HESI Compass Exit B Exam
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Free HESI Compass Exit B Exam Questions
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 administers an oral antiviral to a client with shingles. Which finding is most important for the nurse to report to the healthcare provider?
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Elevated liver function tests
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Vomiting and diarrhea
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Decreased white blood cell count
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Pruritus and muscle aches
Explanation
Correct Answer: C. Decreased white blood cell count
Explanation:
A decreased white blood cell (WBC) count is the most important finding to report because it indicates bone marrow suppression or immunosuppression, a serious adverse effect of antiviral medications such as acyclovir or valacyclovir. A low WBC count increases the client’s risk for infection and requires prompt evaluation, potential discontinuation of the medication, and implementation of infection precautions. Monitoring CBC results is critical during antiviral therapy to detect early signs of hematologic toxicity.
A client with fibromyalgia asks the nurse to arrange for hospice care to help manage the severe, chronic pain. Which intervention should the nurse provide to address the client's problem?
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Arrange an appointment with a pain specialist.
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Form an interdisciplinary team for evaluation.
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Contact a hospice nurse for an evaluation.
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Ask for a consultation with a psychologist.
Explanation
Correct Answer: A. Arrange an appointment with a pain specialist.
Explanation:
Fibromyalgia is a chronic, non–life-threatening condition characterized by widespread musculoskeletal pain, fatigue, and tenderness. Hospice care is reserved for clients with terminal illnesses and limited life expectancy, so it is not appropriate in this case. The nurse should instead refer the client to a pain specialist, who can develop a comprehensive pain management plan, including pharmacologic and nonpharmacologic therapies such as antidepressants, exercise, and cognitive-behavioral techniques to improve function and quality of life.
A multigravida, full-term, laboring client complains of "back labor." Vaginal examination reveals that the client's cervix is dilated 3 cm with 50% effacement, and the fetal head is at -1 station. Which action should the nurse implement?
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Ambulate the client between contractions.
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Turn the client to a lateral position.
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Notify the scrub nurse to prepare the operating room.
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Apply counter-pressure to the sacral area.
Explanation
Correct Answer: D. Apply counter-pressure to the sacral area.
Explanation:
“Back labor” usually occurs when the fetus is in the occiput posterior (OP) position, meaning the fetal skull is pressing against the mother’s sacrum, causing intense lower back pain during contractions. The most effective nonpharmacologic intervention is applying firm, continuous counter-pressure to the sacral area during contractions. This technique helps relieve discomfort by offsetting the pressure of the fetal head on the maternal spine and sacral nerves.
Ambulation (A) can aid fetal descent and rotation but may not provide immediate pain relief. Lateral positioning (B) can promote fetal rotation to a more favorable position but should be combined with counter-pressure for best effect. Preparing the operating room (C) is unnecessary because the client is still in early labor (3 cm dilation). The nurse’s priority is to promote comfort and support normal labor progression using appropriate pain-relief techniques like counter-pressure and position changes.
A client is admitted for type 2 diabetes mellitus (DM) and chronic kidney disease (CKD). When the nurse evaluates diet teaching, which breakfast selection by the client indicates effective learning?
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Scrambled eggs, bacon, one slice of whole wheat toast with butter and jam.
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Banana pancakes with maple syrup, sausage links, half grapefruit, and low-fat milk.
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Oatmeal with butter, artificial sweetener, and strawberries, and 6 ounces coffee.
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Orange juice, yogurt with berries, cold cereal with milk, bran muffin with margarine.
Explanation
Correct Answer:
C. Oatmeal with butter, artificial sweetener, and strawberries, and 6 ounces coffee.
Explanation:
Clients with type 2 diabetes mellitus and chronic kidney disease require meals that help control blood glucose and reduce kidney workload by limiting sodium, phosphorus, and potassium.
Oatmeal with butter, artificial sweetener, and strawberries provides complex carbohydrates and fiber that support steady blood glucose control. Using artificial sweetener avoids excess sugar intake, and strawberries offer vitamins with relatively low potassium compared to other fruits. The small portion of coffee without added sugar is acceptable in moderation.
Which intervention should the nurse include in a long-term plan of care for a client with chronic obstructive pulmonary disease (COPD)?
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Limit fluid intake to reduce secretions.
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Reduce risk factors for infection.
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Use diaphragmatic breathing to achieve better exhalation.
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Administer high flow oxygen during sleep.
Explanation
Correct Answer: B. Reduce risk factors for infection.
Explanation:
For clients with chronic obstructive pulmonary disease (COPD), a major long-term goal of care is to reduce the risk of respiratory infections, which can trigger exacerbations, worsen gas exchange, and lead to hospitalization. The nurse should emphasize infection prevention strategies such as obtaining annual influenza and pneumococcal vaccinations, practicing frequent hand hygiene, avoiding crowded or polluted environments, and maintaining adequate hydration and nutrition to strengthen immune function. Preventing infection helps maintain lung function and improve quality of life.
An adolescent is admitted to the hospital because of a suicide attempt with an overdose of acetaminophen. Which blood values are most important for the nurse to monitor during the first 72 hours following ingestion of this overdose?
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Arterial blood pH, pCO₂, oxygen saturation.
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White blood count, hemoglobin, hematocrit.
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Lactic dehydrogenase (LD), alanine aminotransferase (ALT), aspartate aminotransferase (AST).
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Blood urea nitrogen, creatinine, specific gravity.
Explanation
Correct Answer: C. Lactic dehydrogenase (LD), alanine aminotransferase (ALT), aspartate aminotransferase (AST).
Explanation:
An acetaminophen overdose is highly toxic to the liver, leading to potentially fatal acute hepatocellular necrosis within 24–72 hours after ingestion. The most important laboratory values to monitor during this period are liver function tests (LFTs), especially ALT, AST, and LD (lactic dehydrogenase). Elevations in these enzymes indicate hepatocellular damage. Monitoring these values helps assess the extent of liver injury, determine the effectiveness of treatment with N-acetylcysteine (NAC), and predict prognosis.
While arterial blood gases (A) may be checked if respiratory compromise develops, CBC values (B) are not directly affected by acetaminophen toxicity, and renal tests (D) are secondary unless acute kidney injury develops later. In the first 72 hours, liver enzyme monitoring is the priority to evaluate the degree of hepatic injury from the overdose.
The healthcare provider prescribes 500 mL of 0.45% normal saline with 100 units regular insulin to infuse at 15 units/hour. The drop factor is 20 gtt/mL. The nurse should regulate the IV to deliver how many gtt/minute? (Enter numerical value only.)
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20
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25
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30
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15
Explanation
Correct Answer: B. 25
Explanation:
Concentration = 100 units ÷ 500 mL = 0.2 units/mL.
Required mL/hr = 15 units/hr ÷ 0.2 units/mL = 75 mL/hr.
gtt/min = (mL/hr × drop factor) ÷ 60 = (75 × 20) ÷ 60 = 1500 ÷ 60 = 25 gtt/min.
The nurse administers ophthalmic timolol to a client with glaucoma. The client routinely takes carvedilol, spironolactone, and ibuprofen daily. Which medication(s) should the nurse withhold? (Select all that apply.)
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Any antianxiety medications
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Over-the-counter oral antipyretics
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Nonsteroidal antiinflammatory drugs
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Other beta-adrenergic blocker agents
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Oral and subcutaneous anticoagulants
Explanation
Correct Answers: C. Nonsteroidal antiinflammatory drugs
D. Other beta-adrenergic blocker agents
Explanation:
C. Nonsteroidal antiinflammatory drugs
NSAIDs, such as ibuprofen, can reduce the effectiveness of antihypertensive and diuretic medications like spironolactone and may worsen renal function, particularly in older adults or clients receiving multiple cardiovascular agents. The nurse should withhold NSAIDs and notify the provider to prevent possible drug interactions and kidney injury.
D. Other beta-adrenergic blocker agents
Timolol is a topical beta-adrenergic blocker. Concurrent use with other systemic beta-blockers such as carvedilol can result in additive cardiovascular effects, including bradycardia, hypotension, and heart block. The nurse should withhold additional beta-blocker doses and notify the healthcare provider for further evaluation before administering both medications together.
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.
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