Exam Mode Assessment

End

No.

1 :
The charge nurse is making assignments for one practical nurse (PN) and three registered nurses (RN) who are caring for neurplogically compromised clients. Which client with which change in status is best to assign to the PN?

Viral meningitis whose temperature changed from 101° F (38.3°C) to 102°F (38.9° C).

Myxedema coma whose blood pressure changed from 80/50 mm Hg to 70/40 mm Hg.

Diabetic ketoacidosis whose Glasgow Coma Scale score changed from 10 to 7.

Subdural hematoma whose blood pressure changed from 150/80 mm Hg to 170/60 mm Hg.

Hint : 🤦‍♂️Choose the client with a predictable condition and minor change in vital signs rather than those with critical instability.

Correct Answers:

Viral meningitis whose temperature changed from 101° F (38.3°C) to 102°F (38.9° C).

Rationale :

🧠A practical nurse (PN) can safely care for stable clients with predictable outcomes, as their scope of practice involves implementing established care plans rather than managing acute, unstable conditions.

💉A client with viral meningitis and a mild increase in temperature remains relatively stable, since a 1°F rise is expected in infection and can be managed with routine monitoring and antipyretics.

⚡Clients with myxedema coma, DKA, or subdural hematoma have rapidly changing or life-threatening conditions that require complex assessment and critical thinking, suitable for an RN.

❤️Therefore, assigning the viral meningitis client to the PN promotes safe delegation and ensures that unstable clients are cared for by the RN with appropriate expertise.

📌Core Message

Safely delegate to the PN by assigning clients with stable, predictable conditions and reserve unstable, acute changes for the RN.

2 :
A nurse is caring for a client.

A 57-year-old male client is brought to the emergency department (ED) by emergency medical services (EMS) with reports of chest pain. The client was mowing his lawn and noticed chest pain described as tightness and pressure. The pain continued to increase over about 30 minutes, at which point the client decided to rest. The client’s wife called EMS when the pain was unrelieved after 20 minutes of rest. The client reports no previous episodes of this pain. His medical history includes hypertension, obesity, and a 20-year history of smoking, having quit about 5 years ago. He takes metoprolol succinate ER 25 mg PO daily.

1230:
The client presents to the emergency department (ED) after arrival via EMS with reports of increasing chest pain.

Assessment

Neurological:

Alert and oriented to person, place, time, and situation. Agitated. Denies headaches.

Cardiovascular:

Reported chest pain described as pressure and tightness, unrelieved with rest. Rapid, regular rhythm. Normal heart tones. Radial and pedal pulses 2+. Capillary refill 2 seconds.

Respiratory:

Rapid, shallow breaths. Clear breath sounds throughout bilateral lungs.

Gastrointestinal:

Within normal limits (WNL).

Genitourinary:

WNL.

Musculoskeletal:

WNL.

Pain:

Reports 7/10 tightness and pressure in the chest.

Started approximately 2 hours ago and progressively worsened, unrelieved by rest.

Temperature: 98.1°F (36.7°C) orally

Heart rate: 121 beats/minute

Respirations: 21 breaths/minute

Blood pressure: 162/98 mm Hg

Oxygen saturation: 92% on room air

Body mass index (BMI): 32 kg/m² (normal 18–24.9 kg/m²)

Pain: 7/10 tightness and pressure in chest

1245:

12-lead electrocardiogram (ECG)

Prothrombin time (PT), International normalized ratio (INR), troponin T, troponin I, C-reactive protein, cholesterol, triglycerides, high-density lipoproteins (HDL), low-density lipoproteins (LDL)

Titrate oxygen via nasal cannula to maintain oxygen saturation >94%

Insert peripheral IV (PIV) access and maintain per unit protocol

1250:

12-lead ECG completed

PIV catheter placed in left forearm

Laboratory specimens collected

Applied 2 L/min oxygen via nasal cannula to maintain oxygen saturation >94%

The healthcare provider (HCP) places prescriptions for further diagnostics. Click to indicate if the listed symptoms are consistent with angina, myocardial infarction, or both.

Symptoms	Myocardial infarction	Angina
Occurring without cause
Pain relived by nitroglycerin
Feelings of fear
Pain only relieved by opioids
Epigastric distress
Chest pain radiating down arm

Hint : 🤦‍♂️Distinguish reversible ischemia from irreversible cardiac injury based on response to nitroglycerin and pain characteristics.

Correct Answers

Occurring without cause [ Myocardial infarction ]
Pain relived by nitroglycerin [ Angina ]
Feelings of fear [ Myocardial infarction ]
Pain only relieved by opioids [ Myocardial infarction ]
Epigastric distress [ Myocardial infarction ]
Chest pain radiating down arm [ Myocardial infarction ]

Rationale :

❤️Myocardial infarction (MI) pain occurs without identifiable cause, as it results from complete blockage of a coronary artery leading to tissue necrosis.

⚡Pain relieved only by opioids distinguishes MI from angina, since nitroglycerin cannot reverse the ischemia caused by total occlusion.

💔Epigastric distress and radiating pain down the arm are hallmark symptoms of MI due to referred pain from cardiac nerve pathways.

😨Feelings of fear or impending doom occur because of autonomic nervous system stimulation during acute myocardial injury.

💊Angina, on the other hand, is precipitated by exertion or stress and relieved by nitroglycerin, which dilates coronary arteries to restore oxygen supply temporarily.

📌Core Message

Myocardial infarction presents with unrelieved, radiating, and fear-associated pain, while angina is predictable and relieved by nitroglycerin.

3 :
A nurse is caring for a client.

1230:
The client presents to the emergency department (ED) after arrival via EMS with reports of increasing chest pain.

Assessment

Neurological:

Alert and oriented to person, place, time, and situation. Agitated. Denies headaches.

Cardiovascular:

Reported chest pain described as pressure and tightness, unrelieved with rest. Rapid, regular rhythm. Normal heart tones. Radial and pedal pulses 2+. Capillary refill 2 seconds.

Respiratory:

Rapid, shallow breaths. Clear breath sounds throughout bilateral lungs.

Gastrointestinal:

Within normal limits (WNL).

Genitourinary:

WNL.

Musculoskeletal:

WNL.

Pain:

Reports 7/10 tightness and pressure in the chest.

Started approximately 2 hours ago and progressively worsened, unrelieved by rest.

Temperature: 98.1°F (36.7°C) orally

Heart rate: 121 beats/minute

Respirations: 21 breaths/minute

Blood pressure: 162/98 mm Hg

Oxygen saturation: 92% on room air

Body mass index (BMI): 32 kg/m² (normal 18–24.9 kg/m²)

Pain: 7/10 tightness and pressure in chest

1245:

12-lead electrocardiogram (ECG)

Prothrombin time (PT), International normalized ratio (INR), troponin T, troponin I, C-reactive protein, cholesterol, triglycerides, high-density lipoproteins (HDL), low-density lipoproteins (LDL)

Titrate oxygen via nasal cannula to maintain oxygen saturation >94%

Insert peripheral IV (PIV) access and maintain per unit protocol

1250:

12-lead ECG completed

PIV catheter placed in left forearm

Laboratory specimens collected

Applied 2 L/min oxygen via nasal cannula to maintain oxygen saturation >94%

Test	Result	Reference Range
Prothrombin time	12 sec	11–12.5 sec
INR	1.0	0.8–1.1
Troponin T	0.01 ng/mL	<0.1 ng/mL
Troponin I	0.02 ng/mL	<0.03 ng/mL
C-reactive protein	2.2 mg/dL	<1.0 mg/dL
Cholesterol	240 mg/dL	<200 mg/dL
Triglycerides	186 mg/dL	40–160 mg/dL
HDL	27 mg/dL	>45 mg/dL
LDL	150.8 mg/dL	<130 mg/dL

1300:

12-lead ECG: Sinus tachycardia with a 1st-degree heart block (PR interval 0.22 seconds) and ST depression.

Initial testing is complete, and the nurse is reviewing the results. Choose the most likely options for the information missing from the statement by selecting from the lists provided. The nurse determines that the client hasas evidenced by ST depression on electrocardiogram and normal[blank 2]level.

Hint : 🤦‍♂️Associate normal troponin and ST depression with reversible ischemia instead of permanent damage.

Correct Answers

Blank 1 Correct Option: new onset angina
Blank 2 Correct Option: troponin

Rationale :

❤️ST depression on an ECG and normal troponin levels are consistent with angina, not myocardial infarction.

🧪Troponin is a cardiac biomarker released during myocardial injury; since levels are within normal limits, infarction can be ruled out.

💊Angina results from temporary myocardial ischemia due to partial vessel occlusion, whereas MI involves irreversible necrosis.

📉The ST depression represents subendocardial ischemia, confirming angina rather than transmural infarction.

📌Core Message

ST depression with normal troponin indicates new onset angina rather than myocardial infarction.

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4 :
A nurse is caring for a client.

1230:
The client presents to the emergency department (ED) after arrival via EMS with reports of increasing chest pain.

Assessment

Neurological:

Alert and oriented to person, place, time, and situation. Agitated. Denies headaches.

Cardiovascular:

Reported chest pain described as pressure and tightness, unrelieved with rest. Rapid, regular rhythm. Normal heart tones. Radial and pedal pulses 2+. Capillary refill 2 seconds.

Respiratory:

Rapid, shallow breaths. Clear breath sounds throughout bilateral lungs.

Gastrointestinal:

Within normal limits (WNL).

Genitourinary:

WNL.

Musculoskeletal:

WNL.

Pain:

Reports 7/10 tightness and pressure in the chest.

Started approximately 2 hours ago and progressively worsened, unrelieved by rest.

1600:

The client is admitted to the unit for observation.

Assessment

Neurological:

Alert and oriented to person, place, time, and situation.

Denies headaches.

Reports anxiety and tiredness related to admission.

Cardiovascular:

Reported chest pain described as squeezing that improved with nitroglycerin given in ED.

Tachycardia.

Normal heart tones.

Radial and pedal pulses 2+.

Capillary refill 2 seconds.

Respiratory:

WNL.

Gastrointestinal:

WNL.

Genitourinary:

WNL.

Musculoskeletal:

WNL.

Pain: Reported 2 on a 0 to 10 scale, a squeezing pain in chest that improved with nitroglycerin given in ED

1230:

Temperature: 98.1°F (36.7°C) orally

Heart rate: 121 beats/minute

Respirations: 21 breaths/minute

Blood pressure: 162/98 mm Hg

Oxygen saturation: 92% on room air

Body mass index (BMI): 32 kg/m² (normal 18–24.9 kg/m²)

Pain: 7/10 tightness and pressure in chest

1400:

Temperature: 98.4°F (36.9°C) orally

Heart rate: 124 beats/minute

Respirations: 22 breaths/minute

Blood pressure: 169/96 mm Hg

Oxygen saturation: 89% on room air

Pain: 8 on a 0 to 10 scale, tightness and pressure in chest

1430:

Temperature: 98.4°F (36.9°C) orally

Heart rate: 112 beats/minute

Respirations: 18 breaths/minute

Blood pressure: 151/84 mm Hg

Oxygen saturation: 96% via 2 L/minute nasal cannula

Pain: 2 on a 0 to 10 scale, squeezing in chest

1600:

Temperature: 98.2°F (36.8°C) orally

Heart rate: 106 beats/minute

Respirations: 17 breaths/minute

Blood pressure: 150/81 mm Hg

Oxygen saturation: 95% via 2 L/minute nasal cannula

Pain: 2 on a 0 to 10 scale, squeezing in chest

1245:

12-lead electrocardiogram (ECG)

Prothrombin time (PT), International normalized ratio (INR), troponin T, troponin I, C-reactive protein, cholesterol, triglycerides, high-density lipoproteins (HDL), low-density lipoproteins (LDL)

Titrate oxygen via nasal cannula to maintain oxygen saturation >94%

Insert peripheral IV (PIV) access and maintain per unit protocol

1400:

Aspirin 325 mg PO daily

Nitroglycerin 0.3 mg sublingual (SL) every 5 minutes up to 3 times PRN for chest pain

Titrate oxygen via nasal cannula to maintain oxygen saturation greater than 94%

1500:

Admit to observation unit.

Test	Result	Reference Range
Prothrombin time	12 sec	11–12.5 sec
INR	1.0	0.8–1.1
Troponin T	0.01 ng/mL	<0.1 ng/mL
Troponin I	0.02 ng/mL	<0.03 ng/mL
C-reactive protein	2.2 mg/dL	<1.0 mg/dL
Cholesterol	240 mg/dL	<200 mg/dL
Triglycerides	186 mg/dL	40–160 mg/dL
HDL	27 mg/dL	>45 mg/dL
LDL	150.8 mg/dL	<130 mg/dL

1300:

12-lead ECG: Sinus tachycardia with a 1st-degree heart block (PR interval 0.22 seconds) and ST depression.

The client asks the nurse to explain why a PCI is being completed. Drag and drop the correct word choices to complete the sentence: If healthcare providers (HCPs) see a narrowed heart vessel during a percutaneous coronary intervention (PCI), they may perform a balloon angioplasty to compress the plaque against the vessel wall and place a stent, which will lessenand.

Hint : 👀Focus on how revascularization improves oxygen delivery to reduce ischemic symptoms and prevent complications.

Correct Answers

Blank 1 Correct Option: pain
Blank 2 Correct Option: dysrhythmias

Rationale :

❤️PCI restores blood flow by widening narrowed coronary arteries through angioplasty and stenting.

💉By compressing the plaque, the procedure improves oxygen supply to the myocardium, relieving pain from ischemia.

⚡Restoring perfusion also helps prevent dysrhythmias, which occur due to oxygen deprivation in cardiac tissue.

💁‍♂️Thus, the PCI’s goal is to reduce myocardial ischemia, thereby decreasing anginal pain and preventing rhythm disturbances.

📌Core Message

PCI relieves anginal pain and prevents dysrhythmias by restoring coronary blood flow.

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5 :
A nurse is caring for a client.

1230:
The client presents to the emergency department (ED) after arrival via EMS with reports of increasing chest pain.

Assessment

Neurological:

Alert and oriented to person, place, time, and situation. Agitated. Denies headaches.

Cardiovascular:

Reported chest pain described as pressure and tightness, unrelieved with rest. Rapid, regular rhythm. Normal heart tones. Radial and pedal pulses 2+. Capillary refill 2 seconds.

Respiratory:

Rapid, shallow breaths. Clear breath sounds throughout bilateral lungs.

Gastrointestinal:

Within normal limits (WNL).

Genitourinary:

WNL.

Musculoskeletal:

WNL.

Pain:

Reports 7/10 tightness and pressure in the chest.

Started approximately 2 hours ago and progressively worsened, unrelieved by rest.

1230:

Temperature: 98.1°F (36.7°C) orally

Heart rate: 121 beats/minute

Respirations: 21 breaths/minute

Blood pressure: 162/98 mm Hg

Oxygen saturation: 92% on room air

Body mass index (BMI): 32 kg/m² (normal 18–24.9 kg/m²)

Pain: 7/10 tightness and pressure in chest

1245:

12-lead electrocardiogram (ECG)

Prothrombin time (PT), International normalized ratio (INR), troponin T, troponin I, C-reactive protein, cholesterol, triglycerides, high-density lipoproteins (HDL), low-density lipoproteins (LDL)

Titrate oxygen via nasal cannula to maintain oxygen saturation >94%

Insert peripheral IV (PIV) access and maintain per unit protocol

1250:

12-lead ECG completed

PIV catheter placed in left forearm

Laboratory specimens collected

Applied 2 L/min oxygen via nasal cannula to maintain oxygen saturation >94%

Test	Result	Reference Range
Prothrombin time	12 sec	11–12.5 sec
INR	1.0	0.8–1.1
Troponin T	0.01 ng/mL	<0.1 ng/mL
Troponin I	0.02 ng/mL	<0.03 ng/mL
C-reactive protein	2.2 mg/dL	<1.0 mg/dL
Cholesterol	240 mg/dL	<200 mg/dL
Triglycerides	186 mg/dL	40–160 mg/dL
HDL	27 mg/dL	>45 mg/dL
LDL	150.8 mg/dL	<130 mg/dL

1300:

12-lead ECG: Sinus tachycardia with a 1st-degree heart block (PR interval 0.22 seconds) and ST depression.

The nurse has provided discharge teaching to the client to manage his chest pain at home. Which 2 statements from the client should the nurse recognize as a need for further education?

Answer Options

I will keep my nitroglycerin tablets with me all the time.

I will call 911 if there is no improvement in my chest pain after taking nitroglycerin.

I will take the nitroglycerin 1 or 2 more times 10 minutes apart if pain does not get better.

I will wear a medication alert bracelet to indicate my history of heart problems.

I will chew my nitroglycerin tabs as soon as pain begins.

I will wait 5 minutes after taking my nitroglycerin to see if the pain improves.

I will lie down or sit if I start to feel any chest discomfort.

Hint : 🤦‍♂️Review the timing and route of nitroglycerin administration to ensure rapid absorption and safety.

Correct Answers:

I will take the nitroglycerin 1 or 2 more times 10 minutes apart if pain does not get better.
I will chew my nitroglycerin tabs as soon as pain begins.

Rationale :

💊Nitroglycerin should be taken every 5 minutes, up to three doses, not 10 minutes apart.

⚠️The tablet should be placed under the tongue to dissolve, not chewed, to allow for rapid sublingual absorption.

❤️Chewing destroys the medication coating, delaying its therapeutic effect and reducing absorption efficiency.

📞Clients must call 911 if pain persists after the third dose, as it indicates possible myocardial infarction.

📌Core Message

Nitroglycerin must be taken sublingually every 5 minutes up to three times, and never chewed or delayed.

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6 :
The nurse is conducting a visual screening of a group of older adults. Which finding should the nurse report to the healthcare provider immediately?

Recent change in the ability to read and drive after dark.

Gradual onset of continuous eye pain and blurred vision.

Gray-white circle around the iris of both eyes.

Cloudy opacity of the crystalline lens.

Hint : 🚨Recognize symptoms that show increased eye pressure needing urgent intervention.

Correct Answers:

Gradual onset of continuous eye pain and blurred vision.

Rationale :

👁️A gradual onset of continuous eye pain with blurred vision indicates glaucoma, a serious condition from increased intraocular pressure that can lead to optic nerve damage.

⚠️This requires immediate medical attention to prevent permanent vision loss.

🧠Other findings such as gray-white circles (arcus senilis) or cloudy lenses (cataracts) are normal age-related changes.

🌙Difficulty reading or driving after dark suggests night blindness from cataracts, not an emergency.

📌Core Message

Continuous eye pain with blurred vision indicates glaucoma, a vision-threatening emergency.

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7 :
A client with atrial fibrillation is scheduled for an elective cardioversion. The nurse inserts two intravenous (IV) catheters and connects the monitoring lead wires to the client in preparation for the procedure. Which action is most important for the nurse to implement prior to deploying the current for the cardioversion?

Select a monitor lead with a tall R wave.

Verify the prothrombin time (PT).

Administer prescribed sedative.

Activate the synchronization mode.

Hint : 💁‍♂️Always confirm timing alignment between electrical discharge and the cardiac cycle before shocking.

Correct Answers:

Activate the synchronization mode.

Rationale :

⚡Before cardioversion, the nurse must activate the synchronization mode to align shock delivery with the R wave of the QRS complex.

❤️This prevents delivering a shock during the T wave, which could trigger ventricular fibrillation.

💉Administering sedation and verifying PT are important, but safety depends first on synchronization to prevent lethal arrhythmias.

🩺The R wave synchronization ensures that electrical current is timed properly to restore sinus rhythm safely.

📌Core Message

Synchronization mode must be activated before cardioversion to prevent ventricular fibrillation.

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8 :
An older adult client with emphysema, who continues to smoke cigarettes, returns to the medical unit after a physical therapy session and is short of breath. The nurse notes that the client is lying supine with the head of the bed elevated to 45 degrees. Oxygen is flowing via nasal cannula at 3 L/minute. The client's pulse oximetry is 88%, respiratory rate is 14 breaths/minute, and vital signs are stable. Which intervention should the nurse implement?

Notify the healthcare provider of the low pulse oximetry value.

Administer a prescribed albuterol inhaler.

Encourage client to initiate a smoking cessation program.

Assess lung sounds for signs of infection.

Hint : 🤦‍♂️Start with a focused respiratory assessment before initiating treatment or notification.

Correct Answers:

Assess lung sounds for signs of infection.

Rationale :

💨An 88% oxygen saturation in a client with emphysema can be baseline due to chronic hypoxia, so immediate alarm is not necessary.

💁‍♂️Assessing lung sounds determines whether symptoms result from infection, bronchospasm, or mucus accumulation.

🚭Encouraging smoking cessation is essential but not priority when the patient is acutely short of breath.

⚕️Assessment guides whether bronchodilator therapy or oxygen titration is needed next.

📌Core Message

Always assess lung sounds first in a dyspneic emphysema patient to identify the cause of distress.

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9 :
A client tells the nurse about beginning an exercise program a month ago to lose weight and improve sleep. The client states, "It still takes at least two hours to fall asleep at night." Which action should the nurse implement?

Ask the client for a description of the exercise schedule that is being followed.

Encourage the client to exercise every day to eliminate bedtime wakefulness.

Determine the amount of weight the client has lost since increasing activity.

Advise the client that lifestyle changes often take several weeks to be effective.

Hint : 🧠Start by assessing the client’s habits that could be interfering with rest before suggesting lifestyle adjustments.

Correct Answers:

Ask the client for a description of the exercise schedule that is being followed.

Rationale :

🕐Exercise timing can significantly influence sleep quality, and engaging in vigorous activity close to bedtime can increase alertness and delay sleep onset.

🧠By asking the client to describe their exercise schedule, the nurse gathers assessment data to determine if late-evening exercise is contributing to insomnia.

💤Nursing actions should always begin with assessment before giving advice or interventions, ensuring care is individualized and evidence-based.

⚕️Encouraging daily exercise or simply stating that changes take time without understanding the timing and type of exercise could overlook an underlying behavioral cause.

📌Core Message

Begin with assessment of the client’s exercise routine to identify if timing or intensity is causing difficulty falling asleep.

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10 :
A postpartal client who is bottle-feeding develops breast engorgement. Which is the best recommendation for the nurse to provide this client?

Express a small amount of breast milk by hand.

Take a prescribed analgesic and expose breasts to air.

Place warm packs on both of the breasts.

Avoid stimulation of the breasts and wear a tight bra.

Hint : 🤦‍♂️Prevent lactation stimulation when the client is not breastfeeding to reduce breast fullness and pain.

Correct Answers:

Avoid stimulation of the breasts and wear a tight bra.

Rationale :

💁‍♂️Breast engorgement in non-breastfeeding clients results from vascular congestion and milk production that is not released.

🚫To reduce milk production, the nurse should instruct the client to avoid stimulation, including warm compresses, pumping, or expressing milk.

💨Wearing a tight-fitting supportive bra minimizes engorgement by reducing blood flow and stimulation to the breast tissue.

🧊Using cold compresses and analgesics may help relieve discomfort, but suppression of lactation is the primary goal.

📌Core Message

For non-lactating mothers, manage engorgement by avoiding breast stimulation and using a supportive tight bra.

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Total Questions: 10

Choose Different Exam !

HESI Exit (RN) 2025 Exam-8

No.

1 : The charge nurse is making assignments for one practical nurse (PN) and three registered nurses (RN) who are caring for neurplogically compromised clients. Which client with which change in status is best to assign to the PN?

2 : A nurse is caring for a client.

Correct Answers

3 : A nurse is caring for a client.

Correct Answers

4 : A nurse is caring for a client.

Correct Answers

5 : A nurse is caring for a client.

Answer Options

6 : The nurse is conducting a visual screening of a group of older adults. Which finding should the nurse report to the healthcare provider immediately?

9 : A client tells the nurse about beginning an exercise program a month ago to lose weight and improve sleep. The client states, "It still takes at least two hours to fall asleep at night." Which action should the nurse implement?

10 : A postpartal client who is bottle-feeding develops breast engorgement. Which is the best recommendation for the nurse to provide this client?

1 :
The charge nurse is making assignments for one practical nurse (PN) and three registered nurses (RN) who are caring for neurplogically compromised clients. Which client with which change in status is best to assign to the PN?

2 :
A nurse is caring for a client.

3 :
A nurse is caring for a client.

4 :
A nurse is caring for a client.

5 :
A nurse is caring for a client.

6 :
The nurse is conducting a visual screening of a group of older adults. Which finding should the nurse report to the healthcare provider immediately?

9 :
A client tells the nurse about beginning an exercise program a month ago to lose weight and improve sleep. The client states, "It still takes at least two hours to fall asleep at night." Which action should the nurse implement?

10 :
A postpartal client who is bottle-feeding develops breast engorgement. Which is the best recommendation for the nurse to provide this client?