HESI Management Practice Exam

The charge nurse working the 3 to 11 shift of a 24-bed medical unit in a large acute care hospital is making assignments. Currently, there are 20 clients on the unit and 4 admissions are scheduled to arrive during the shift. Besides the charge nurse, the staff consists of two experienced practical nurses (PN) and one unlicensed assistive personnel (UAP) who has worked on the unit for 10 years. Taking into consideration the acuity of each client, which distribution of clients is the best assignment for the nurse to make? - 10 clients and 2 admissions to each of the PNs. Have the UAP take all vital signs and collect all I&Os. - 10 clients to each of the PNs. Have the UAP take vital signs. The charge nurse takes the 4 new admissions. - 8 clients to each of the PNs, 4 clients to the charge nurse, and the 4 admissions to the UAP. - 8 clients to each of the PNs, 4 admissions to the charge nurse, and 4 low-acuity clients to the UAP.

- 10 clients to each of the PNs. Have the UAP take vital signs. The charge nurse takes the 4 new admissions. Considering acuity level, it is best for the nurse to assign 10 clients to each of the PNs, have the UAP take vial signs and collect I&Os and the charge nurse care for the new admissions since they will all require assessment by the RN (B). The charge nurse should take admissions (A). The UAP is not qualified to conduct an admission assessment (C). The UAP, even with 10 years experience, is not qualified to take responsibility for total care of clients (D).

The nurse is giving change-of-shift report for four clients in the emergency center and reports the client with a terminal disease has a living will and a "Do not resuscitate" (DNR) order on file. Which client fits the criteria for a terminal illness? - 2-year-old child with esophageal burns from drinking drain cleaner who now has a gastrostomy tube. - 76-year-old female client with Alzheimer's disease who is pacing the halls and trying to "go home." - 52-year-old male client who had a partial lobectomy and on a ventilator on the 2 postoperative day. - 43-year-old male with amyotrophic lateral sclerosis who is refusing artificial nutrition or hydration.

- 43-year-old male with amyotrophic lateral sclerosis who is refusing artificial nutrition or hydration. "Terminal illness" describes the client's life expectancy as less than six months without life-sustaining measures, so (D) describes the client with a terminal disease who may not survive more than a few days after the refusal of food and hydration. (A, B, and C) do not describe a client with a terminal illness and require further information to clarify the DNR order.

A nurse who works in an acute minor illness clinic returns from lunch and finds several clients who need attention. Which client should the nurse attend to first? - A 10-year-old with asthma who is responding well to nebulizer treatments. - A three-week-old infant who is nursing and was brought in because he had a fever. - A 4-year-old receiving intravenous fluid for dehydration whose IV fluid bag is empty. - A 6-year-old with Down syndrome who has been coughing productively.

- A 4-year-old receiving intravenous fluid for dehydration whose IV fluid bag is empty. The child who is dehydrated needs care first (C). Not knowing how long the fluid bag has been empty, the nurse should hang a new bag, see if it flows, and if not, assess for infiltration. A new IV site may have to be started. (A) is stable and responding well to treatment, thus can wait. (B)'s initial symptom of fever may be of concern, but the fact that the child is nursing means he/she is not in acute distress. (D) is of less immediacy than (C).

Which pediatric client requires immediate intervention by the nurse? - A 2-year-old with a twenty-four hour urinary output of 500 ml. - A 3-year-old with several episodes of nocturnal enuresis. - A 4-year-old with an easily palpable bladder and frequency. - A 5-year-old with diuresis following furosemide (Lasix) administration.

- A 4-year-old with an easily palpable bladder and frequency. Frequency and bladder distention (C) are indications of urinary retention, which requires immediate intervention by the nurse. (A) is the normal output for a child of this age. (B) describes bed-wetting, not uncommon in a child of this age, although if the problem persists in a child older than 5 years of age, further assessment and intervention is warranted. (D) is an expected response to the medication, which requires routine monitoring, but does not indicate a need for immediate intervention.

The nurse receives report in the emergency center for four clients. Which client should the nurse assess first? - A screaming child with a compound fracture of the wrist. - A diabetic client with a laceration on the sole of the foot. - A client experiencing shortness of breath and dyspnea. - A geriatric client with many new and old bruises noted.

- A client experiencing shortness of breath and dyspnea. Maslow's hierarchy of needs prioritizes oxygen and airway maintainance as immediate needs, so the emergency, life-threatening needs of a client who is short of breath and dyspneic should be assessed for airway maintainance, breathing, and circulation as determined by assessment of vital signs (C). (A, B, and D) do not have the priority of (C).

The charge nurse working on a surgical unit must discharge as many clients as possible to prepare for emergency admissions. Which client is stable enough to be discharged from the unit? - An elderly client with end-stage cirrhosis who had a liver biopsy 8 hours ago. - A client scheduled for a femoro-popliteal bypass surgery tomorrow. - A middle-aged client with acute diverticulitis and lower left quadrant pain. - A female client with angina and ectopy noted on the telemetry monitor.

- A client scheduled for a femoro-popliteal bypass surgery tomorrow. An elective surgical procedure can be rescheduled for a later date (B). (A) is not stable enough for discharge because a recent biopsy can result in bleeding due to the high vascularity of the liver. (C) is unstable, in acute pain, and at risk for rupture of diverticula. (D) has a life-threatening condition because of the risk for ventricular tachycardia.

The nurse-manager is talking to a new nurse who is thinking about resigning before orientation to the unit is over. The nurse-manager explains that reality shock after graduation is common. Which explanation should the nurse-manager use to best describe reality shock to the new nurse? - A realization that practice and education are not the same. - A series of experiences to become an experienced nurse. - A period of role adjustment from school into the work force. - A phase that new nurses go through before changing jobs.

- A period of role adjustment from school into the work force. Reality shock is a term often used to describe the reaction experienced when one moves after several years of educational preparation (C), which occurs in a familiar, idealistic educational environment, into a new role in the work force where the expectations are not clearly defined in a realistic setting. Nursing education provides selected but similar clinical experiences that prepare the graduate with tools to function successfully in the reality of practice (A). (B) supports the ongoing growth process in nursing that requires experiences to move the new nurse from novice to expert. The new nurse should be able to adapt and function successfully in the nursing position, and not change jobs (D), when reality shock is understood and addressed.

A 15-year-old sexually active girl diagnosed with pelvic inflammatory disease (PID) is admitted to the hospital with a temperature of 101.6 F and a purulent vaginal discharge. She has no insurance and tells the nurse she enjoys small children. Which room should the nurse assign this client? - A semi-private room with a 4-year-old girl who is currently receiving chemotherapy. - A semi-private room with an older adolescent girl who had surgery yesterday. - A room close to the nurse's station. - A private room.

- A private room. Despite the fact that the client has no insurance and enjoys small children, she is infected and should be placed in a private room (D). This client is infected, which is a priority consideration, so (A and B) would not be the best room assignment for this client because they would put the roommates at serious, unnecessary risk. This client is not acutely ill and does not need to be assigned to a room next to the nurse's station (C).

The charge nurse is assigning a room for a newly-admitted client, diagnosed with acute Pneumocystis carinii pneumonia, secondary to acquired immunodeficiency syndrome (AIDS). Which room would be best to assign to this client? - A private room fully equipped with an outside air ventilation system. - A semi-private room shared with an bed-ridden elder who would enjoy the company. - A semi-private room with a bed available nearest to the bathroom. - A semi-private room that does not have a client in the other bed at this time.

- A semi-private room that does not have a client in the other bed at this time. A semi-private room without a roommate (D) is the best assignment because the room can be easily blocked to create a private room should the client require isolation measures due to the pneumonia (the AIDS diagnosis alone does not affect the type of room assignment). A client with pneumonia should not be exposed to an outside air ventilation system (A). The client should not be assigned to a room with a client who is at risk for pneumonia (B). Mobility is not a factor for this client, therefore (C) is not indicated.

An emergency room anticipates an influx of injured clients from a large motor vehicle collision on a major freeway. Which client should the triage nurse send to the trauma staff for immediate intervention? - A young adult male with a suspected closed head injury who has no respirations despite having his airway repositioned by the emergency medical team. - An adult with a suspected intraabdominal bleed who was not breathing on arrival, but is currently responding since repositioning the airway. - A teenager with a suspected fractured left leg whose respirations are 26 breaths/minute, capillary refill - A young adult with a facial laceration that is controlled by pressure and whose respiratory rate, capillary refill, and ability to follow commands are all WNL.

- An adult with a suspected intraabdominal bleed who was not breathing on arrival, but is currently responding since repositioning the airway. Clients with life-threatening injuries and a respiratory rate >30 (B) are red tagged and receive immediate treatment. Clients with catastrophic injuries (A) and no respiratory rate have minimal chance of survival and should be black tagged, and receive no treatment. Clients whose injuries have systemic effects and complications, but whose respiratory rate, capillary refill, and mental status are WNL (C) are yellow tagged and should receive treatment within 30 to 60 minutes. The "walking wounded" with no systemic complications (D) should be removed to a separate area and treatment can be delayed for several hours.

The nurse notes a client's postoperative leg is cool with a capillary refill greater than 4 seconds and calls the healthcare provider. After 30 minutes of not receiving a return call from the healthcare provider, which action should the nurse take first? - Attempt to recall the same healthcare provider. - Notify the hospital's "on call" nursing supervisor. - Continue to monitor and call if there is a change. - Describe the problem to the answering service.

- Attempt to recall the same healthcare provider. The healthcare provider may have inadvertently not received the first call, so (A) is the best action to take first. According to the TeamSTEPPS, two attempts should be made to notify the provider before proceeding through the chain of command (B). (C) should be implemented, but these assessment findings require immediate medical action. Although (D) is an option, the client's urgent condition needs treatment.

The nurse is caring for 4 clients on an orthopedic floor: 2 clients with total hip replacements, one client with total knee replacement, and one client with a fractured femur who is in skeletal traction. Which nursing task should the nurse delegate to the unlicensed assistive personnel (UAP)? - Adjust the setting on the continuous passive motion machine (CPM). - Clean the skeletal traction insertion sites while performing a.m. care. - Assist the client to ambulate for the first time after surgery. - Change the linens for the client with skeletal traction.

- Change the linens for the client with skeletal traction. The client in skeletal traction cannot get out of the bed, so the UAP should change the linens (D) with the client in the bed. The physical therapist or RN should implement (A and C). Infection at the pin sites can lead to osteomyelitis, so the RN must assess the insertion sites, so (B) should not be delegated.

The charge nurse assigns the care of a client with diabetes who has hyperglycemia to a practical nurse (PN). In supervising the PN, what is the charge nurse's most important action? - Decide which sliding scale insulin dose should be administered. - Obtain the blood sugar results via skin puncture and glucometer. - Notify the healthcare provider of the daily serum glucose results. - Confer with the PN about any manifestations the client is exhibiting.

- Confer with the PN about any manifestations the client is exhibiting. The nurse's expertise is needed to perform a critical assessment, such as assessing the client for signs of hyperglycemia and to supervise the ongoing monitoring of the client by the PN (D). (A, B, and C) are tasks which the PN can perform.

During report, the charge nurse informs a nurse that she must work on another unit. The nurse begins to sigh deeply and tosses about her belongings as she is preparing to leave, making it known that she is very unhappy about having to "float." What is the best immediate action for the charge nurse to take? - Continue with report, and talk to the nurse about the incident at a later time. - Ask the nurse to call the supervisor to see if she can be reassigned. - Stop report and remind the nurse that all staff must "float" at some time. - In the presence of other staff members, inform the nurse that her behavior is inappropriate.

- Continue with report, and talk to the nurse about the incident at a later time. (A) is the best immediate action. At a later time (after the nurse has "cooled off") the charge nurse should discuss with the nurse in private her inappropriate conduct. (B) only reinforces inappropriate behavior and dismisses the problem to the supervisor. (C and D) would incite conflict in that both actions would likely encourage justification and argumentative behavior, and reprimanding the nurse in front of colleagues is poor management (D). The first priority is to provide care for clients--hopefully, traveling to the unit will provide a "cooling off" time for the nurse.

The nurse is preparing assignments for the day shift. It is most important that the client with which diagnosis and description is assigned to a registered nurse? - Menorrhagia: 24 hours post vaginal hysterectomy. - Myocardial Infarction: 4-days post infarction, transferred from ICU yesterday. - Depression: Admitted during the night, following a suicide attempt with an overdose of Tylenol. - Pneumonia: A 4-year-old who is receiving IV antibiotics.

- Depression: Admitted during the night, following a suicide attempt with an overdose of Tylenol. (C) requires communication skills and assessment skills beyond the educational level of a practical nurse or UAP. Establishing a therapeutic, one-to-one relationship with a depressed client is beyond the scope of practice for a practical nurse. Additionally, Tylenol is extremely hepatotoxic and careful assessment is essential. (A, B, and D) could all be cared for by a practical nurse under the supervision of the registered nurse or, depending on additional data, by a UAP with the assistance of the practical nurse.

The charge nurse working in a long-term care facility is informed by the LPN that a client's son is unhappy with the care his mother is receiving. What action should the nurse take first? - Ask the family member to come to the nurses' station to discuss the concerns. - Provide the son with a complaint form and ask him to describe the situation. - Discuss with the LPN the son's concerns about his mother's care. - Notify the administrator of the long-term care facility about the son's discontent.

- Discuss with the LPN the son's concerns about his mother's care. The nurse should first obtain information about the nature of the complaint and ask the LPN to describe what he/she knows of the situation. (C) should be the nurse's first action. (A, B, and D) may all need to be implemented after (C).

The nurse is designing a program to control nosocomial infections on a geriatric unit of an acute care hospital. What strategy should be included in this plan? - Do not allow those with influenza to be admitted to the unit. - Require that all clients receive a pneumonia vaccine prior to admission. - Ensure that sterile technique is followed when changing surgical dressings. - Encourage clients to drink water to prevent urinary tract infections.

- Ensure that sterile technique is followed when changing surgical dressings. A nosocomial infection is one that was not present or incubating at the time of admission, and using good sterile technique (C) and medical asepsis helps to prevent this type of infection from occurring. (A, B, and D) are infection preventive techniques, but are not specific to the prevention of nosocomial infections.

Which task should the nurse delegate to an Unlicensed Assistive personnel (UAP)? - Accompany the healthcare provider during client visits. - Determine a client's response to pain. - Observe a client's central venous catheter site. - Feed a client with minimal dysphagia.

- Feed a client with minimal dysphagia. Delegation of client care is delineated by state boards of nursing practice and include specific guidelines regarding which tasks are within the scope of practice for each level of care provider and include the components of delegation to the UAP. Feeding a client (D) is a basic client care measure that is within the scope of practice for a UAP. (A, B, and C) require assessment and analysis which require the expertise of a licensed nurse.

When planning care for a client with polycystic kidney disease, which collaborative problem has the highest priority? - Hypertension. - Calculi formation. - Acute renal failure. - Infection.

- Hypertension. Blood pressure control (A) has the highest priority, which is necessary to reduce cardiovascular complications and slow the progression of renal dysfunction, which can contribute to (B, C, and D).

The nurse educator is teaching the nursing staff about a new computerized documentation system that is recently implemented. What information is the best indication that the education is effective? - A decrease in number of calls to the technology department. - Less time for nursing staff to complete the daily charting. - An increase in staff acceptance of computerized charting. - An improvement from pretest scores of the training session.

- Less time for nursing staff to complete the daily charting. Being able to use the system to accomplish charting more efficiently and in less time (B) compared to previous documentation techniques indicates the staff has learned how to use the system effectively. (A) may be related to technology functionality and is not related to effective user learning. Acceptance (C) does not indicate that the staff understand or can use the system correctly. (D) measures cognition but not application.

A female client is receiving an enteral feeding via nasogastric feeding tube. The daughter reports to the charge nurse that her mother is coughing vigorously and sounds congested. Which staff member should the charge nurse ask to check on the client? - Registered nurse (RN) who is admitting a new postoperative client to the unit. - Practical nurse (PN) who is giving routine medications. - Practical nurse (PN) who is talking with anxious family members. - Registered nurse (RN) who is entering nursing notes at the computer.

- Registered nurse (RN) who is entering nursing notes at the computer. The RN who is entering nursing notes (D) is working on a task that has less priority than (A). The client requires advanced, problem solving assessment skills and the RN is best qualified to assess the client's lungs, the position of the NGT, and the possibility that the feeding tube has moved or kinked, allowing the tube feeding to enter the client's lungs. (B and C) are qualified to perform limited, routine assessments. In addition, the PNs are working on tasks which are a higher priority than entering nursing notes.

The nurse witnesses a male client's signature for surgical consent for a Billroth II procedure after the surgeon discusses the procedure and its implication with the client. After signing the consent, the client questions the importance of a change in his diet postoperatively. What action should the nurse implement? - Review information about dumping syndrome. - Have the client sign another consent. - Notify the surgeon about the client's comment. - Explain the surgical procedure.

- Review information about dumping syndrome. Further review of information about potential dumping syndrome (A), which is managed postoperatively with dietary modification after a Billroth II procedure (partial gastrectomy), should be explained to address the client's expressed concern. (B) is not necessary since informed consent verifies the client's understanding of surgical risks and the surgical procedure. (C) is not indicated because the client does not question his consent for the surgery. (D) may be indicated if the client asks for further interpretation of the surgeons's explanation.

When the charge nurse is making assignments, which tasks can be assigned to an unlicensed assistive personnel (UAP)? - Perform a dressing change, oral suctioning, and admission of a client to the unit. - Time contractions, determine heart fetal rate, and administer an enema to a client in early labor. - Take vital signs, give a cleansing enema, and apply soft restraints to an older client. - Irrigate a naso-gastric tube, collect a stool specimen, and measure intake and output.

- Take vital signs, give a cleansing enema, and apply soft restraints to an older client. After the nurse has validated an individual's competency, all of the tasks listed in (C) can be assigned to a UAP. Tasks that involve assessment, such as (A, B, and D) should be assigned to licensed personnel--practical nurses (PN)s or registered nurses (RN)s.

Which situation requires intervention by the nurse who is caring for a terminally ill client in a hospital? - The case manager notifies the family that the critical pathway requires transfer to a hospice facility. - The case manager notifies the social worker of the client's financial needs related to hospice care. - The social worker describes the client's feelings of grief to the spiritual counselor. - The social worker provides information about long-term care facilities to the client.

- The case manager notifies the family that the critical pathway requires transfer to a hospice facility. Critical pathways provide care guidelines, rather than required methods of care. The nurse should intervene in the situation described in (A) to ensure that the client and family are aware of options available. (B, C, and D) reflect appropriate actions by members of the interdisciplinary team, and require no intervention by the nurse.

A registered nurse (RN) is caring for several clients on a progressive care "step-down" unit. After assessing the clients, which clerical task should the nurse assign to a unlicensed assistive personnel (UAP)? - Chart pulse oximeter readings and type of breath sounds auscultated in the medical record. - Record the presence of blood-tinged urine and the hourly Foley output on the flow sheet. - Document the type and amount of drainage on a new surgical dressing in the progress note. - Transcribe the vital signs from a unit worksheet to the individual graphic page in the client charts.

- Transcribe the vital signs from a unit worksheet to the individual graphic page in the client charts. Recording the vital signs on the graphic record (D) does not entail assessment or evaluation of the findings, so the UAP may perform this function. RNs may not delegate assessment or documentation responsibilities to UAPs. RNs must complete assessment activities and record findings in the medical record. The RN is responsible for including the evaluation of the vital signs in the nursing assessment. (A, B, and C) include activities that are within the scope of practice for the RN, but cannot be delegated to the UAP.

The charge nurse, along with two registered nurses (RN), one practical nurse (PN), and one unlicensed assistive personnel (UAP), is working in an emergency department. What activity should be assigned to the UAP? - Monitor a client with mid-sternal chest pain, nausea, and vomiting. - Give instructions to the EMS about a patient being transferred to a nursing home. - Transport a client diagnosed with septicemia to the medical unit. - Obtain the history from a female client who presents in early labor.

- Transport a client diagnosed with septicemia to the medical unit. The client with septicemia could be safely transported by the UAP to the medical unit (C). (A) may be experiencing a myocardial infarction and has an unstable medical condition. This client should be monitored by an RN. EMS personnel need transfer instructions from the RN, and this activity cannot be delegated to a UAP (B). The RN must assess (D). She cannot be assigned to a UAP.

The registered nurse (RN) and unlicensed assistive personnel (UAP) are working together to provide care for a bedfast client needing total care, medications, and Foley catheter irrigation. How should the RN assign the client's care? - UAP: Personal care, catheter irrigation, I&O. RN: Medications. - UAP: Personal care. RN: Medications, catheter irrigation, I&O. - UAP: Catheter irrigation, I&O. RN: Medications. Both provide personal care. - UAP: Personal care, I&O. RN: Catheter irrigation, medications.

- UAP: Personal care, I&O. RN: Catheter irrigation, medications. The RN is responsible for medication administration and sterile procedures such as catheter irrigation. The UAP is qualified to provide personal care and measure I&O. Based on these management concepts (D) provides the best assignment of the client's care.

During coronary artery bypass graft (CABG) surgery, a male client with a history of chronic tobacco abuse experiences a dramatic decrease in his oxygen saturation. Subsequently, the client remains on a ventilator two days longer than anticipated. Which factor should the nurse consider when evaluating the client's progress? - Goal. - Variance. - Standard. - Outcome.

- Variance. A variance is any event that may alter a client's progress through the clinical pathway, such as remaining on a ventilator for an additional two days (B). (A) is part of the evaluation process of the client's plan of care. The nurse should use (C) to provide guidance in implementing and evaluating procedural processes. (D) is the end result of the interventions of the healthcare team and is based on the client's goal.

The unlicensed assistive personnel (UAP) reports morning vital signs to the primary nurse. Which client should the nurse assess first? The client who is - diagnosed with myxedema with a temperature of 96.8 F. - one-day postoperative abdominal surgery with a pulse of 104 beats/minute. - diagnosed with hypertension and has a blood pressure of 154/94 mm Hg. - diagnosed with pneumonia and has a respiratory rate of 26 breaths/minute.

- diagnosed with pneumonia and has a respiratory rate of 26 breaths/minute. The normal respiratory rate is 12 to 20 breaths/minute, so a client with respiratory compromise (pneumonia) who has an increased respiratory rate should be assessed immediately (D). (A) is an expected outcome for clients with hypothyroidism (myxedema). The normal pulse rate is 60 to 100 beats/minute, but (B) might be related to pain in a postoperative client, so this finding does not have the priority of oxygenation-related problems. The normal blood pressure is 140/85, but (C) is expected for a client with hypertension.