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2021 HESI RN EXIT V3 FULL 160 ANSWERS

1. The nurse is has just admitted a client with severe depression. From which focus should

the nurse identify apriority nursing diagnosis?

A) Nutrition

B) Elimination

C) Activity

D) Safety

The correct answer is D: Safety

2. While explaining an illness to a 10 year-old, what should the nurse keep in mind

about the cognitivedevelopment at this age?

A) They are able to make simple association of ideas

B) They are able to think logically in organizing facts

C) Interpretation of events originate from their own perspective D) Conclusions are

based on previousexperiences

The correct answer is B: Think logically in organizing facts

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3. The nurse enters the room as a 3 year-old is having a generalized seizure. Which

intervention should thenurse do first?

A) Clear the area of any hazards

B) Place the child on the side

C) Restrain the child

D) Give the prescribed anticonvulsant

The correct answer is B: Place the child on the side

4. The nurse is reviewing a depressed client's history from an earlier admission.

Documentation of anhedonia is noted. The nurse understands that this finding refers to

A) Reports of difficulty falling and staying asleep

B) Expression of persistent suicidal thoughts

C) Lack of enjoyment in usual pleasures

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D) Reduced senses of taste and smell

The correct answer is C: Lack of enjoyment in usual pleasures

5. A client has just returned to the medical-surgical unit following a segmental lung

resection. After assessingthe client, the first nursing action would be to

A) Administer pain medication

B) Suction excessive tracheobronchial secretions

C) Assist client to turn, deep breathe and cough

D) Monitor oxygen saturation

The correct answer is B: Suction excessive tracheobronchial secretions

6. While assessing a client in an outpatient facility with a panic disorder, the nurse

completes a thoroughhealth history and physical exam. Which finding is most

significant for this client?

A) Compulsive behavior

B) Sense of impending doom

C) Fear of flying

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D) Predictable episodes

The correct answer is B: Sense of impending doom

7. A 16 month-old child has just been admitted to the hospital. As the nurse assigned to this

child enters the hospital room for the first time, the toddler runs to the mother, clings to

her and begins to cry. What would bethe initial action by the nurse?

A) Arrange to change client care assignments

B) Explain that this behavior is expected

C) Discuss the appropriate use of "time-out"

D) Explain that the child needs extra attention

The correct answer is B: Explain that this behavior is expected

8. A 15 year-old client with a lengthy confining illness is at risk for altered growth and

development of whichtask?

A) Loss of control

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