HESI RN
HESI RN CAT Exit Exam Questions
Question 1 of 5
A client with an electrical burn on the forearm asks the nurse why there is no feeling of pain from the burn. During the dressing change, the nurse determines that the burn is dry, waxy, and white. What information should the nurse provide this client?
Correct Answer: C
Rationale: The correct answer is C. Full-thickness burns destroy the nerves, leading to a lack of pain sensation. The dry, waxy appearance and white color of the burn also indicate deeper tissue involvement. Choice A is incorrect because minor burns typically involve only the superficial layers of the skin and would not result in nerve destruction. Choice B is incorrect as nerve compression does not explain the lack of pain in this scenario. Choice D is incorrect because second-degree burns, which involve the epidermis and part of the dermis, are usually painful due to intact nerve endings.
Question 2 of 5
The client diagnosed with a right fractured femur has skeletal traction applied to the right femur. Which interventions should the nurse implement?
Correct Answer: D
Rationale: The correct answer is D. Maintaining skeletal pin sites and assessing for signs of infection is crucial to prevent complications like osteomyelitis. Regular assessment helps identify infection early. Passive range of motion (A) can dislodge the traction, removing weights (B) may lead to further complications, and turning frequently (C) can disrupt the traction alignment.
Question 3 of 5
An angry client screams at the emergency department triage nurse, 'I've been waiting here for two hours! You and the staff are incompetent.' What is the best response for the nurse to make?
Correct Answer: D
Rationale: The correct answer is D: "I understand you are frustrated with the wait time." This response demonstrates empathy, validates the client's feelings, and shows understanding without admitting fault. It acknowledges the client's emotions while maintaining professionalism. A: "The emergency department is very busy at this time." This response does not address the client's feelings of frustration and may come off as dismissive. B: "I'll let you see the doctor next because you've waited so long." Giving special treatment based on complaining sets a poor precedent and is unfair to other patients. C: "I'm doing the best I can for the sickest clients first." While this response emphasizes prioritization based on medical need, it does not address the client's feelings of frustration and may escalate the situation.
Question 4 of 5
The nurse is caring for a laboring 22-year-old primigravida following administration of regional anesthesia. In planning care for this client, what nursing intervention has the highest priority?
Correct Answer: A
Rationale: The correct answer is A. The highest priority is ensuring the safety of the client. By raising the side rails and placing the call bell within reach, the nurse can prevent falls and easily attend to any urgent needs. This intervention promotes the client's physical safety and ensures immediate assistance if necessary. Choice B is incorrect because pushing effectively is important but not the highest priority. Choice C is incorrect as timing and recording contractions are important but not as critical as ensuring immediate safety. Choice D is incorrect as positioning for anesthesia distribution is important but ensuring safety takes precedence.
Question 5 of 5
A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 2 liters per minute by nasal cannula. The client develops respiratory distress and the nurse increases the oxygen to 4 liters per minute. Shortly afterward, the client becomes lethargic and confused. What action should the nurse take first?
Correct Answer: B
Rationale: The correct answer is B: Lower the oxygen rate. Rationale: 1. Increasing oxygen flow in COPD patients can lead to oxygen toxicity, causing lethargy and confusion. 2. Lowering the oxygen rate will help alleviate oxygen toxicity symptoms. 3. This is an immediate intervention to address the client's condition. Summary: A: Repositioning the nasal cannula won't address the underlying issue of oxygen toxicity. C: Encouraging cough and deep breathing won't resolve the client's lethargy and confusion. D: Monitoring oxygen saturation is important, but lowering the oxygen rate is more urgent in this situation.