HESI Compass Exit B Exam
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Free HESI Compass Exit B Exam Questions
One hundred victims of a train derailment are brought to the Emergency Department of a small rural hospital. An older client with extensive crushing injuries to the lower extremities and pelvis has a blood pressure of 42/28, a thready pulse of 120 beats/minute, and a respiratory rate of 10 breaths/minute with periods of apnea. Using the disaster triage system, which action should the nurse take?
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Transport to radiology department.
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Obtain the crash cart and defibrillator.
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Initiate a large bore IV infusion.
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Assign a black triage color.
Explanation
Correct Answer: D. Assign a black triage color.
Explanation:
In mass casualty and disaster triage, victims are categorized based on the likelihood of survival and urgency of care. A black tag is assigned to individuals who are expected to die or whose injuries are so severe that survival is unlikely even with treatment. This client’s findings—extensive crush injuries, severe hypotension (42/28 mm Hg), thready pulse, and respiratory depression with apnea—indicate irreversible shock and impending death. Providing extensive interventions would divert resources from victims with a higher chance of survival.
An adult male client presents to the psychiatric clinic accompanied by his mother who is concerned that her child is going to jail because he broke into a jewelry store. The nurse conducts an intake assessment and determines that the son is using marijuana daily. Which information should the nurse provide this mother?
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Describe the consequences of enabling behaviors.
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Refer the son to a drug treatment program immediately.
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Tell the mother to discourage her son's marijuana use.
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Suggest to the mother that she allow her son to go to jail.
Explanation
Correct Answer: A. Describe the consequences of enabling behaviors.
Explanation:
When a parent continually protects or rescues an adult child from the negative consequences of substance use, this is considered enabling behavior. Enabling allows the substance abuse to continue by preventing the individual from experiencing the natural results of their actions, such as legal, social, or financial consequences. The nurse’s role is to educate the mother about how her behavior—such as covering for her son or attempting to keep him out of jail—reinforces his dependency and prevents accountability. By understanding this dynamic, the mother can set appropriate boundaries that may encourage her son to seek treatment voluntarily.
The nurse receives report on four clients who are reporting an increase in pain. Which client requires immediate intervention by the nurse?
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Paresthesia of fingers due to carpal tunnel syndrome.
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Burning pain due to a Morton's neuroma.
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Sharp pain related to a crushed femur.
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Stinging pain related to plantar fasciitis.
Explanation
Correct Answer: C. Sharp pain related to a crushed femur.
Explanation:
A crushed femur can cause severe, sharp pain due to tissue damage and compromised circulation, placing the client at high risk for compartment syndrome—a surgical emergency. Immediate assessment of neurovascular status (pain, pallor, pulselessness, paresthesia, paralysis, and pressure) is crucial to prevent permanent nerve and muscle damage or limb loss. Prompt intervention, such as notifying the provider and preparing for possible fasciotomy, is necessary to restore perfusion and prevent systemic complications like rhabdomyolysis or shock.
In preparing to administer an intravenous medication, the nurse notes that the drug is listed in the drug reference guide as being incompatible with the currently infusing intravenous solution of Ringer's Lactate. What action should the nurse take?
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Administer the scheduled dose slowly and observe the client for any signs of a reaction.
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Flush the line with a compatible solution before and after administering the medication.
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Hold the scheduled dose of medication and notify the healthcare provider of the identified incompatibility.
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Discontinue the intravenous solution and use the IV only for medication administration.
Explanation
Correct Answer:
B. Flush the line with a compatible solution before and after administering the medication.
Explanation:
When a prescribed IV medication is incompatible with the primary infusing solution, the nurse should stop the current infusion and flush the IV line with a compatible solution, such as normal saline, both before and after administering the medication. This procedure prevents drug-solution interaction, precipitate formation, and potential vein irritation or embolism. Once the medication is safely administered, the primary IV solution can be resumed.
The nurse working on a medical unit is assigned to care for four clients. Which client should the nurse assess first?
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A client who has a pressure ulcer and now has a temperature of 102.3° F.
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A client who had a stroke and now has right-sided weakness.
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An elderly client who is requesting medication for constipation.
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A client who is quadriplegic and is complaining of a severe headache.
Explanation
Correct Answer: D. A client who is quadriplegic and is complaining of a severe headache.
Explanation:
A severe headache in a client with quadriplegia (especially resulting from a spinal cord injury above T6) is a hallmark sign of autonomic dysreflexia, a life-threatening medical emergency. This condition is triggered by a noxious stimulus—often bladder distention, fecal impaction, or skin irritation—that causes sudden, uncontrolled hypertension, bradycardia, and severe headache. Immediate nursing action is required to sit the client upright, loosen restrictive clothing, and identify and remove the triggering cause (such as emptying the bladder). If untreated, autonomic dysreflexia can lead to stroke, seizures, or death.
The healthcare provider prescribes 1 liter of lactated Ringer’s to infuse in 8 hours. The IV administration set delivers 15 gtt/mL. How many mL/hour should the nurse program the infusion pump? (Enter numeric value only. If rounding is required, round to the nearest whole number.)
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100
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125
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150
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175
Explanation
Correct Answer: B. 125
Explanation:
1 liter = 1000 mL.
Infusion time = 8 hours.
1000 mL ÷ 8 hr = 125 mL/hr.
The infusion pump should therefore be programmed to deliver 125 mL per hour to complete the infusion over 8 hours.
(Note: The drop factor applies only to manual IV flow rate calculations, not pump settings.)
The charge nurse observes an unlicensed assistive personnel (UAP) preparing to use a standard-sized blood pressure cuff to measure the blood pressure of an adult client with thrombocytopenia. Which action should the charge nurse take?
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Ask the client's primary nurse to measure the vital signs rather than the UAP.
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Observe the technique of the UAP in measuring the client's blood pressure.
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Advise the UAP that the client is at risk for excessive bleeding and bruising.
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Instruct the UAP to use a smaller blood pressure cuff to prevent injury.
Explanation
Correct Answer: C. Advise the UAP that the client is at risk for excessive bleeding and bruising.
Explanation:
Clients with thrombocytopenia have a low platelet count, placing them at high risk for bleeding and bruising even with minor trauma or pressure. When measuring blood pressure, excessive cuff inflation or repeated measurements can cause ecchymosis, petechiae, or hematoma formation at the site. The charge nurse should instruct the UAP about this risk and reinforce the need for gentle handling, minimal cuff pressure, and rotating arms when possible. The UAP must be made aware of these precautions to prevent injury and maintain client safety.
It is not necessary to reassign the task to the primary nurse (A) if the UAP understands proper technique. Simply observing (B) without intervention fails to address the teaching need. Using a smaller cuff (D) would increase compression and risk of bruising, worsening the problem. The priority action is to educate and caution the UAP about the client’s bleeding risk before proceeding.
An older female client who resides at an assisted living facility comes for an annual gynecological visit at the clinic and states she has a burning sensation when urinating. Assessment findings include: blood pressure 128/88 mm Hg, urine negative for bacteria, and ecchymotic areas on both forearms. She reports being sexually active and drinks beer once or twice a month. During this clinic visit, which intervention(s) should the nurse implement? Select all that apply.
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Ask the client if someone brought her to the clinic.
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Review list of daily medications for aspirin or other anticoagulants.
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Question her if she previously or currently uses any illicit drugs.
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Inquire if she is being emotionally or physically abused.
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Determine number of sexual partners she has had recently.
Explanation
Correct Answers:
B. Review list of daily medications for aspirin or other anticoagulants.
D. Inquire if she is being emotionally or physically abused.
E. Determine number of sexual partners she has had recently.
B: Review list of daily medications for aspirin or other anticoagulants.
Ecchymotic areas (bruising) on the forearms may be related to anticoagulant or antiplatelet medication use, such as aspirin or warfarin. Reviewing the medication list helps identify potential causes of bruising and assess the client’s bleeding risk, which is especially important before performing gynecologic procedures or obtaining specimens.
D: Inquire if she is being emotionally or physically abused.
Unexplained bruising, particularly on the forearms, may be a red flag for elder abuse. The nurse should sensitively and privately question the client about possible emotional or physical abuse, following mandatory reporting laws. Early recognition and intervention protect the client’s safety and promote appropriate support services.
E: Determine number of sexual partners she has had recently.
The client’s report of burning during urination despite a negative urinalysis may indicate a sexually transmitted infection (STI). Assessing her sexual history, including number of partners and protection use, helps guide appropriate screening, diagnosis, and education for STI prevention and sexual health.
The nurse is caring for a toddler who has a medical diagnosis of coarctation of the aorta. Which assessment finding should the nurse report to the healthcare provider immediately?
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Pulse oximeter reading of 94%.
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Weak femoral pulses.
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Crackles at the end of inspiration.
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Blood pressure higher in upper extremities.
Explanation
Correct Answer: A. Pulse oximeter reading of 94%.
Explanation:
A pulse oximeter reading of 94% in a toddler with coarctation of the aorta can indicate reduced systemic oxygenation and compromised perfusion due to worsening cardiac output or a developing heart failure state. Children with this condition rely on unobstructed systemic blood flow, and even a small drop in oxygen saturation below normal pediatric levels (95–100%) is concerning. It may signal decreased perfusion distal to the narrowing, hypoxemia, or hemodynamic instability. This warrants immediate notification of the healthcare provider for prompt assessment and potential intervention.
The nurse and a social worker are talking when a client with psychosis angrily shouts at the nurse to "Stop talking about me." The nurse should document the client is exhibiting which symptom?
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Ideas of reference.
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Visual hallucinations.
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Thought broadcasting.
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Auditory hallucinations.
Explanation
Correct Answer:
C. Thought broadcasting.
Explanation:
Thought broadcasting is a psychotic symptom in which the client believes that their private thoughts are being transmitted or made known to others without their consent. In this scenario, the client’s statement—“Stop talking about me”—reflects the belief that others are aware of their inner thoughts and are discussing them aloud. This distortion demonstrates a loss of ego boundaries, a common feature of schizophrenia and other psychotic disorders.
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