HESI RN FUNDAMENTALS EXIT EXAM 2024 / FUNDAMENTALS RN HESI EXIT 2024
ACTUAL EXAM ALL QUESTIONS AND CORRECT DETAILED ANSWERS .
The nurse is called to the waiting room of a pediatric clinic. The
frantic mother states, "I think my 4-month-old baby is choking!" What
steps will the nurse take? (Select all that apply.)
A.
Compress the chest once between the nipples with two fingers.
B.
Note any obstruction or absence of breathing.
C.
Deliver five backslaps between the shoulder blades.
D.
Place the infant over the nurse's arm.
E.
Perform a blind finger sweep. - ANSWER-B, C, D
Rationale: The fingers are placed at the same location on an infant as
chest compressions for CPR; however, the nurse must deliver five
chest thrusts, after the five back slaps. Blind sweeps are not used as
this action may push the object deeper into the throat. The remaining
steps are correct.
Which fluid will the nurse select to administer with the prescribed
blood transfusion? A.
5% Dextrose and water
B.
,Normal saline
C.
Lactated Ringers solution
D.
5% Dextrose and lactated ringers - ANSWER-B
Rationale: Normal saline solution is the only solution that is
compatible with blood.
When assisting a client from the bed to a chair, which procedure is
best for the nurse to follow? A.
Place the chair parallel to the bed, with its back toward the head of the
bed and assist the client in moving to the chair. B.
With the nurse's feet spread apart and knees aligned with the client's
knees, stand and pivot the client into the chair. C.
Assist the client to a standing position by gently lifting upward,
underneath the axillae. D.
Stand beside the client, place the client's arms around the nurse's
neck, and gently move the client to the chair. - ANSWER-B Rationale:
Option B describes the correct positioning of the nurse and affords
the nurse a wide base of support while stabilizing the client's knees
when assisting to a standing position. The chair should be placed at a
45-degree angle to the bed, with the back of the chair toward the head
of the bed. Clients should never be lifted under the axillae; this could
damage nerves and strain the nurse's back. The client should be
instructed to use the arms of the chair and should never place his or
,her arms around the nurse's neck; this places undue stress on the
nurse's neck and back and increases the risk for a fall.
How many mL will the nurse document on the client's intake and
output record from the items listed? _____ mL
1200 mL water
4 ounce container of gelatin
8 ounces of orange juice
355 mL can of soda1 cup of soup - ANSWER-Answer: 2155
Rationale: 1200 + 240 (8 oz) + 240 (1 cup) + 120 (4 oz) + 355 = 2155
The nurse observes a UAP taking a client's blood pressure in the
lower extremity. Which observation of this procedure requires the
nurse to intervene with the UAP's approach? A.
The cuff wraps around the girth of the leg.
B.
The UAP auscultates the popliteal pulse with the cuff on the lower leg.
C.
The client is placed in a prone position.
D.
The systolic reading is 20 mm Hg higher than the blood pressure in
the client's arm. - ANSWER-B
Rationale: When obtaining the blood pressure in the lower
extremities, the popliteal pulse is the site for auscultation when the
blood pressure cuff is applied around the thigh. The nurse should
intervene with the UAP who has applied the cuff on the lower leg.
, Option A ensures an accurate assessment, and option C provides the
best access to the artery. Systolic pressure in the popliteal artery is
usually 10 to 40 mm Hg higher than in the brachial artery.
During a clinic visit, the mother of a 7-year-old reports to the nurse
that her child is often awake until midnight playing and is then very
difficult to awaken in the morning for school. Which assessment data
should the nurse obtain in response to the mother's concern? A.
The occurrence of any episodes of sleep apnea
B.
The child's blood pressure, pulse, and respirations
C.
Length of rapid eye movement (REM) sleep that the child is
experiencing
D.
Description of the family's home environment - ANSWER-D
Rationale: School-age children often resist bedtime. The nurse should
begin by assessing the environment of the home to determine factors
that may not be conducive to the establishment of bedtime rituals that
promote sleep. Option A often causes daytime fatigue rather than
resistance to going to sleep. Option B is unlikely to provide useful
data. The nurse cannot determine option C.
The nurse identifies a potential for infection in a client with
partialthickness (second-degree) and full-thickness (third-degree)
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