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NCLEX HESI exam 2023 latest update 265 questions and correct answers graded A
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NCLEX HESI exam 2023 latest update265 questions and correct answers
graded A
A nurse in a physician's office is reviewing the medical record of a child with a diagnosis of lactose
intolerance. Which of the following findings does the nurse expect to see documented in the child's
record? - answer-Episodes of cramping abdominal pain and excessive flatus
A client is found to have posttraumatic stress disorder (PTSD) after witnessing a terrorist attack that
caused the deaths of hundreds of people. The nurse, developing a plan of care for the client, identifies
posttrauma syndrome as a concern and identifies a client outcome that states, "The client will cope
effectively with thoughts and feelings of the event." Which nursing interventions will assist the client in
achieving this outcome? Select all that apply. - answer-Being honest, nonjudgmental, and empathetic
Assessing the immediate posttraumatic reaction
Encouraging the client to keep a journal focused on the trauma
Asking the client about the use of alcohol and drugs before and since the event
A client who has been undergoing long-term therapy with an antipsychotic medication is admitted to
the inpatient mental health unit. Which of the following findings does the nurse, knowing that long-term
use of an antipsychotic medication can cause tardive dyskinesia, monitor in the client? - answer-Tongue
protrusion
Chlorpromazine (Thorazine) has been prescribed to a client with Huntington's disease for the relief of
choreiform movements. Of which common side effect does the nurse warn the client? - answer-
Drowsiness
A nurse assigns a nursing assistant to care for a client who is hearing impaired and provides instructions
to the nursing assistant about the effective methods for communicating with the client. Which
statement by the nursing assistant indicates that further instruction is needed? - answer-"I should raise
the volume of my voice and stand on the client's affected side when I'm talking to him."
,A nurse is preparing to care for a client who has undergone abdominal hysterectomy for the treatment
of endometrial cancer. The nurse determines that the priority in the 24 hours after surgery is: - answer-
Encouraging the client to deep-breathe, cough, and use an incentive spirometer
A client is found to have iron-deficiency anemia, and ferrous sulfate (Feosol) is prescribed. The nurse
tells the client that it is best to take the medication with: - answer-Orange juice
A nurse is developing a plan of care for a client admitted to the nursing unit with a diagnosis of paranoid
personality disorder. On which characteristic of the disorder does the nurse base the plan of care? -
answer-Projecting blame, possibly becoming hostile
A nurse has given a client with viral hepatitis instructions about home care. Which of the following
statements by the client indicates to the nurse that the client needs further teaching? - answer-"I need
to eat three meals a day with foods high in protein, fat, and carbs."
Oral prednisone 5 mg/day has been prescribed for a client with a chronic respiratory disorder, and the
nurse provides instructions to the client about the medication. The nurse tells the client to: - answer-Call
the physician if a fever, sore throat, or muscle aches develop
The nurse, auscultating the breath sounds of a client, hears these sounds. What are they? - answer-
Wheezes
Laboratory studies are performed on a client with suspected sickle cell disease, and electrophoresis
reveals a large percentage of hemoglobin S (HbS). Which additional laboratory finding will the nurse
expect to note that is a characteristic of this disease? - answer-Increased white blood cell (WBC) count
A client is found to have hypoxemic respiratory failure. Which finding does the nurse expect to note on
review of the results of the client's arterial blood gas analysis? - answer-Pao2 of 49 mm Hg, Paco2 of 32
mm Hg
,A nurse is monitoring a client who was brought to the emergency department in an unresponsive state
and is now being treated for hyperglycemic hyperosmolar nonketotic syndrome (HHNS). Which of the
following findings indicates to the nurse that fluid replacement is inadequate? - answer-Level of
consciousness remains unchanged
A nurse is providing dietary instructions to a client who is taking tranylcypromine sulfate (Parnate).
Which of the following foods does the nurse tell the client to avoid while she is taking this medication?
Select all that apply. - answer-Beer
Yogurt
Pickled herring
An emergency department nurse assessing a client with Bell's palsy collects subjective and objective
data. Which of the following findings does the nurse expect to note? - answer-Complaints of inability to
close the eye on the affected side
A nurse provides information to a client with chronic obstructive pulmonary disease (COPD) about
methods of alleviating shortness of breath while the client is eating. Which statement by the client
indicates a need for further instruction? - answer-"I should eat three meals a day, and the biggest meal
should be at suppertime."
A nurse is providing morning care to a client in end-stage renal failure. The client is reluctant to talk and
shows little interest in participating in hygiene care. Which statement by the nurse would be
therapeutic? - answer-"What are your feelings right now?"
A nurse provides information about activity and exercise to the wife of a client with Parkinson's disease.
Which statement by the spouse indicates a need for further instruction? - answer-"I should encourage
him to keep his hands hanging at his side when he walks."
A nurse is providing home care instructions to a client with coronary artery disease (CAD) who will be
discharged home and will be taking 1 aspirin daily. The nurse tells the client: - answer-The answer for
this question should be something relating to toxicity that may present itself as tinnitus, ie., ringing in
the ears.
, A client who has undergone extensive gastrointestinal surgery is receiving intermittent enteral tube
feedings that will be continued after he is discharged home. When the nurse tells the client that he will
be taught how to administer the feedings, the client states, "I don't think I'll be able to do these feedings
by myself." Which response by the nurse is appropriate? - answer-"Tell me more about your concerns
regarding the tube feedings."
A nurse is providing information to a client with acute gout about home care. Which of the following
measures does the nurse tell the client to take? Select all that apply. - answer-Drinking 2 to 3 L of fluid
each day
Resting and immobilizing the affected area
A nurse is caring for a client who has had a stroke and is experiencing hemianopsia. Which of the
following measures does the nurse take in the care of the client? - answer-Teaching the client to move
the head from side to side (scan) when eating
A client undergoing therapy with carbidopa/levodopa (Sinemet) calls the nurse at the clinic and reports
that his urine has become darker since he started taking the medication. The nurse should tell the client:
- answer-That this is an occasional side effect of the medication
A nurse reviews the laboratory results of a hospitalized pregnant client with a diagnosis of sepsis who is
at risk for disseminated intravascular coagulopathy (DIC). Which laboratory finding would indicate to the
nurse that DIC has developed in the client? - answer-Positive result on d-dimer study
The nurse is the first responder at the scene of a bus crash. After a quick assessment of the victims,
which one does the nurse care for first? - answer-A victim with an open fracture of the arm that is
bleeding profusely
A client with depression is being encouraged to attend art therapy as part of the treatment plan. The
client refuses, stating, "I can't draw or paint." Which of the following responses by the nurse is
therapeutic? - answer-"Perhaps you could attend and talk to the other clients and see what they're
drawing and painting."
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