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PN HESI EXIT EXAM 160 QUESTIONS & CORRECT ANSWERS LATEST 2025, Exams of Nursing

York UniversityNursing

PN HESI EXIT EXAM 160 QUESTIONS & CORRECT ANSWERS LATEST 2025

Typology: Exams

2024/2025

Available from 06/16/2025

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PN HESI EXIT EXAM 160 QUESTIONS & CORRECT ANSWERS LATEST 2025
1.
Which information is a priority for the RN to reinforce to an older client afterintravenous
pylegraphy?
A)
Eat a light diet for the rest of the day
B)
Rest for the next 24 hours since the preparation and the test is tiring.
C)
During waking hours drink at least 1 8-ounce glass of fluid every hour for the next 2days
D)
Measure the urine output for the next day and immediately notify the health careprovider if it should
decrease.
The correct answer is D: Measure the urine output for the next day and immediatelynotify the health care
provider if it should decrease.
2.
A client has altered renal function and is being treated at home. The nurse recognizesthat the most accurate
indicator of fluid balance during the weekly visits is
A)
difference in the intake and output
B)
changes in the mucous membranes
C)
skin turgor
D)
weekly weight
The correct answer is D: weekly weight
3.
A client has been diagnosed with Zollinger-Ellison syndrome.Which information ismost important for
the nurse to reinforce with the client?
A)
It is a condition in which one or more tumors called gastrinomas form in the pancreasor in the upper part of
the small intestine (duodenum)
B)
It is critical to report promptly to your health care provider any findings of pepticulcers
c)Treatment consists of medications to reduce acid and heal any peptic ulcers and, ifpossible, surgery to remove
any tumors
D)With the average age at diagnosis at 50 years the peptic ulcers may occur at unusualareas of the stomach or
intestine
The correct answer is B: It is critical to report promptly to your health care provider anyfindings of peptic ulcers .
4.
A primigravida in the third trimester is hospitalized for preeclampsia. The nurse
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PN HESI EXIT EXAM 160 QUESTIONS & CORRECT ANSWERS LATEST 2025

  1. Which information is a priority for the RN to reinforce to an older client afterintravenous pylegraphy? A) Eat a light diet for the rest of the day B) Rest for the next 24 hours since the preparation and the test is tiring. C) During waking hours drink at least 1 8 - ounce glass of fluid every hour for the next 2days D) Measure the urine output for the next day and immediately notify the health careprovider if it should decrease. The correct answer is D: Measure the urine output for the next day and immediatelynotify the health care provider if it should decrease.
  2. A client has altered renal function and is being treated at home. The nurse recognizesthat the most accurate indicator of fluid balance during the weekly visits is A) difference in the intake and output B) changes in the mucous membranes C) skin turgor D) weekly weight The correct answer is D: weekly weight
  3. A client has been diagnosed with Zollinger-Ellison syndrome.Which information ismost important for the nurse to reinforce with the client? A) It is a condition in which one or more tumors called gastrinomas form in the pancreasor in the upper part of the small intestine (duodenum) B) It is critical to report promptly to your health care provider any findings of pepticulcers c)Treatment consists of medications to reduce acid and heal any peptic ulcers and, ifpossible, surgery to remove any tumors D)With the average age at diagnosis at 50 years the peptic ulcers may occur at unusualareas of the stomach or intestine The correct answer is B: It is critical to report promptly to your health care provider anyfindings of peptic ulcers.
  4. A primigravida in the third trimester is hospitalized for preeclampsia. The nurse

determines that the client’s blood pressure is increasing. Which action should the nurse take first? A) Check the protein level in urine B) Have the client turn to the left side C) Take the temperature D) Monitor the urine output The correct answer is B: Have the client turn to the left side

  1. The nurse is caring for a client in atrial fibrillation. The atrial heart rate is 250 and theventricular rate is controlled at 75. Which of the following findings is cause for the most concern? A) Diminished bowel sounds B) Loss of appetite C) A cold, pale lower leg D) Tachypnea The correct answer is C: A cold, pale lower leg
  2. The client with infective endocarditis must be assessed frequently by the home healthnurse. Which finding suggests that antibiotic therapy is not effective, and must be reported by the nurse immediately to the healthcare provider? A) Nausea and vomiting B) Fever of 103 degrees Fahrenheit (39.5 degrees Celsius) C) Diffuse macular rash D) Muscle tenderness The correct answer is B: Fever of 103 degrees F (39.5 degrees C)
  3. A client who had a vasectomy is in the post recovery unit at an outpatient clinic. Whichof these points is most important to be reinforced by the nurse? A) Until the health care provider has determined that your ejaculate doesn't containsperm, continue to use another form of contraception. B) This procedure doesn't impede the production of male hormones or the production ofsperm in the testicles. The sperm can no longer enter your semen and no sperm are in your ejaculate. C) After your vasectomy, strenuous activity needs to be avoided for at least 48 hours. If your work doesn't involve hard physical labor, you can return to your job as soon as you

than age 5 and children of Hispanic descent

  1. A client has viral pneumonia affecting 2/3 of the right lung. What would be the best position to teach the client to lie in every other hour during first 12 hours after admission?A) Side-lying on the left with the head elevated 10 degrees B) Side-lying on the left with the head elevated 35 degrees C) Side-lying on the right wil the head elevated 10 degrees D) Side-lying on the right with the head elevated 35 degrees The correct answer is A: Side-lying on the left with the head elevated 10 degrees
  2. A client has an indwelling catheter with continuous bladder irrigation after undergoing a transurethral resection of the prostate (TURP) 12 hours ago. Which findingat this time should be reported to the health care provider? A) Light, pink urine B) occasional suprapubic cramping C) minimal drainage into the urinary collection bag D) complaints of the feeling of pulling on the urinary catheter The correct answer is C:minimal drainage into the urinary collection bag
  3. A nurse is performing CPR on an adult who went into cardiopulmonary arrest. Another nurse enters the room in response to the call. After checking the client’s pulseand respirations, what should be the function of the second nurse? A) Relieve the nurse performing CPR B) Go get the code cart C) Participate with the compressions or breathing D) Validate the client's advanced directive The correct answer is C: Participate with the compressions or breathing
  4. The nurse assesses a 72 year-old client who was admitted for right sided congestiveheart failure. Which of the following would the nurse anticipate finding? A) Decreased urinary outputB) Jugular vein distention C) Pleural effusion D) Bibasilar crackles The correct answer is B: Jugular vein distention
  1. A client with heart failure has a prescription for digoxin. The nurse is aware that sufficient potassium should be included in the diet because hypokalemia in combinationwith this medication A) Can predispose to dysrhythmias B) May lead to oliguria C) May cause irritability and anxiety D) Sometimes alters consciousness The correct answer is A: Can predispose to dysrhythmias
  2. A nurse assesses a young adult in the emergency room following a motor vehicleaccident. Which of the following neurological signs is of most concern? A) Flaccid paralysis B) Pupils fixed and dilated C) Diminished spinal reflexes D) Reduced sensory responses The correct answer is B: Pupils fixed and dilated
  3. A 14 year-old with a history of sickle cell disease is admitted to the hospital with adiagnosis of vaso- occlusive crisis. Which statements by the client would be most indicative of the etiology of this crisis? A) ”I knew this would happen. I've been eating too much red meat lately." B) ”I really enjoyed my fishing trip yesterday. I caught 2 fish." C) ”I have really been working hard practicing with the debate team at school." D)”I went to the health care provider last week for a cold and I have gotten worse." The correct answer is D: "I went to the doctor last week for a cold and I have gottenworse."
  4. Which these findings would the nurse more closely associate with anemia in a 10month-old infant? A) Hemoglobin level of 12 g/dI B) Pale mucosa of the eyelids and lips C) Hypoactivity D) A heart rate between 140 to 160 The correct answer is B: Pale mucosa of the eyelids and lips
  5. The nurse is caring for a client in hypertensive crisis in an intensive care unit. The

A) Call the health care provider immediately B) Administer acetaminophen as ordered as this is normal at this time C) Send blood, urine and sputum for culture D) Increase the client's fluid intake The correct answer is B: Administer acetaminophen as ordered as this is normal at thistime

  1. A client is admitted for first and second degree burns on the face, neck, anterior chestand hands. The nurse's priority should be A) Cover the areas with dry sterile dressingsB) Assess for dyspnea or stridor C) Initiate intravenous therapy D) Administer pain medication The correct answer is B: Assess for dyspnea or stridor
  2. Which of these clients who call the community health clinic would the nurse ask tocome in that day to be seen by the health care provider? A) I started my period and now my urine has turned bright red. B) I am an diabetic and today I have been going to the bathroom every hour. C) I was started on medicine yesterday for a urine infection. Now my lower belly hurtswhen I go to the bathroom. D) I went to the bathroom and my urine looked very red and it didn’t hurt when I went.The correct answer is D: I went to the bathroom and my urine looked very red and it didn’t hurt when I went.
  3. A middle aged woman talks to the nurse in the health care provider’s office aboututerine fibroids also called leiomyomas or myomas. What statement by the woman indicates more education is needed? A) I am one out of every 4 women that get fibroids, and of women my age – between the30s or 40s, fibroids occurs more frequently. B) My fibroids are noncancerous tumors that grow slowly. C) My associated problems I have had are pelvic pressure and pain, urinary incontinence,frequent urination or urine retention and constipation. D) Fibroids that cause no problems still need to be taken out.

The correct answer is D: Fibroids that cause no problems still need to be taken out.

  1. An elderly client admitted after a fall begins to seize and loses consciousness. Whataction by the nurse is appropriate to do next? A) Stay with client and observe for airway obstruction B) Collect pillows and pad the side rails of the bed C) Place an oral airway in the mouth and suction D) Announce a cardiac arrest, and assist with intubation The correct answer is A: Stay with client and observe for airway obstruction
  2. A nurse is providing care to a primigravida whose membranes spontaneously ruptured(ROM) 4 hours ago. Labor is to be induced. At the time of the ROM the vital signs were T-99.8 degrees F, P-84, R-20, BP-130/78, and fetal heart tones (FHT) 148 beats/min.Which assessment findings taken now may be an early indication that the client is developing a complication of labor? A) FHT 168 beats/min B) Temperature 100 degrees Fahrenheit. C) Cervical dilation of 4 D) BP 138/ The correct answer is A: FHT 168 beats/min
  3. A client with pneumococcal pneumonia had been started on antibiotics 16 hours ago.During the nurse’s initial evening rounds the nurse notices a foul smell in the room. The client makes all of these statements during their conversation. Which statement would alert the nurse to a complication? A) "I have a sharp pain in my chest when I take a breath." B) "I have been coughing up foul-tasting, brown, thick sputum." C) "I have been sweating all day." D) "I feel hot off and on." The correct answer is B: "I have been coughing up foul tasting, brown, thick sputum."
  4. The nurse is performing an assessment on a client in congestive heart failure.Auscultation of the heart is most likely to reveal A) S3 ventricular gallop B) Apical click C) Systolic murmur

A) Breath sounds can be heard bilaterally B) Mist is visible in the T-PieceC) Pulse oximetry of 88 D) Client is unable to speak The correct answer is C: Pulse oximetry of 88

  1. A nurse checks a client who is on a volume-cycled ventilator. Which finding indicatesthat the client may need suctioning? A) drowsiness B) complaint of nausea C) pulse rate of 92 D) restlessness The correct answer is D: restlessness
  2. The most effective nursing intervention to prevent atelectasis from developing in apost operative client is to A) Maintain adequate hydration B) Assist client to turn, deep breathe, and cough C) Ambulate client within 12 hours D) Splint incision The correct answer is B: Assist client to turn, deep breathe, and cough
  3. When caring for a client with a post right thoracotomy who has undergone an upperlobectomy, the nurse focuses on pain management to promote A) Relaxation and sleep B) Deep breathing and coughing C) Incisional healing D) Range of motion exercises The correct answer is B: Deep breathing and coughing
  4. A nurse is to collect a sputum specimen for acid-fast bacillus (AFB) from a client.Which action should the nurse take first? A) Ask client to cough sputum into container B) Have the client take several deep breaths C) Provide a appropriate specimen containerD) Assist with oral hygiene

The correct answer is D: Assist with oral hygiene

  1. The nurse is caring for a child immediately after surgical correction of a ventricularseptal defect. Which of the following nursing assessments should be a priority? A) Blanch nail beds for color and refill B) Assess for post operative arrhythmias C) Auscultate for pulmonary congestion D) Monitor equality of peripheral pulses The correct answer is B: Assess for post operative arrhythmias
  2. A client has a history of chronic obstructive pulmonary disease (COPD). As the nurse enters the client's room, his oxygen is running at 6 liters per minute, his color is flushed and his respirations are 8 per minute. What should the nurse do first? A) Obtain a 12 - lead EKG B) Place client in high Fowler's positionC) Lower the oxygen rate D) Take baseline vital signs The correct answer is C: Lower the oxygen rate
  3. A 4 year-old has been hospitalized for 24 hours with skeletal traction for treatment ofa fracture of the right femur. The nurse finds that the child is now crying and the right foot is pale with the absence of a pulse. What should the nurse do first?
  • A) Notify the health care provider B) Readjust the traction C) Administer the ordered prn medication D) Reassess the foot in fifteen minutes The correct answer is A: Notify the health care provider
  1. The nurse is assessing a client 2 hours postoperatively after a femoral popliteal bypass. The upper leg dressing becomes saturated with blood. The nurse's first actionshould be to A) Wrap the leg with elastic bandages B) Apply pressure at the bleeding site C) Reinforce the dressing and elevate the leg D) Remove the dressings and re-dress the incision The correct answer is C: Reinforce the dressing and elevate the leg

The high pressure alarm goes off on the ventilator. What is the first action the nurseshould perform? A) Disconnect the client from the ventilator and use a manual resuscitation bagB) Perform a quick assessment of the client's condition C) Call the respiratory therapist for help D) Press the alarm re-set button on the ventilator The correct answer is B: Perform a quick assessment of the client''s condition

  1. The nurse is preparing a client who will undergo a myelogram. Which of thefollowing statements by the client indicates a contraindication for this test? A) "I can't lie in 1 position for more than thirty minutes."B) "I am allergic to shrimp." C) "I suffer from claustrophobia." D) "I developed a severe headache after a spinal tap."The correct answer is B: "I am allergic to shrimp."
  2. The health care provider order reads "aspirate nasogastric feeding (NG) tuber every 4hours and check pH of aspirate." The pH of the aspirate is 10. Which action should the nurse take? A) Hold the tube feeding and notify the provider B) Administer the tube feeding as scheduled C) Irrigate the tube with diet cola soda D) Apply intermittent suction to the feeding tube The correct answer is A: Hold the tube feeding and notify the provider
  3. To prevent unnecessary hypoxia during suctioning of a tracheostomy, the nurse mustA) Apply suction for no more than 10 seconds B) Maintain sterile technique C) Lubricate 3 to 4 inches of the catheter tip D) Withdraw catheter in a circular motion Applying suction for more than 10 seconds
  4. An antibiotic IM injection for a 2 year-old child is ordered. The total volume of theinjection equals 2.0 ml The correct action is to A) administer the medication in 2 separate injections B) give the medication in the dorsal gluteal site

C) call to get a smaller volume ordered D) check with pharmacy for a liquid form of the medication skip The correct answer is A: administer the medication in 2 separate injections

  1. The nurse receives an order to give a client iron by deep injection. The nurse knowthat the reason for this route is to A) enhance absorption of the medication B) ensure that the entire dose of medication is given C) provide more even distribution of the drugD) prevent the drug from tissue irritation Skip The correct answer is D: prevent the drug from tissue irritation
  2. A client with heart failure has Lanoxin (digoxin) ordered. What would the nurseexpect to find when evaluating for the therapeutic effectiveness of this drug? A) diaphoresis with decreased urinary output B) increased heart rate with increase respirations C) improved respiratory status and increased urinary output D) decreased chest pain and decreased blood pressure The correct answer is C: improved respiratory status and increased urinary output
  3. While providing home care to a client with congestive heart failure, the nurse is askedhow long diuretics must be taken. What is the nurse’s best response? A) ”As you urinate more, you will need less medication to control fluid." B) ”You will have to take this medication for about a year." C) ”The medication must be continued so the fluid problem is controlled." D) ”Please talk to your health care provider about medications and treatments." The correct answer is C: "The medication must be continued so the fluid problem iscontrolled."
  4. A client is being discharged with a prescription for chlorpromazine (Thorazine). Before leaving for home, which of these findings should the nurse teach the client toreport? A) Change in libido, breast enlargementB) Sore throat, fever C) Abdominal pain, nausea, diarrhea D) Dsypnea, nasal congestion

following common side effects? A) Urinary incontinence B) Constipation C) Nystagmus D) Occult bleeding The correct answer is D: Occult bleeding

  1. The nurse is caring for a client with clinical depression who is receiving a MAO inhibitor. When providing instructions about precautions with this medication, whichaction should the nurse stress to the client as important? A) Avoid chocolate and cheese B) Take frequent naps C) Take the medication with milk D) Avoid walking without assistance The correct answer is A: Avoid chocolate and cheese
  2. A parent asks the school nurse how to eliminate lice from their child. What is themost appropriate response by the nurse? A) Cut the child's hair short to remove the nits B) Apply warm soaks to the head twice daily C) Wash the child's linen and clothing in a bleach solutionD) Application of pediculicides The correct answer is D: Application of pediculicides
  3. The nurse is teaching a client about precautions with Coumadin therapy. The clientshould be instructed to avoid which over-the-counter medication? A) Non-steroidal anti-inflammatory drugs B) Cough medicines with guaifenesin C) Histamine blockers D) Laxatives containing magnesium salts The correct answer is A: Non-steroidal anti-inflammatory drugs
  4. A client diagnosed with cirrhosis of the liver and ascites is receiving Spironolactone(Aldactone). The nurse understands that this medication spares elimination of which element?

A) Sodium B) Potassium C) Phosphate D) Albumin The correct answer is B: Potassium

  1. The nurse is caring for a client receiving a blood transfusion who develops urticaria one-half hour after the transfusion has begun. What is the first action the nurse should take? A) Stop the infusion B) Slow the rate of infusion C) Take vital signs and observe for further deterioration D) Administer Benadryl and continue the infusionThe correct answer is A: Stop the infusion
  2. Discharge instructions for a client taking alprazolam (Xanax) should include which ofthe following? A) Sedative hypnotics are effective analgesics B) Sudden cessation of alprazolam (Xanax) can cause rebound insomnia and nightmares C) Caffeine beverages can increase the effect of sedative hypnotics D) Avoidance of excessive exercise and high temperature is recommendedThe correct answer is B: Sudden cessation of alprazolam
  3. A client has received 2 units of whole blood today following an episode of GI bleeding. Which of the following laboratory reports would the nurse monitor mostclosely? A) Bleeding time B) Hemoglobin and hematocrit C) White blood cells D) Platelets The correct answer is B: Hemoglobin and hematocrit
  4. A client is receiving intravenous heparin therapy. What medication should thenurse have available in the event of an overdose of heparin? A) ProtamineB) Amicar

The correct answer is B: Check the client’s gag reflex

  1. The nurse is planning care for a client with a CVA. Which of the following measuresplanned by the nurse would be most effective in preventing skin breakdown? A) Place client in the wheelchair for four hours each day B) Pad the bony prominence C) Reposition every two hours D) Massage reddened bony prominence The correct answer is C: Reposition every two hours
  2. A nurse is assessing several clients in a long term health care facility. Which client isat highest risk for development of decubitus ulcers? A) A 79 year-old malnourished client on bed rest B) An obese client who uses a wheelchair C) A client who had 3 incontinent diarrhea stools D) An 80 year-old ambulatory diabetic client The correct answer is A: A 79 year-old malnourished client on bed rest
  3. Constipation is one of the most frequent complaints of elders. When assessing thisproblem, which action should be the nurse's priority? A) Obtain a complete blood count B) Obtain a health and dietary history C) Refer to a provider for a physical examination D) Measure height and weight The correct answer is B: Obtain a health and dietary history
  4. After a client has an enteral feeding tube inserted, the most accurate method forverification of placement is A) Abdominal x-ray B) Auscultation C) Flushing tube with saline D) Aspiration for gastric contents The correct answer is A: Abdominal x-ray
  5. A client was just taken off the ventilator after surgery and has a nasogastric tube draining bile colored liquids. Which nursing measure will provide the most comfort to theclient?

A) Allow the client to melt ice chips in the mouth B) Provide mints to freshen the breath C) Perform frequent oral care with a tooth sponge D) Swab the mouth with glycerin swabs The correct answer is C: Perform frequent oral care with a tooth sponge

  1. The nurse is instructing a 65 year-old female client diagnosed with osteoporosis. Themost important instruction regarding exercise would be to A) Exercise doing weight bearing activities B) Exercise to reduce weight C) Avoid exercise activities that increase the risk of fracture D) Exercise to strengthen muscles and thereby protect bones The correct answer is A: Exercise doing weight bearing activities
  2. The nurse has been teaching a client with congestive heart failure about proper nutrition. The selection of which lunch indicates the client has learned about sodiumrestriction? A) Cheese sandwich with a glass of 2% milk B) Sliced turkey sandwich and canned pineapple C) Cheeseburger and baked potato D) Mushroom pizza and ice cream The correct answer is B: Sliced turkey sandwich and canned pineapple
  3. Which bed position is preferred for use with a client in an extended care facility onfalls risk prevention protocol? A) All 4 side rails up, wheels locked, bed closest to door B) Lower side rails up, bed facing doorway C) Knees bent, head slightly elevated, bed in lowest positionD) Bed in lowest position, wheels locked, place bed against wall The correct answer is D: Bed in lowest position, wheels locked, place bed against wall
  4. When administering enteral feeding to a client via a jejunostomy tube, the nurseshould administer the formula A) Every four to six hoursB) Continuously C) In a bolus