HESI Milestone 2 Exam New 2025 Latest Version
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The nurse is caring for a teenage client admitted to the hospital with a suspected diagnosis of acute
appendicitis. Which laboratory result should the nurse expect to note if the client does have appendicitis?
1. Leukopenia with a shift to the left
2. Leukocytosis with a shift to the left
3. Leukopenia with a shift to the right
4. Leukocytosis with a shift to the right ------------ Correct Answer -------------- Leukocytosis with a shift
to the left
Laboratory findings do not establish the diagnosis of appendicitis, but there is often an elevation of the
white blood cell count (leukocytosis) with a shift to the left (an increased number of immature white
blood cells). Options 1, 3, and 4 are incorrect because they are not associated findings in acute
appendicitis.
A client has been prescribed clozapine. The nurse reviews the result of which laboratory study to detect a
serious adverse effect associated with this medication?
1. Platelet count
2. Liver function
3. Blood glucose level
4. White blood cell count ------------ Correct Answer -------------- Platelet count
Clozapine is an antipsychotic medication. The client taking clozapine may experience agranulocytosis as
an adverse effect, which is monitored by obtaining weekly white blood cell counts. Treatment is withheld
if the level drops below 3000 mm3 (3 × 109/L). Agranulocytosis could be fatal if undetected and
untreated. The other options are incorrect.
The nurse is preparing a plan of care for an infant who will be returning from the recovery room
following the surgical repair of a cleft lip located on the right side of the lip. On return from the recovery
room, the nurse would plan to place the infant in which position?
1. Prone and flat
2. Supine and flat
3. On the left side
4. On the right side ------------ Correct Answer -------------- On the left side
Following cleft lip repair, the infant would be positioned supine or on the side opposite the repair to
prevent the suture line from contacting the bed linens. Immediately after surgery, it is best to place the
infant on the left side rather than supine to prevent aspiration if the infant vomits.
The nurse is reviewing the laboratory results of a client diagnosed with multiple myeloma. Which would
the nurse expect to note specifically in this disorder?
,1. Increased calcium level
2. Increased white blood cells
3. Decreased blood urea nitrogen level
4. Decreased number of plasma cells in the bone marrow ------------ Correct Answer --------------
Increased calcium level
Findings indicative of multiple myeloma are an increased number of plasma cells in the bone marrow,
anemia, hypercalcemia caused by the release of calcium from the deteriorating bone tissue, and an
elevated blood urea nitrogen level. An increased white blood cell count may or may not be present and is
not related specifically to multiple myeloma.
A home care nurse is visiting a client to provide follow-up evaluation and care of a leg ulcer. On
removing the dressing from the leg ulcer, the nurse notes that the ulcer is pale and deep and that the
surrounding tissue is cool to the touch. The nurse would document that these findings identify which type
of ulcer?
1. A stage 1 ulcer
2. A vascular ulcer
3. An arterial ulcer
4. A venous stasis ulcer ------------ Correct Answer -------------- An arterial ulcer
Arterial ulcers have a pale deep base and are surrounded by tissue that is cool with trophic changes such
as dry skin and loss of hair. Arterial ulcers are caused by tissue ischemia from inadequate arterial supply
of oxygen and nutrients. A stage 1 ulcer indicates a reddened area with an intact skin surface. A venous
stasis ulcer (vascular) has a dark red base and is surrounded by brown skin with local edema. This type of
ulcer is caused by the accumulation of waste products of metabolism that are not cleared, as a result of
venous congestion.
A client calls the nurse at the clinic and reports experiencing a sensation as though the affected leg is
falling asleep ever since the vein ligation and stripping procedure was performed. The nurse would make
which response to the client?
1. "Apply warm packs to the leg."
2. "Keep the leg elevated as much as possible."
3. "Your primary health care provider needs to be contacted to report this problem."
4. "This normally occurs after surgery and will subside when the edema goes down." ------------ Correct
Answer -------------- "Your primary health care provider needs to be contacted to report this problem."
A sensation of pins and needles or feeling as though the surgical limb is falling asleep may indicate
temporary or permanent nerve damage after surgery. The saphenous vein and the saphenous nerve run
close together, and damage to the nerve will produce paresthesias. The remaining options are inaccurate
responses. An alternative to surgery is endovenous ablation of the saphenous vein. Ablation involves the
insertion of a catheter that emits energy. This causes collapse and sclerosis of the vein. Potential
complications include bruising, tightness along the vein, recanalization (reopening of the vein), and
paresthesia. Endovenous ablation also may be done in combination with saphenofemoral ligation or
phlebectomy. Transilluminated powdered phlebectomy involves the use of a powdered resector to destroy
the varices and then removes the pieces via aspiration.
The nurse has completed an educational course about first-degree heart block. Which statement by the
nurse indicates that teaching has been effective?
,1. "Presence of Q waves indicates first-degree heart block."
2. "Tall, peaked T waves indicate first-degree heart block."
3. "Widened QRS complexes indicate first-degree heart block."
4. "Prolonged, equal PR intervals indicate first-degree heart block." ------------ Correct Answer -------------
- "Prolonged, equal PR intervals indicate first-degree heart block."
Prolonged and equal PR intervals indicate first-degree heart block. The development of Q waves indicates
myocardial necrosis. Tall, peaked T waves may indicate hyperkalemia. A widened QRS complex
indicates a delay in intraventricular conduction, such as bundle branch block. An electrocardiogram
(ECG) taken during a pain episode is intended to capture ischemic changes, which also include ST
segment elevation or depression.
The ambulatory care nurse is working with a client who has been diagnosed with Prinzmetal's (variant)
angina. What would the nurse plan to teach the client about this type of angina?
1. It is most effectively managed by beta-blocking agents.
2. It has the same risk factors as stable and unstable angina.
3. It can be controlled with a low-sodium, high-potassium diet.
4. Generally it is treated with calcium channel-blocking agents. ------------ Correct Answer --------------
Generally it is treated with calcium channel-blocking agents.
Prinzmetal's angina results from spasm of the coronary vessels and is treated with calcium channel
blockers. Beta blockers are contraindicated because they may actually worsen the spasm. The risk factors
are unknown, and this type of angina is relatively unresponsive to nitrates. Diet therapy is not specifically
indicated.
A client with myocardial infarction (MI) has been transferred from the coronary care unit (CCU) to the
general medical unit. What activity level would the nurse encourage for the client immediately after
transfer?
1. Ad lib activities as tolerated
2. Strict bed rest for 24 hours after transfer
3. Bathroom privileges and self-care activities
4. Unsupervised hallway ambulation for distances up to 200 feet (60 meters) ------------ Correct Answer --
------------ Bathroom privileges and self-care activities
On transfer from CCU to an intermediate care or general medical unit, the client is allowed self-care
activities and bathroom privileges. Activities ad lib as tolerated is premature at this time and potentially
harmful for this client. It is unnecessary and possibly harmful to limit the client to bed rest. The client
would ambulate with supervision in the hall for brief distances, with the distances being gradually
increased to 50, 100, and 200 feet (15, 30, and 60 meters).
A client with no history of heart disease has experienced acute myocardial infarction and has been given
thrombolytic therapy with tissue plasminogen activator. What assessment finding would the nurse
identify as an indicator that the client is experiencing complications of this therapy?
1. Tarry stools
2. Nausea and vomiting
3. Orange-colored urine
4. Decreased urine output ------------ Correct Answer -------------- Tarry stools
, Thrombolytic agents are used to dissolve existing thrombi, and the nurse would monitor the client for
obvious or occult signs of bleeding. This includes assessment for obvious bleeding within the
gastrointestinal (GI) tract, urinary system, and skin. It also includes Hematest testing of secretions for
occult blood. The correct option is the only one that indicates the presence of blood.
A client has experienced an episode of pulmonary edema. The nurse determines that the client's
respiratory status is improving after this episode if which breath sounds are noted?
1. Ronchi
2. Wheezes
3. Crackles in the bases
4. Crackles throughout the lung fields ------------ Correct Answer -------------- Crackles in the base
Pulmonary edema is characterized by extreme breathlessness, dyspnea, air hunger, and the production of
frothy, pink-tinged sputum. As the client's condition improves, the amount of fluid in the alveoli
decreases, which may be detected by crackles in the bases. (Clear lung sounds indicate full resolution of
the episode.) Rhonchi and wheezes are not associated with pulmonary edema. Auscultation of the lungs
reveals crackles throughout the lung fields.
A hospitalized client has been diagnosed with heart failure as a complication of hypertension. In
explaining the disease process to the client, the nurse identifies which chamber of the heart as primarily
responsible for the symptoms?
1. Left atrium
2. Right atrium
3. Left ventricle
4. Right ventricle ------------ Correct Answer -------------- Left ventricle
Hypertension increases the workload of the left ventricle because the ventricle has to pump the stroke
volume against increased resistance (afterload) in the major blood vessels. Over time this causes the left
ventricle to fail, leading to signs and symptoms of heart failure. The remaining options are not the
chambers that are primarily responsible for this disease process, although these chambers may be affected
as the disease becomes more chronic.
The registered nurse (RN) is educating a new nurse on mitral stenosis. Which statement by the new nurse
indicates that the teaching has been effective?
1. "Left ventricle to aorta narrowing will impede flow of blood."
2. "Left atrium to left ventricle narrowing will impede flow of blood."
3. "Right atrium to right ventricle narrowing will impede flow of blood."
4. "Right ventricle to pulmonary artery narrowing will impede flow of blood." ------------ Correct Answer
-------------- "Left atrium to left ventricle narrowing will impede flow of blood."
The mitral valve separates the left atrium from the left ventricle. The remaining options describe impeded
flow due to aortic, tricuspid, and pulmonic stenosis, respectively.
The registered nurse (RN) is educating a new nurse about aortic regurgitation. Which statement by the
new nurse indicates that the teaching has been effective?
1. "Failure of the aortic valve to close completely allows blood to flow retrograde through the aorta to the
left ventricle."
