Ultimate HESI RN
Exit Exam 2024-
2025 : 100%
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,1. To avoid undesired hypoxia when suctioning a tracheostomy, the nurse should:
A) Limit suction duration to a maximum of 10 seconds
B) Uphold sterile technique
C) Apply lubricant to 3 to 4 inches of the catheter tip
D) Withdraw the catheter using a circular motion
Correct answer: A) Limit suction duration to a maximum of 10 seconds
2. An intramuscular antibiotic injection totaling 2.0 ml is prescribed for a 2-year-
old child. The appropriate action would be to: A) Split the medication into two
separate injections
B) Administer it in the dorsal gluteal region
C) Contact the physician for a smaller volume order
D) Consult the pharmacy for a liquid version of the medication
Correct answer: A) Split the medication into two separate injections
3. If a nurse is instructed to administer iron via deep injection, they recognize that
this route is primarily used to: A) Improve the absorption rate of the medication
B) Ensure the full dosage is administered
C) Provide a more uniform drug distribution
D) Mitigate the risk of tissue irritation
Correct answer: D) Mitigate the risk of tissue irritation
4. A patient with heart failure has been prescribed Lanoxin (digoxin). When
assessing the drug's therapeutic effectiveness, the nurse would look for: A)
Increased perspiration and a drop in urinary output
B) Elevated heart rate along with increased breathing efforts
C) Enhanced respiratory function and improved urinary output
D) Reduced chest discomfort and lower blood pressure
Correct answer: C) Enhanced respiratory function and improved urinary output
,5. While caring for a client with congestive heart failure at home, the nurse is asked
about the duration of diuretic therapy. The most appropriate response would be:
A) "As your urination increases, the medication dosage will likely decrease."
B) "You should plan to be on this medication for about a year."
C) "It's essential to continue the medication to control fluid levels."
D) "You should discuss your medications and treatments with your healthcare
provider."
Correct answer: C) "It's essential to continue the medication to control fluid
levels."
6. Before a client is discharged with a prescription for chlorpromazine (Thorazine),
which symptoms should the nurse instruct the client to report? A) Alterations in
sexual desire, breast enlargement
B) Sore throat and fever
C) Stomach pain, nausea, and diarrhea
D) Difficulty breathing and nasal congestion
Correct answer: B) Sore throat and fever
7. A mother brings her 6-year-old child, who has just punctured their foot with a
rusty nail, to the clinic. Upon examination, the nurse discovers that the nail
penetrated through the shoe and into the foot. What should be the nurse’s first
action? A) Clean the foot with soap and water, and apply an antibiotic ointment
B) Explain the necessity for a tetanus booster within 72 hours
C) Ask the mother to monitor the child’s temperature every 4 hours for 24 hours
D) Transfer the child to the emergency department for a gamma globulin
injection
Correct answer: A) Clean the foot with soap and water, and apply an antibiotic
ointment
, 8. A 26-year-old woman is hospitalized for treatment of a simple goiter and
prescribed levothyroxine sodium (Synthroid). What symptoms might indicate to
the nurse that the dosage is excessively high? A) Low heart rate and constipation
B) Fatigue and diminished appetite
C) Muscle cramps and dry, flushed skin
D) Heart palpitations and shortness of breath
Correct answer: D) Heart palpitations and shortness of breath
9. In a clinical setting, a patient with a history of heart failure presents with
nausea, vomiting, visual disturbances (yellow vision), and palpitations. What is
the most critical information for the nurse to gather? Correct answer: Obtain a
detailed list of the patient's cardiac medications.
10. What pathophysiological mechanisms contribute to the development of
ascites resulting from liver failure? (Select all that apply) A) Fluid movement from
the vascular to interstitial space due to low serum protein levels
B) Increased hydrostatic pressure in the portal system resulting in fluid leakage
into the abdomen
C) Elevated levels of aldosterone, leading to increased retention of sodium and
water
Correct answer:
A) Fluid movement from the vascular to interstitial space due to low serum
protein levels
B) Increased hydrostatic pressure in the portal system resulting in fluid leakage
into the abdomen
C) Elevated levels of aldosterone, leading to increased retention of sodium and
water
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