HESI Adult Health 2025
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Patient Data
History and Physical
A 59-year-old male client presents to the clinic reporting pain in the right great toe. The client says that the pain feels like it is another attack of gout, which he has had on 2 other occasions in the last 4 months. The client tells the nurses that the pain started about 9 days ago in the evening and that it got very painful and swollen shortly thereafter. In the past, the gout attacks have resolved without treatment after about 5 days, but the client reports that his condition has not improved and that he is unable to walk or work without excruciating pain in the great toe joint. The client has type 2 diabetes mellitus, osteoarthritis, hypertension, obesity, and sleep apnea. Currently, the client takes metformin, aspirin, and enalapril daily. Ibuprofen is taken as needed for pain. The client reports that he has never smoked or used tobacco products. He does not use recreational drugs. Typically, he drinks 2 to 3 dark beers nightly.
Nurses' Notes
0830
Assessment
. Neurological: Within normal limits (WNL).
· Cardiovascular: 1+ edema in bilateral lower extremities.
. Respiratory: Diminished breath sounds in bilateral bases of the lungs.
. Gastrointestinal: WNL.
· Genitourinary: WNL.
. Integumentary: Redness and warmth at the right great toe. On palpation, noted small hard firm deposits under the skin on the right great toe.
. Musculoskeletal: Pain and swelling in right great toe. Great toe is slightly deformed at the joint. Right sided limp present when ambulating.
Flow Sheet
0830
Vital signs
· Temperature: 100.5° F (38.1° C), orally
. Heart rate: 97 beats/minute
· Respirations: 18 breaths/minute
· Blood pressure: 151/87 mm Hg
· Oxygen saturation: 95% on room air
· Height: 5 ft 11 in (180.34 cm)
· Weight: 228 lb (103.4 kg)
· Body mass index (BMI): is 31.8 kg/m2 (normal 18.0 to 24.9 kg/m2)
. Pain: rated 8 on a 0 to 10 scale, in the right foot
Client history has been collected, and the nurse performs a physical assessment and records vital signs. Which finding(s) in the client's health record should the nurse recognize that places the client at a greater risk of developing gout? Select all that apply.
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Osteoarthritis
-
Nonsmoker
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Ibuprofen for pain
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Obesity
-
Drinks beer nightly
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Type 2 diabetes mellitus
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Sleep apnea
-
Daily aspirin
-
Hypertension
Explanation
The Correct Answers are: D. Obesity, E. Drinks beer nightly, F. Type 2 diabetes mellitus, H. Daily aspirin, I. Hypertension
Explanation of Correct Answers
D. Obesity
Obesity increases uric acid production and reduces renal clearance, making it a major modifiable risk factor for gout. Excess weight also contributes to metabolic syndrome, which is strongly linked to hyperuricemia.
E. Drinks beer nightly
Alcohol, especially beer, contains purines that are metabolized into uric acid. Frequent alcohol use increases both uric acid levels and the risk of recurrent gout flares.
F. Type 2 diabetes mellitus
Diabetes is associated with insulin resistance, which reduces the kidneys’ ability to excrete uric acid. This directly increases the risk of gout.
H. Daily aspirin
Low-dose aspirin reduces renal excretion of uric acid, raising serum urate levels. Daily use is a well-recognized contributor to gout flares in at-risk clients.
I. Hypertension
High blood pressure is commonly associated with impaired renal function and diuretic use, both of which reduce uric acid clearance and contribute to gout development.
Why the Other Options Are Incorrect
A. Osteoarthritis
While it causes joint pain and deformity, osteoarthritis itself does not increase uric acid levels or gout risk.
B. Nonsmoker
Not smoking is protective for health in general but has no link to increased risk of gout.
C. Ibuprofen for pain
NSAIDs like ibuprofen are actually used as treatment for acute gout flares; they do not increase risk.
G. Sleep apnea
Though associated with obesity and metabolic syndrome, sleep apnea itself is not a direct risk factor for gout.
A client with type 2 diabetes mellitus (DM) is admitted to the hospital for uncontrolled DM. Insulin therapy is initiated with an initial dose of insulin isophane (NPH) subcutaneous at 0800. At 1600, the client reports having diaphoresis, rapid heartbeat, and feeling shaky. Which should the nurse do first?
- A Give the client one half cup (120 mL) of fruit juice.
- B Determine the client's current glucose level.
- C Give the client skim milk and crackers.
- D Assess the client's oxygen saturation level.
Explanation
B. Determine the client's current glucose level.
These symptoms—diaphoresis, tachycardia, and shakiness—strongly indicate possible hypoglycemia, which often occurs when NPH peaks around 1600. Before administering carbohydrates, the nurse must confirm the blood glucose level to ensure the symptoms are due to hypoglycemia. This step guides safe and appropriate intervention, prevents overtreatment, and aligns with priority nursing action: assess before implementing.
While changing the dressing of a client who is immobile, the nurse notices the boundary of the wound has increased. Before reporting this finding to the healthcare provider, the nurse should evaluate which of the client's laboratory values?
-
Neutrophil count.
-
Serum potassium and sodium levels.
-
Platelet count.
-
reactive protein level.
Explanation
The Correct Answer is: A. Neutrophil count
Explanation
An enlarging wound boundary suggests possible infection or worsening inflammation. Neutrophils are the primary white blood cells that respond to bacterial infection. Evaluating the neutrophil count helps determine if infection is contributing to wound progression. Elevated neutrophils would support an acute infection, while a low count may indicate impaired immune response, both critical for guiding the provider’s management plan.
Why the other options are incorrect:
B. Serum potassium and sodium levels
Electrolyte levels are important for overall health and healing but do not directly reflect infection or wound progression. They are not the priority in this scenario.
C. Platelet count
Platelets are involved in clotting and wound healing, but changes in wound boundary are more indicative of infection or inflammation than clotting dysfunction. Platelet count is not the most relevant lab here.
D. C-reactive protein level
CRP is a nonspecific marker of inflammation. While it may be elevated in infection, it is less specific than evaluating the neutrophil count, which directly indicates the body’s immune response to possible infection.
A client with chronic venous insufficiency is being discharged from the hospital and plans to return home. Which client statement indicates an understanding of home care instructions?
- "I will avoid sitting and crossing my legs."
- "I will lift weights every other day."
- "I will be able to stand as long as my legs do not hurt."
- "I will need to get someone to walk my dog."
Explanation
A. "I will avoid sitting and crossing my legs."
Chronic venous insufficiency is caused by impaired venous return, leading to pooling of blood in the legs. Sitting for long periods and crossing the legs increase venous pressure and worsen edema, pain, and skin changes. Avoiding these positions helps promote better circulation, reduce swelling, and prevent complications such as venous stasis ulcers. This statement demonstrates correct understanding of venous return–promoting behaviors.
An older adult client arrives at the outpatient eye surgery clinic for a right cataract extraction and lens implant. During the immediate postoperative period, which intervention should the nurse implement?
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Obtain vital signs every 2 hours during hospitalization.
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Provide an eye shield to be worn while sleeping.
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Teach a family member to administer eye drops.
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Encourage deep breathing and coughing exercises.
Explanation
The Correct Answer is: B. Provide an eye shield to be worn while sleeping.
Explanation of the Correct Answer
B. Provide an eye shield to be worn while sleeping
After cataract extraction and lens implant, the eye is vulnerable to pressure or trauma. An eye shield protects the surgical site from accidental rubbing or injury, especially during sleep. This intervention is essential to prevent complications such as wound dehiscence or increased intraocular pressure, supporting safe healing during the immediate postoperative period.
Why the Other Options Are Incorrect
A. Obtain vital signs every 2 hours during hospitalization
Cataract surgery is usually an outpatient procedure, and frequent vital sign monitoring every 2 hours is not necessary once the client is stable. Post-op care focuses more on eye protection and medication compliance.
C. Teach a family member to administer eye drops
Teaching is important, but in the immediate postoperative period the nurse’s priority is to protect the operative eye. Education about medications is typically reinforced before discharge, not as the first intervention.
D. Encourage deep breathing and coughing exercises
Coughing should be avoided after eye surgery because it increases intraocular pressure, which could disrupt healing. Gentle deep breathing for relaxation may be allowed, but coughing is contraindicated.
A client with hyperparathyroidism reports a sudden onset of severe flank pain. Which intervention should the nurse include in the client's plan of care (POC)?
- A Administer a PRN dose of a laxative.
- B Initiate cardiac telemetry.
- C Begin straining all urine.
- D Implement seizure precautions.
Explanation
C. Begin straining all urine
Hyperparathyroidism causes increased secretion of parathyroid hormone, which raises serum calcium levels. Chronic hypercalcemia leads to the formation of renal calculi (kidney stones). The client’s sudden, severe flank pain is classic for a stone moving through the urinary tract. Straining all urine is critical to capture stone fragments for analysis, confirm the diagnosis, and guide future treatment.
Patient Data
History and Physical
The client is a young male who appears to be 25 to 30 years old. He was found unconscious on a sidewalk by a jogger who was passing by. The jogger called an ambulance, and the emergency medical technicians (EMTs) transported the client to the hospital. Client is arousable but unable to say what his name is or what happened to him. A STAT head computed tomography (CT) scan in the emergency department (ED) showed no abnormalities, so the client will be admitted to the medical floor for observation and further tests.
Nurses' Notes
1000
Client admitted to the medical floor. Upon arrival, the client was assessed.
. Is difficult to arouse but follows commands.
· Has a peripheral IV (PIV) infusing 0.9% sodium chloride at 145 mL/hr.
· No redness or edema at site.
. Breath sounds are clear and equal bilaterally.
. Appears pink and well perfused
Vital signs
. Heart rate: 58 beats/minute
· Respirations: 13 breaths/minute
. Blood pressure: 114/81 mm Hg
· Oxygen saturation: 100% on 2 L/minute supplemental oxygen via nasal cannula
Orders
1000
. Admit to the medical floor
· Oxygen 2 L/minute via nasal cannula
· Place a peripheral IV (PIV) access device
. Infuse 0.9% sodium chloride IV at 145 mL/hr
. Urine drug screen
Imaging Studies
0930
· Head computed tomography (CT): No abnormalities.
The nurse identifies that the client is having a tonic clonic seizure. The oxygen saturation is 40% and the respiratory rate is 4 breaths/minute. The nurse calls for help and 2 other nurses enter the room. Which 3 interventions should be performed first?
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Place pillows around the bed rails to provide padding.
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Manually ventilate the client with a bag valve mask (BVM).
-
Watch the seizure activity and document the time and client movement.
-
Increase the supplemental oxygen to 10 L/minute via nasal cannula.
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Stop the IV fluids.
-
Begin chest compressions.
Explanation
The Correct Answers are:
A. Place pillows around the bed rails to provide padding.
B. Manually ventilate the client with a bag valve mask (BVM).
C. Watch the seizure activity and document the time and client movement.
Explanation of the Correct Answers
A. Place pillows around the bed rails to provide padding
Correct. During a tonic-clonic seizure, uncontrolled muscle activity places the client at risk of hitting extremities against the bed rails. Padding helps prevent fractures, bruises, or lacerations. Safety from injury is always part of the first nursing actions during seizures.
B. Manually ventilate the client with a bag valve mask (BVM)
Correct. With oxygen saturation at 40% and respirations at only 4/min, this is life-threatening respiratory failure. A nasal cannula cannot provide adequate ventilation. Using a BVM ensures immediate assisted ventilation and oxygen delivery until advanced airway support arrives.
C. Watch the seizure activity and document the time and client movement
Correct. Accurate seizure documentation is vital for medical management. The type of movements, onset, and duration help classify seizure type and evaluate the effectiveness of interventions. While airway and safety come first, documenting the episode is still a priority early intervention.
Why the Other Options Are Incorrect
D. Increase the supplemental oxygen to 10 L/minute via nasal cannula
Incorrect. A nasal cannula only delivers passive oxygen. With a respiratory rate of 4/min, oxygen will not be adequately inhaled. The client needs assisted ventilation with a BVM, not just more oxygen through a nasal cannula.
E. Stop the IV fluids
Incorrect. IV fluids are not causing the seizure and do not worsen the current respiratory crisis. In fact, IV access must remain open for emergency seizure medications such as lorazepam. Stopping fluids does not address the priority problems of airway and breathing.
F. Begin chest compressions
Incorrect. Chest compressions are only indicated in cardiac arrest when no pulse is present. The client still has a pulse but is experiencing respiratory failure due to the seizure. Airway management and ventilation are required, not compressions.
The nurse is evaluating the effectiveness of the incentive spirometer implemented in the client's plan of care. Which outcome statement best describes the effectiveness of the incentive spirometer?
- A Client exhibits a frequent productive cough.
- B Client demonstrates proper use of an incentive spirometer.
- C Client's breath sounds are clear to auscultation bilaterally.
- D Client reports using the incentive spirometer every hour while awake.
Explanation
C. Client's breath sounds are clear to auscultation bilaterally
The purpose of an incentive spirometer is to improve lung expansion, prevent atelectasis, and enhance ventilation. The best indicator of effectiveness is improved respiratory status, demonstrated by clear breath sounds. This shows that alveoli are open, lung inflation has improved, and airway secretions are reduced—reflecting the desired therapeutic outcome of incentive spirometry.
A client with chronic venous insufficiency is being discharged from the hospital, and plans to return home. Which client statement indicates an understanding of home care instructions?
-
"I will avoid sitting and crossing my legs."
-
"I will lift weights every other day."
-
"I will be able to stand as long as my legs do not hurt."
-
"I will need to get someone to walk my dog."
Explanation
The Correct Answer is: A. "I will avoid sitting and crossing my legs."
Explanation
Chronic venous insufficiency requires lifestyle modifications that improve venous return and reduce venous stasis. Avoiding prolonged sitting and crossing legs helps prevent impaired circulation, swelling, and worsening of venous insufficiency. This statement shows correct understanding of home care instructions.
Why the other options are incorrect:
B. "I will lift weights every other day."
Weightlifting is not specifically recommended and may strain circulation if not balanced with leg elevation and walking. Exercise is beneficial, but the focus should be on activities that enhance venous return, such as walking, not heavy lifting.
C. "I will be able to stand as long as my legs do not hurt."
Prolonged standing worsens venous pooling and swelling even if no pain is present. Patients should avoid standing for extended periods to prevent progression of venous disease.
D. "I will need to get someone to walk my dog."
Walking is actually encouraged because it activates the calf muscle pump, promoting venous return. Clients with venous insufficiency should remain active with regular walking, not avoid it.
The nurse is caring for a client who is dehydrated. Which action by the nurse is the best assessment of the client's hydration status?
-
Measure the blood pressure.
-
Take the client's temperature.
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Obtain the client's weight.
-
Count the pulse rate.
Explanation
The Correct Answer is: C. Obtain the client's weight.
Explanation of the Correct Answer
Daily weight is the most accurate indicator of fluid balance and hydration status. Small changes in body weight reflect fluid gains or losses more precisely than vital signs or temperature. A 1 kg (2.2 lb) weight change corresponds to approximately 1 liter of fluid, making it the best ongoing assessment of hydration in a dehydrated client.
Why the Other Options Are Incorrect
A. Measure the blood pressure
Although hypotension can occur with dehydration, blood pressure is not a reliable or early indicator because it may remain normal until dehydration is severe or accompanied by shock.
B. Take the client’s temperature
Dehydration may cause a low-grade fever, but temperature changes are nonspecific and can also be caused by infection or other conditions. It does not directly measure hydration status.
D. Count the pulse rate
Tachycardia may indicate dehydration, but it is a compensatory response to decreased circulating volume. Like blood pressure, it is not as accurate or consistent as monitoring weight for hydration status.
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