Intro Nursing HESI Practice Questions

34. The healthcare provider prescribes haloperidol (Haldol) 1.5mg twice daily for a client with Tourette's syndrome. The drug is available in a solution labeled, "2 mg/ml." How many ml should the nurse administer? (Round to the nearest hundredth.)

0.75

4. A nurse who is working on a medical-surgical unit receives a phone call requesting information about a client who has undergone surgery. The nurse observes that the client requested a do not publish (DNP) order on any information regarding condition or presence in the hospital. What is the best response bythe nurse? 1 "We have no record of that client on our unit. Thank you for calling." 2 "The new privacy laws prevent me from providing any client information over the phone." 3"The client has requested that no information be given out. You'll need to call the client directly." 4"It is against the hospital's policy to provide you with any information regarding any of our clients."

1 "We have no record of that client on our unit. Thank you for calling."

3.A client is diagnosed with AIDS. When examining the client's oral cavity, the nurse assesses white patchy plaques on the mucosa. The nurse recognizes that this finding most likely represents what opportunistic infection? 1.Cytomegalovirus 2.Histoplasmosis 3.Candida albicans 4.Human papillomavirus

3.Candida albicans

27.A client is receiving a cephalosporin antibiotic IV and complains of pain and irritation at the infusion site. The nurse observes erythema, swelling, and a red streak along the vessel above the IV access site. Which action should the nurse take at this time? A) Administer the medication more rapidly using the same IV site. B) Initiate an alternate site for the IV infusion of the medication. C) Notify the healthcare provider before administering the next dose. D) Give the client a PRN dose of aspirin while the medication infuses

B) Initiate an alternate site for the IV infusion of the medication.

50.A client with Raynaud's disease asks the nurse about using biofeedback for self-management of symptoms. What response is best for the nurse to provide? A. The responses to biofeedback have not been well established and may be a waste of time and money. B. Biofeedback requires extensive training to retrain voluntary muscles, not involuntary responses. C. Although biofeedback is easily learned, it is mostly often used to manage exacerbation of symptoms. D. Biofeedback allows the client to control involuntary responses to promote peripheral vasodilation.

D. Biofeedback allows the client to control involuntary responses to promote peripheral vasodilation.

54. To obtain the most complete assessment data for a client with chronic pain, which information should the nurse obtain? A. Can you describe where your pain is the most severe? B. What is your pain intensity on a scale of 1 to 10? C. Is your pain best described as aching, throbbing, orsharp? D. Which activities during a routine day are impacted by your pain?

D. Which activities during a routine day are impacted by your pain?

1. The nurse teaching a health awareness class identifies which situation as being the highest risk factor for the development of a deep vein thrombosis (DVT)?

Pregnancy

12.Which age-related change should the nurse consider when formulating a plan of care for an older adult? Select all that apply. 1. Difficulty in swallowing 2.Increased sensitivity to heat 3.Increased sensitivity to glare 4.Diminished sensation of pain 5.Heightened response to stimuli

3.Increased sensitivity to glare 4.Diminished sensation of pain

52.A female client who has breast cancer with metastasis to the liver and spine is admitted with constant, severe pain despite around-the-clock use of oxycodone (Percodan) and amitriptyline (Elavil) for pain control at home. During the admission assessment, which information is most important for the nurse to obtain? A. Sensory pattern, area, intensity, and nature of the pain. B. Trigger points identified by palpation and manual pressure of painful areas. C. Schedule and total dosages of drugs currently used for breakthrough pain. D. Sympathetic responses consistent with onset of acute pain.

A. Sensory pattern, area, intensity, and nature of the pain.

55. On admission, a client presents a signed living will that includes a Do Not Resuscitate (DNR) prescription.When the client stops breathing, the nurse performs cardiopulmonary resuscitation (CPR) and successfully revives the client. What legal issues could be brought against the nurse? A) Assault. B) Battery. C) Malpractice. D) False imprisonment.

B) Battery.

49.A male client with an infected wound tells the nurse that he follows a macrobiotic diet. Which type of foods should the nurse recommend that the client select from the hospital menu? A. Low fat and low sodium foods. B. Combination of plant proteins to provide essential amino acids. C. Limited complex carbohydrates and fiber. D. Increased amount of vitamin C and beta carotene rich foods.

B. Combination of plant proteins to provide essential amino acids.

44. A 73-year-old Hispanic client is seen at the community health clinic with a history of protein malnutrition. What information should the nurse obtain first? A. Amount of liquid protein supplements consumed daily. B. Foods and liquids consumed during the past 24 hours. C. Usual weekly intake of milk products and red meats. D. Grains and legume combinations used by the client.

B. Foods and liquids consumed during the past 24 hours.

35. A male client with limited mobility is discharged with home health services. When the home health nurse arrives, the client asks what he can do for the swelling in his legs. Which should nurse implement? A) Encourage the client to take short walks around the block. B) Explain the need to keep the head of the bed elevated. C) Advise the client to dangle his feet during meals and before bedtime. D) Instruct the client to flex both of his feet several times a day.

D) Instruct the client to flex both of his feet several times a day.

9. A nurse is teaching an adolescent about type 1 diabetes and self-care. Which questions from the client indicate a need for additional teaching in the cognitive domain? Select all that apply. 1. "What is diabetes?" 2. "What will my friends think?" 3 "How do I give myself an injection?" 4. "Can you tell me how the glucose monitor works?" 5."How do I get the insulin from the vial into the syringe?

1. "What is diabetes?" 2. "What will my friends think?" 3 "How do I give myself an injection?" 4. "Can you tell me how the glucose monitor works?"

10.Place each step of the nursing process in the order that it should be used. 1.Obtain client's nursing history. 2.State client's nursing needs. 3.Identify goals for care. 4.Develop a plan of care. 5.Implement nursing interventions.

1.Obtain client's nursing history. 2.State client's nursing needs. 3.Identify goalsfor care. 4.Develop a plan of care.

8.Alternative therapy measures have become increasingly accepted within the past decade, especially in the relief of pain. Which methods qualify as alternative therapies for pain? Select all that apply. 1.Prayer 2. Hypnosis 3. Medication 4. Aromatherapy 5Guided imagery

1.Prayer 2. Hypnosis 3. Medication 4. Aromatherapy

11.In what position should the nurse place a client recovering from general anesthesia? 1. Supine 2. Side-lying 3. High Fowler 4. Trendelenburg

2. Side-lying

7.A nurse is caring for a client diagnosed with methicillin-resistant Staphylococcus aureus (MRSA) in the urine. The health care provider orders an indwelling urinary catheter to be inserted. Which precaution should the nurse take during this procedure? 1.Droplet precautions 2.Reverse isolation 3.Surgical asepsis 4Medical asepsis

3.Surgical asepsis

6.The nurse plans care for a client with a somatoform disorder based on the understanding that the disorder is: 1. A physiological response to stress 2 A conscious defense against anxiety 3. An intentional attempt to gain attention 4. An unconscious means of reducing stress

4. An unconscious means of reducing stress

5.When being interviewed for a position as a registered professional nurse, the applicant is asked to identify an example of an intentional tort. What is the appropriate response? 1. Negligence 2 Malpractice 3 .Breach of duty 4. False imprisonment

4. False imprisonment

13.The spouse of a comatose client who has severe internal bleeding refuses to allow transfusions of whole blood because they are Jehovah's Witnesses. The client does not have a Durable Power of Attorney for Healthcare. What action should the nurse take? 1. Institute the prescribed blood transfusion because the client's survival depends on volume replacement. 2. Clarify the reason why the transfusion is necessary and explain the implications if there is no transfusion. 3 Phone the health care provider for an administrative prescription to give the transfusion under these circumstances. 4. Give the spouse a treatment refusal form to sign and notify the health care provider that a court order now can be sought

4. Give the spouse a treatment refusal form to sign and notify the health care provider that a court order now can be sought

2. A client on hospice care is receiving palliative treatment. A palliative approach involves planning measures to: 1. Restore the client's health 2. Remove and dispose of the patch in an appropriate receptacle. 3.Have the family return the patch to the pharmacy for disposal. 4.Leave the patch in place for the mortician to remove.

4.Leave the patch in place for the mortician to remove.

29.Heparin 20,000 units in 500 ml D5W at 50 ml/hour has been infusing for 5½ hours. How much heparin has the client received? A) 11,000 units. B) 13,000 units. C) 15,000 units. D) 17,000 units

A) 11,000 units.

24.While instructing a male client's wife in the performance of passive range-of-motion exercises to his contracted shoulder, the nurse observes that she is holding his arm above and below the elbow. What nursing action should the nurse implement? A) Acknowledge that she is supporting the arm correctly. B) Encourage her to keep the joint covered to maintain warmth. C) Reinforce the need to grip directly under the joint for better support. D) Instruct her to grip directly over the joint for better motion.

A) Acknowledge that she is supporting the arm correctly.

17.After completing an assessment and determining that a client has a problem, which action should the nurse perform next? A) Determine the etiology of the problem. B) Prioritize nursing care interventions. C) Plan appropriate interventions. D) Collaborate with the client to set goals.

A) Determine the etiology of the problem.

41. A male Native American presents to the clinic with complaints of frequent abdominal cramping and nausea. He states that he has chronic constipation and had not had a bowel movement in five days, despite trying several home remedies. Which intervention is most important for the nurse to implement? A) Determine what home remedies were used. B) Assess for the presence of an impaction. C) Obtain list of prescribed home medications. D) Evaluate stool sample for presence of blood.

A) Determine what home remedies were used.

28.The nurse is using a genogram while conducting a client's health assessment and past medical history. What information should the genogram provide? A) Genetic and familial health disorders. B) Chronic health problems. C) Reason for seeking health care. D) Undetected disorders.

A) Genetic and familial health disorders.

37. The nurse measures the client's blood pressure (BP) and notes that it is significantly higher than the previous reading. What should the nurse do next? (Select all that apply.) A) Retake the client's blood pressure in the opposite arm. B) Ask another nurse to assist in assessing for an apical-radial pulse deficit. C) Assign the unlicensed assistive personal to recheck the BP in an hour. D) Immediately take 2 more readings on the same arm. E) Determine the client's activity and feelings prior to the BP measurement.

A) Retake the client's blood pressure in the opposite arm. C) Assign the unlicensed assistive personal to recheck the BP in an hour. E) Determine the client's activity and feelings prior to the BP measurement.

40. Which landmarks are useful to the nurse when administering an intramuscular injection in ventrogluteal site? A) The greater trochanter and anterior superior iliac spine. B) The knee and greater trochanter. C) D) The deltoid muscle.

A) The greater trochanter and anterior superior iliac spine.

30. A male client tells the nurse that he does not know where he is or what year it is. What data should the nurse document that is most accurate? A) demonstrates loss of remote memory. B) exhibits expressive dysphasia. C) has a diminished attention span. D) is disoriented to place and time.

D) is disoriented to place and time.

53.A client who has moderate, persistent, chronic neuropathic pain due to diabetic neuropathy takes gabapentin (Neurontin) and ibuprofen (Motrin, Advil) daily. If Step 2 of the World Health Organization (WHO) pain relief ladder is prescribed, which drug protocol should be implemented? A. Continue gabapentin. B. Discontinue ibuprofen. C. Add aspirin to the protocol. D. Add oral methadone to the protocol.

A. Continue gabapentin.

47.A middle-aged woman who enjoys being a teacher and mentor feels that she should pass down her legacy of knowledge and skills to the younger generation. According to Erikson, she is involved in what developmental stage? A. Generativity. B. Ego integrity. C. Identification. D. Valuing wisdom.

A. Generativity.

48.Which statement best describes durable power of attorney for health care? A. The client signs a document that designates another person to make legally binding healthcare decisions if client is unable to do so. B. The healthcare decisions made by another person designated by the client are not legally binding. C. Instructions about actions to be taken in the event of a client's terminal or irreversible condition are not legally binding. D. Directions regarding care in the event of a terminal or irreversible condition must be documented to ensure that they are legally binding.

A. The client signs a document that designates another person to make legally binding healthcare decisions if client is unable to do so.

42. What information is most important for the nurse to obtain in determining a client's need for referral for obesity counseling? A) Body weight 10% over ideal body weight. B) Body mass index greater than 35. C) Daily caloric intake of 3500 calories. D) Client's expressed desire to lose 50 pounds

B) Body mass index greater than 35.

31. The nurse observes that there are reddened areas on the cheekbones of a client receiving oxygen per nasal cannula at 3L/minute, and the client's oxygen saturation level is 92%. What intervention should the nurse implement? A) Decrease the flow rate to 1 L/minute. B) Discontinue the use of the nasal cannula. C) Apply lubricant to the cannula tubing. D) Place padding around the cannula tubing.

B) Discontinue the use of the nasal cannula.

22.An elderly male client who suffered a cerebral vascular accident is receiving tube feedings via a gastrostomy tube. The nurse knows that the best position for this client during administration of the feedings is A) prone. B) Fowler's. C) Sims'. D) supine

B) Fowler's.

19.Three days following surgery, a male client observes his colostomy for the first time. He becomes quite upset and tells the nurse that it is much bigger than he expected. What is the best response by the nurse? A) Reassure the client that he will become accustomed to the stoma appearance in time. B) Instruct the client that the stoma will become smaller when the initial swelling diminishes. C) Offer to contact a member of the local ostomy support group to help him with his concerns. D) Encourage the client to handle the stoma equipment to gain confidence with the procedure

B) Instruct the client that the stoma will become smaller when the initial swelling diminishes.

25.A young mother of three children complains of increased anxiety during her annual physical exam. What information should the nurse obtain first? A) Sexual activity patterns. B) Nutritional history. C) Leisure activities. D) Financial stressors

B) Nutritional history.

14. A female client with a nasogastric tube attached to low suction states that she is nauseated. The nurse assesses that there has been no drainage through the nasogastric tube in the last two hours. What action should the nurse take first? A) Irrigate the nasogastric tube with sterile normal saline. B) Reposition the client on her side. C) Advance the nasogastric tube an additional five centimeters. D) Administer an intravenous antiemetic prescribed for PRN use.

B) Reposition the client on her side.

21.The healthcare provider prescribes the diuretic metolazone (Zaroxolyn) 7.5 mg PO. Zaroxolyn is available in 5 mg tablets. How much should the nurse plan to administer? A) ½ tablet. B) 1 tablet. C) 1½ tablets. D) 2 tablets.

C) 1½ tablets.

32. A female nursing home resident and her family only speak Spanish. During a visit, the entire family begins to cry hysterically. When unable to determine why the family is upset, what intervention is most important for the nurse to implement? A) Ask a Spanish speaking staff member to talk with the family. B) Use a Spanish translation reference to interview the family. C) Close the door to client's room to provide family privacy. D) Sit quietly with the family to offer comfort and support.

C) Close the door to client's room to provide family privacy.

23. A resident in a skilled nursing facility for short-term rehabilitation after a hip replacement tells the nurse, "I don't want any more blood taken for those useless tests." Which narrative documentation should the nurse enter in the client's medical record? A) Healthcare provider notified of failure to collect specimens for prescribed blood studies. B) Blood specimens not collected because client no longer wants blood tests performed. C) Healthcare provider notified of client's refusal to have blood specimens collected for testing. D) Client irritable, uncooperative, and refuses to have blood collected. Healthcare provider notified

C) Healthcare provider notified of client's refusal to have blood specimens collected for testing.

26.The nurse is caring for a client who is receiving 24-hour total parenteral nutrition (TPN) via a central line at 54 ml/hr. When initially assessing the client, the nurse notes that the TPN solution has run out and the next TPN solution is not available. What immediate action should the nurse take? A) Infuse normal saline at a keep vein open rate. B) Discontinue the IV and flush the port with heparin. C) Infuse 10 percent dextrose and water at 54 ml/hr D) Obtain a stat blood glucose level and notify the healthcare provider.

C) Infuse 10 percent dextrose and water at 54 ml/hr

16.When conducting an admission assessment, the nurse should ask the client about the use of complimentary healing practices. Which statement is accurate regarding the use of these practices? A) Complimentary healing practices interfere with the efficacy of the medical model of treatment. B) Conventional medications are likely to interact with folk remedies and cause adverse effects. C) Many complimentary healing practices can be used in conjunction with conventional practices. D) Conventional medical practices will ultimately replace the use of complimentary healing practices.

C) Many complimentary healing practices can be used in conjunction with conventional practices.

36. The home care nurse is teaching a client how to change the dressing on a new venous stasis ulcer. The client has a history of a deep vein thrombosis and is allergic to latex. When removing the adhesive bandages, the nurse observes skin redness surrounding the draining wound. What action should the nurse implemented? A) Replace dressing with cotton pads and silk tape. B) Measure and compare ankle-brachial pressure index. C) Obtain sample of the drainage for culture. D) Apply an antibiotic ointment to the wound.

C) Obtain sample of the drainage for culture.

33. The nurse is performing a routine dressing change for a client with a stage 3 pressure ulcer that is red with significant grandution. The wound has a gauze dressing covering the area. What action should the nurse implemented? A) Apply a hydro gel (Duaderm) dressing B) Increase the frequency of the dressing changes. C) Replace the gauze with transparent dressing. D) Leave the dressing off until consulting with the healthcare provider.

C) Replace the gauze with transparent dressing.

20.An unlicensed assistive personnel (UAP) places a client in a left lateral position prior to administering a soap suds enema. Which instruction should the nurse provide the UAP? A) Position the client on the right side of the bed in reverse Trendelenburg. B) Fill the enema container with 1000 ml of warm water and 5 ml of castile soap. C) Reposition in a Sim's position with the client's weight on the anterior ilium. D) Raise the side rails on both sides of the bed and elevate the bed to waist level.

C) Reposition in a Sim's position with the client's weight on the anterior ilium.

43. 6.Which technique is most important for the nurse to implement when performing a physical assessment? A. A head-to-toe approach. B. The medical systems model. C. A consistent, systematic approach. D. An approach related to a nursing model.

C. A consistent, systematic approach.

51.A female client informs the nurse that she uses herbal therapies to supplement her diet and manage common ailments. What information should the nurse offer the client about general use of herbal supplements? A. Most herbs are toxic or carcinogenic and should be used only when proven effective. B. There is no evidence that herbs are safe or effective as compared to conventional supplements in maintaining health. C. Herbs should be obtained from manufacturers with a history of quality control of their supplements. D. Herbal therapies may mask the symptoms of serious disease, so frequent medical evaluation is required during use.

C. Herbs should be obtained from manufacturers with a history of quality control of their supplements.

46. Which statement correctly identifies a written learning objective for a client with peripheral vascular disease? A. The nurse will provide client instruction for daily foot care. B. The client will demonstrate proper trimming toenail technique. C. Upon discharge, the client will list three ways to protect the feet from injury. D. After instruction, the nurse will ensure the client understands foot care rationale.

C. Upon discharge, the client will list three ways to protect the feet from injury.

39. A middle-aged male client tells the nurse that has weeks ago he began exercising four times a week to lose weight and to help him sleep better. He states that it still takes an hour to fall asleep at night. What action should the nurse implement? A) Advice the client that lifestyle changes often take several weeks to be effective. B) Determine the amount of weight the client has lost since increasing his activity. C) Encourage the client to exercise every day to eliminate bedtime wakefulness. D) Ask the client to describe the exercise schedule that he has been following.

D) Ask the client to describe the exercise schedule that he has been following.

18.The nurse notices that the Hispanic parents of a toddler who returns from surgery offer the child only the broth that comes on the clear liquid tray. Other liquids, including gelatin, popsicles, and juices, remain untouched. What explanation is most appropriate for this behavior? A) The belief is held that the "evil eye" enters the child if anything cold is ingested. B) After surgery the child probably has refused all foods except broth. C) Eating broth strengthens the child's innate energy called "chi." D) Hot remedies restore balance after surgery, which is considered a "cold" condition.

D) Hot remedies restore balance after surgery, which is considered a "cold" condition.

15.The UAPs working on a chronic neuro unit ask the nurse to help them determine the safest way to transfer an elderly client with left-sided weakness from the bed to the chair. What method describes the correct transfer procedure for this client? A) Place the chair at a right angle to the bed on the client's left side before moving. B) Assist the client to a standing position, then place the right hand on the armrest. C) Have the client place the left foot next to the chair and pivot to the left before sitting. D) Move the chair parallel to the right side of the bed, and stand the client on the right foot

D) Move the chair parallel to the right side of the bed, and stand the client on the right foot

38. A client is admitted with pneumonia and has a recent history of methicillin-resistant Staphylococcus aureus (MRSA). The client is placed in isolation. While caring for the client, which item should the nurse place in a designated biohazard bag before it is removed from the room? A) The nurse's stethoscope. B) Paper mask and gown. C) Bed linens D) A sputum.

D) A sputum.

45.The nurse formulates the nursing diagnosis of, "Ineffective health maintenance related to lack of motivation" for a client with Type 2 diabetes. Which finding supports this nursing diagnosis? A. Does not check capillary blood glucose as directed. B. Occasionally forgets to take daily prescribed medication. C. Cannot identify signs or symptoms of high and low blood glucose. D. Eats anything and does not think diet makes a difference in health.

D. Eats anything and does not think diet makes a difference in health.