   • D.Keep the client NPO and request a formal swallowing evaluation.

   Answer and rationale are in the full material.