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HESI EXIT PRACTICE, Real Hesi PN,
KHESI2, you got this 2, Exit HESI PN Exam
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What steps should you take for an older female client who was just admitted to a long-term facility and is confused about the day of the week? - CORRECT ANSWERS Remind the client what day of the week it is
Which information about end-of-life care should a practical nurse (PN) ensure the client has? - CORRECT ANSWERS Instructions for care should be included in the clients living will
(Advance directives)
After a routine vaginal delivery of a healthy newborn, a client who is pregnant is taken to the recovery room. You notice the client is shaking asks if she's cold. What's next? - CORRECT ANSWERS Apply light warm blanket and assure her that this is normal following delivery
The practical nurse (PN) is assessing an older client with left sided heart failure what intervention is most important for the PN to implement - CORRECT ANSWERS Auscultate all the lung fields
What is the most crucial step for the practical nurse to take while giving prescription medication to an elderly resident of an extended care home who is having trouble hearing? - CORRECT ANSWERS Determine if client has had difficulty hearing in the past
A full term 24 hour old infant in the nursery regulates and suddenly turns cyanotic which immediate interventions should the practical nurse (PN) take? - CORRECT ANSWERS Turn the infant to the right side
The practical nurse (PN) views the midline episiotomy of a client who reports pain in her stiches. What action should the action should the PN take first? - CORRECT ANSWERS Observe suture line for separation and hematoma formation
The practical nurse (PN) is obtaining fetal heart rates on a client in their third trimester of pregnancy what fetal heart rate should be reported to the registered nurse? - CORRECT ANSWERS 180
Which problem has happened in an older client with these issues? - CORRECT ANSWERS Evisceration
Which location should the practical nurse palpate to determine if a client submandibular lymph node are enlarged? - CORRECT ANSWERS Beneath the lower jaw
The most significant side effect that a practical nurse (PN) should check for after administering an epidural to a client during labor is observation of the side effect. - CORRECT ANSWERS Maternal hypotension
Which person has the highest risk of developing laryngeal cancer? - CORRECT ANSWERS A older male who drinks a 6 pack of beer nightly and smokes heavily
A home health practical nurse (PN) visits and older client living with offspring who exhibits fear unkept and has lost a lot of weight which action should the PN take> - CORRECT ANSWERS Report suspected abuse to supervisor and protective services
Which interventions should the practical nurse (PN) reinforce for a client with pruritis? - CORRECT ANSWERS Keep fingernails trimmed short.
When gathering data about a client with dark skin tones which site should the practical nurse (PN) observe? - CORRECT ANSWERS Finger and toe nails
What is the best course of action for the practical nurse (PN) to take when the parents of a child with pre-diabetes inform the PN that the youngster wants to join the soccer team? - CORRECT ANSWERS Reassure the patents that increased physical activity reduces risk for diabetes
While assisting the RN with the admission of a toddler which intervention should the practical nurse (PN) implement to make the experience lease stressful for the client - CORRECT ANSWERS Remove child's clothing down to the diaper
A client with hypertension complains of a persistent dry cough the practical nurse (PN) should tell the client that this is a common side effect with what medication? - CORRECT ANSWERS Quinapril
In a noisy voice that the client and visitors might overhear, a practical nurse (Pn) is recounting her social life, sexual activities, and alcohol use at the nurses station. - CORRECT ANSWERS Suggest going to the nurses lounge to discuss these topics
Which symptoms are the parents of a kid with acute glomerulonephritis describing to the practical nurse (PN) as the ones that initially prompted them to seek medical attention? - CORRECT ANSWERS Hematuria
A pleural effusion is visible on the chest x-ray of a patient who has been admitted with pneumonia. When auscultating the upper lobe, what should the PN listen for? - CORRECT ANSWERS A rubbing pleural sound
A client receives ondansetron prior to chemotherapy treatment how should the practical nurse evaluate the effectiveness of the medication? - CORRECT ANSWERS Monitor the client for nausea or vomiting following the treatment
A new protocol for fall prevention is being implemented on the medical unit during safety rounds the practical nurse (PN) identifies that the UAP had omitted a vital component of the protocol after implementing the missing component which action should the nurse take? - CORRECT ANSWERS Supervise the UAP after reviewing the protocol
What standard of care is acceptable in a nursing malpractice case? - CORRECT ANSWERS What would a responsible prudent nurse have done under similar circumstances
The practical nurse (PN) administers a anticonvulsant that causes photosensitivity which action should the PN take after admitting the medication? - CORRECT ANSWERS Remind the client to protect skin from sunlight
What is a appropriate task for a UAP assisting the nurse for a dressing change? - CORRECT ANSWERS Gather supplies
The practical nurse (PN) is changing the abdominal dressing of a male client who was discharged home following a colon resection which information should the PN report to the health care provider? - CORRECT ANSWERS The client reports the wound care is painful and would like a prescription for an analgesic
When getting a blood glucose, what intervention should the practical nurse implement? - CORRECT ANSWERS Determine what finger was used previously
A client diagnosed with c-diff which action should the practical nurse (PN) implement to prevent the spread of the organism? - CORRECT ANSWERS Hand washing
A client had surgery 2 days ago complains of difficulty sleeping which initial intervention is best for the practical nurse to implement? - CORRECT ANSWERS Reposition the client and provide a back rub
The practical nurse (PN) plans to use distraction technique while client undergoes a brief painful procedure which action should the PN implement during the procedure? - CORRECT ANSWERS ncourage the client to reminisce about a favorite past family event
Which interventions is within the scope of practice for a practical nurse (PN)? - CORRECT ANSWERS Demonstrating deep breathing and coughing to a post operative client
A woman visits the clinic for a medical examination, the practical nurse (PN) notices a purple bruise on the client's upper arm and a yellow bruise under her right eye. What should the nurse ask the client? - CORRECT ANSWERS Is anyone hurting you
When a male preop client who has already given informed consent for a surgical procedure informs the PN that he is particularly terrified and anxious about having the surgery, what priority action should you take? - CORRECT ANSWERS Notify the charge nurse of the clients concerns
What kind of intervention should the PN use when engaging a client who is hospitalized with obsessive compulsive disorder and is repeatedly wiping off door knobs? - CORRECT ANSWERS Provide time for the behaviors then guide the client to other actives
What assessment questions are most crucial for a client with schizophrenia who has auditory hallucinations when they are brought to the hospital? - CORRECT ANSWERS What is the voices altering
What information is most crucial for the practical nurse (PN) to find out when a female client with bipolar illness tells them they haven't taken their medication? - CORRECT ANSWERS mind frame
Which of the following statements made by an older female client should alert the practical nurse (PN) that the client could require treatment counseling? The client lost her spouse 3 years ago. - CORRECT ANSWERS I realized that life must go on but sometimes I wonder why
What is the behavior that the nurse should document with a client having cocaine withdrawal? - CORRECT ANSWERS Intense cravings
The Practical Nurse (PN) is assigned to care for four children which should be assessed first? - CORRECT ANSWERS 18 month old who has cystic fibrosis is wheezing
An older client tells the home health care practical nurse (PN) about experiencing dizziness when standing, whats most important for the PN to obtain? - CORRECT ANSWERS Obtain orthostatic blood pressures.
The practical nurse (PN) learns that the client whos receiving chemotherapy has developed stomatitis which information should the PN obtain from the client during focused assessment - CORRECT ANSWERS Ability to swallow
Which technique should the practical nurse (PN) employ while giving nystatin suspension to an infant whose gums have a candida infection? - CORRECT ANSWERS Use a gloved finger to suspension over the infected area
Prior to administering pain medication to an older adult post operative client what information should the practical nurse (PN) obtain? - CORRECT ANSWERS Clients pain rating 1-10 scale
Time of last administration of pain medication
Effectives of last pain8 medication administration
The practical nurses client last bowel movement occurred days ago, which action should the PN implement first? - CORRECT ANSWERS Determine the clients usual bowel patterns
When explaining how to correctly utilize assistive equipment to an elderly client who is recuperating from a stroke, the practical nurse (PN) plans to reinforce where the client should position the cane. Where should the PN instruct the client to place the cane? - CORRECT ANSWERS Ineffective side
The practical nurse is caring for a client with influenza who requires droplet precautions which action should the PN take after entering the room to provide care? - CORRECT ANSWERS Close the door to the client's room
A male client tells the practical nurse (PN) that the pill he has been taking at home is different color and size then the one the PN is trying to give him now how should the nurse respond? - CORRECT ANSWERS Explain that the pharmacy often substitutes generic for more expensive brands
A client afraid of getting cancer plans to stop smoking and use smokeless tobacco. What should you provide? - CORRECT ANSWERS provide info of risks of smokeless tobacco
Client slumped in chair with no visible signs of life. What should you do? - CORRECT ANSWERS shake and shout to determine LOC
Short leg cast applied 2 hours ago cap refill is 5 second. What should PN do? - CORRECT ANSWERS Notify provider and charge nurse
A client unconscious with weak thready pulse, cool, moisten skin cyanosis of nail bed, Kussmaul respirations. Whats next? - CORRECT ANSWERS provide oxygen
What is the most crucial thing for PN to give to UAP while caring for a client who has pitting edema of the feet and ankles and is taking spironolactone (a potassium sparing diuretic)? - CORRECT ANSWERS Maintain accurate intake and output
At 1000, a fresh prescription is given to a patient that calls for stopping IV fluids and IV antibiotics. Why should the practical nurse (PN) administer the medication Pantoprazole at 1300? - CORRECT ANSWERS treat acid reflux
A man client participates in a community support program for people with mental illness and substance abuse issues. The client informs the practical nurse (PN) that cocaine and heroin are his preferred substances. What is the client's biggest health risk? - CORRECT ANSWERS Hepatitis
A postoperative male client has been refusing pain medicine for the previous six hours because he thought he could "tough it out." The client has trouble achieving a reasonable degree of comfort when an opioid analgesic is given. What technique should the practical nurse (PN) employ to help this client manage his pain? - CORRECT ANSWERS Guide the client through slow, rhythmic breathing
The practical nurse finds a client who is assigned to another nurse bleeding from an intravenous (IV) site and the IV tubing and fluid are on the floor. The PN immediately applies a dressing to stop the bleeding. Which action should the PN take next? - CORRECT ANSWERS Enter computer documentation of the findings and the application of a dressing
The practical nurse (PN) is assigning tasks to unlicensed assistive personnel (UAP) who is giving basic care to a group of residents in a long-term care facility. Which client's task should be completed by a PN, rather than the UAP? - CORRECT ANSWERS A client with continuous urinary bladder irrigation via a 3-way catheter
The practical nurse (PN) palpates a client's radial pulse and notes that the pulse disappears when light pressure is applied. How should the PN document this finding? - CORRECT ANSWERS Thready pulse volume
Client expresses concern about receiving proper care in accordance with the client's religion. Which action is best for the practical nurse (PN) to take? - CORRECT ANSWERS Ask the client about individual care preferences.
Which action by a practical nurse (PN) indicates the best understanding of the principles related to medical asepsis and effective handwashing? - CORRECT ANSWERS Hold your hands lower than your elbows to promote microbe removal.
An older adult client with cancer of the liver is in a hepatic coma and unresponsive. How should the practical nurse respond to family members who are inquiring about the condition of their loved one? - CORRECT ANSWERS Convey that their loved one's condition is extremely critical, and there has been no response in the last 24 hours
In caring for a client following a below-the-knee amputation, which task is best for the practical nurse (PN) to assign to the unlicensed assistive personnel (UAP) who is assisting with the care of this client? - CORRECT ANSWERS Empty and measure the drainage in the suction drainage device.
What information should the practical nurse (PN) review with a client who has symptoms of orthostatic hypotension - CORRECT ANSWERS Rise slowly from sitting or lying positions.
A client with cancer eats only 10% of the food on the meal tray provided for lunch, stating everything tastes "funny" and "the meat is bitter." Which action should the practical nurse (PN) take? - CORRECT ANSWERS Offer alternative food and flavoring options.
The practical nurse (PN) is caring for a group of clients on a postpartum unit. After shift report, which client should the PN assess first? - CORRECT ANSWERS Gravida 3 Para 3 who delivered vaginally 2 hours ago.
On the first day after a cesarean section, a client who is a primipara is being assisted to the bathroom for the first time. The client experiences a sudden gush of vaginal blood and notices that several blood clots are in the toilet. Which action should the practical nurse (P) take? - CORRECT ANSWERS Massage the funds and avoid direct pressure on the cesarean incision
A 6-year-old child with diabetes is PO for a diagnostic procedure. Which action should the practical nurse (PN) take since the child receives regular insulin at 0700 each morning? - CORRECT ANSWERS Give 0700 insulin as received every day.
When caring for a child with sickle cell disease, the practical nurse (PN) expects that the describe which symptom when experiencing a sickle cell crisis? - CORRECT ANSWERS Joint pain
The practical nurse (PN) is offering fluids to a client who has been NPO. Which intervention is most important for the PN to implement? - CORRECT ANSWERS Maintain head alignment with head of bed elevated.
A female client returns to her room following her initial external radiation treatment for cancer. The practical nurse (PN) enters the client's room and observes the unlicensed assistive personnel (UP), who has just finished washing the radiation markings off the client's skin and is gently patting the skin dry. What action should the PN take? - CORRECT ANSWERS Report the situation to the radiation department.
Immediately after log-rolling a client to a lateral position, which intervention should the practical nurse (PN) implement? - CORRECT ANSWERS Place pillows to maintain alignment.
A client who is a primigravida tells the practical nurse (PN), "My baby seems to be sleeping, but look at the funny movements he is making." The PN notices that the infant is making hand-to-hand movements, smacking his lips, and turning his head. Which is the best response for the PN to make? - CORRECT ANSWERS These movements indicate that the infant is hungry
A newborn infant is prescribed an immunization prior to discharge. Which action should the practical nurse (PN) implement? - CORRECT ANSWERS Obtain signed consent from the mother for administration of Hepatitis B vaccine.
The practical nurse (PN) is caring for a client with a new prescription for fluticasone furoate nasal spray, a glucocorticoid prescribed for the client's nasal allergy symptoms. In reinforcing instructions about self- administration of the nasal spray, the PN should emphasize the need for the client to take which action before self-administration? - CORRECT ANSWERS Gently blow the nose
After administering pantoprazole to a client with gastroesophageal reflux disorder (GERD), which statement by the client indicates to the practical nurse (PN) that the medication is producing the desired effect? - CORRECT ANSWERS I did not experience any heartburn after eating lunch."
Which actions should the practical nurse include when assessing a client for signs and symptoms of fluid volume excess? - CORRECT ANSWERS Palpate the rate and volume of the pulse
Measure body weight at the same time daily
Observe the color and amount of urine
When preparing to change a client's sterile dressing, the practical nurse (PN) opens a package of gauze pads as seen in the picture. Which action should the PN take next? - CORRECT ANSWERS Pick up pads and place them on a sterile field.
Get the fire extinguisher.
Shut the doors to all client rooms.
The practical nurse (PN) is assisting a client who is multiparous in active labor with breathing techniques during contractions. The client's contractions occur every 2 minutes, with a duration of 80 seconds, when she suddenly wants to go to the bathroom to have a bowel movement. Which should the PN do first? - CORRECT ANSWERS Notify the RN of the client's urge to push
A client is admitted with a hemothorax following a motor vehicle collision, and the surgeon inserts a chest tube that is attached to a chest drainage system with suction at 20 cm water pressure. The practical nurse (PN) observes that the suction chamber fluid level is at 15 cm. Which action should the PN implement to ensure effective functioning of the chest drainage system? - CORRECT ANSWERS Additional sterile water should be added to the suction chamber to the 20 cm level.
The practical nurse (PN) administers a skeletal muscle relaxant to a client with left leg pain. Which assessment provides data related to the effectiveness of the medication? - CORRECT ANSWERS Pain level has decreased
During a home health visit, a male client reports to the practical nurse (PN) that he experiences severe back pain that interferes with his activities of daily living (ADLS) following each physical therapy session. Which actions should the PN take? - CORRECT ANSWERS Document the situation on a variance report to submit to the supervisor.
Gather specific data about the characteristics of the pain.
Communicate with the physical therapist about the client's back pain.
The home health practical nurse (PN) is visiting an older adult with Parkinson's disease. Which problems should the PN expect to address in the client's home health care plan? - CORRECT ANSWERS Risk for falls
Fragile skin.
Feeding assistance.
Depression.
A client who is admitted to the hospital for depression is escorted to a private room. Prior to leaving the room, which intervention is most important for the practical nurse (P) to implement? - CORRECT ANSWERS Search all personal belongings
A hospitalized 5-year-old boy recovering from surgery refuses to drink fluids. Which intervention is best for the practical nurse to implement? - CORRECT ANSWERS Offer the child a popsicle and allow him to pick the flavor he prefers.
A primigravida client confides in the practical nurse (PN) that her sister told her that she should eliminate all salt once she is at 26-weeks' gestation because it will eliminate fluid retention and swelling. How should the PN respond? - CORRECT ANSWERS Salt foods lightly during cooking, but add no additional salt at the table
The practical nurse (PN) overhears a conversation between unlicensed assistive personnel (UAP) and another staff member in the hospital cafeteria line concerning a client's reaction to being given a diagnosis of terminal cancer. What is the best nursing action? - CORRECT ANSWERS Approach the individuals involved and ask them to stop.
An elderly female client who resides in a long-term care home has a male acquaintance who often visits her in thE evenings. The couple is in bed together when the practical nurse (PN) enters the client's room to administer medication. What steps ought to the PN take? - CORRECT ANSWERS Exit the room and quietly close the door.
The practical nurse (PN) should perform oral suctioning for a client with what problem? - CORRECT ANSWERS Dysphagia
A client in the psychiatric unit's dayroom is becoming agitated, talking incessantly, and starting to yell and swear at the other clients. Which action should the practical nurse (PN) implement first? - CORRECT ANSWERS Escort the client to a calm and quiet place
T/F The Rubella vaccine should be given subcutaneously. - CORRECT ANSWERS True
Prior to an invasive examination of a hospitalized client, a consent form should be obtained. Which action best describes the responsibility of the practical nurse (PN)? - CORRECT ANSWERS Checks the medical record for the correct signed consent form prior to the examination,
The practical nurse (PN) is removing the personal protective equipment (PPE) worn when caring for a client. Which PPE should be removed first? - CORRECT ANSWERS Gloves
The practical nurse (PN) is caring for a client newly diagnosed with diabetes melius (DM). Which finding is an early sign of hypoglycemia? - CORRECT ANSWERS Tremors.
An elderly male senior whose house is being visited by a practical nurse (PN) is recently diagnosed with Herpes zoster (shingles). The customer states that a sharp, searing sensation has started to develop along his right trunk side. What steps ought to the PN take? - CORRECT ANSWERS Administer a prescribed PRN dose of analgesic.
When a paranoid client is brought into the mental health facility, he or she instantly leaves towards the corner of the room and sits there silently without speaking. What action should the practical nurse (PN) take initially when approaching the client? - CORRECT ANSWERS Describe functions of the PN
The unlicensed assistance staff (UAP) is getting instructions from the practical nurse (PN) as they get ready to deliver a complete bed bath to an immobile client who has a gastrostomy tube for continuous feeding (GT). Which instruction should the PN emphasize the most? - CORRECT ANSWERS Keep the head of the bed raised while the tube feeding is infusing
What stage of the grieving process when a client refuses to accept an outcome? - CORRECT ANSWERS Denial
A client at 39-weeks' gestation is admitted in early labor. During the focused assessment, the practical nurse (PN) reviews the obstetrical history with the client who states that she has been pregnant 5 times but has only 2 living children, both of whom were full-term. The other three pregnancies were miscarriages during the first trimester. Which parity should the PN document be for term, premature,
abortion, and living children (PAL) for this client? - CORRECT ANSWERS Term 3, Premature 0, Abortion 3, Living 2
A client with somatic symptom disorder reports experiencing chest pain to the practical nurse (PN). What should the PN remind the client? - CORRECT ANSWERS Remind the client that the symptoms are psychological in cause
What should you remember about a Hemovac or Jacks Pratt drain? - CORRECT ANSWERS Compress hemovac unit and replace stopper
Xerostomia - CORRECT ANSWERS Dryness of the mouth caused by reduction of saliva
if membranes bag of water has rupture - CORRECT ANSWERS pt. should be allowed to ambulate during labor only if the FHR is within normal range
Pyloric stemosis - CORRECT ANSWERS turn sideways
When given morphine do what - CORRECT ANSWERS Monitor Respirations
An elderly client who is 12 hours postoperative for a hernia repair suddenly becomes agitated, staggers out into the corridor and demands to be set free. After assisting the client back to bed and administering pain medication. Which intervention is best for the practical nurse (PN) to implement?
A. Notify the healthcare provider and request a prescription for restraints to minimize the client's danger to self.
B. Raise the side and notify the family to come sit with the client to reorientate and cooperative.
C. Administer prescribed narcotic antagonist to reverse the effects of any analgesic accumulation.
D. Instruct a UAP to keep the upper side rails up and check on the client every 15 minutes until the client is resting. - CORRECT ANSWERS C. Administer prescribed narcotic antagonist to reverse the effects of any analgesic accumulation.
