HESI Compass Exit B Exam

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Free HESI Compass Exit B Exam Questions

1.

A client with gestational diabetes, at 39-weeks gestation, is in the second stage of labor. After delivery of the fetal head, the nurse recognizes that shoulder dystocia is occurring. Which intervention should the nurse implement first?

  • Lower the head of the bed and apply suprapubic pressure.

  • Assist the client to sharply flex her thighs up against the abdomen.

  • Prepare the client for an emergency cesarean birth.

  • Encourage the client to move to a hands-and-knees position.

Explanation

Correct Answer:

A. Lower the head of the bed and apply suprapubic pressure.

Explanation:

When shoulder dystocia occurs, the first immediate nursing action is to lower the head of the bed and apply suprapubic pressure while calling for assistance. Suprapubic pressure is applied just above the pubic bone to push the fetal anterior shoulder downward and under the symphysis pubis, helping to release the trapped shoulder. This technique directly relieves the obstruction and allows delivery to proceed while preventing excessive traction on the fetal head, which could cause brachial plexus injury.


2.

Prior to obtaining a trapeze bar for a client with limited mobility, which client assessment is most important for the nurse to obtain?

  • Balance and posture.

  • Risk for disuse syndrome.

  • Pressure sore risk.

  • Upper body muscle strength.

Explanation

Correct Answer: D. Upper body muscle strength.

Explanation:

Before providing a trapeze bar, the nurse must assess the client’s upper body muscle strength, as the device requires the client to lift or reposition themselves using their arms and shoulders. Adequate strength ensures safe and effective use, preventing strain or injury. Clients with sufficient arm strength benefit from improved mobility, reduced risk of pressure injuries, and increased independence with repositioning. If weakness is identified, alternative assistive devices or additional support should be considered to maintain safety and prevent falls or musculoskeletal injury.


3.

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?

  • Arrange an appointment with a pain specialist.

  • Form an interdisciplinary team for evaluation.

  • Contact a hospice nurse for an evaluation.

  • 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.


4.

A client who had a left above-knee amputation (AKA) two days ago has a soft stump dressing in place. To prevent the development of a contracture on the left leg, which intervention should the nurse implement?

  • Position the client prone 3 to 4 times a day.

  • Elevate the client's left leg on two pillows at all times.

  • Turn the client to the unaffected side only.

  • Instruct the client to push the stump against a soft pillow.

Explanation

Correct Answer: A. Position the client prone 3 to 4 times a day.

Explanation:

After an above-knee amputation (AKA), the major concern during the postoperative phase is preventing hip flexion contracture on the affected side. When a client lies in the supine position for prolonged periods with the residual limb elevated or flexed, the hip tends to remain in a flexed position, leading to muscle shortening and permanent deformity that interferes with prosthetic fitting and ambulation.

To prevent this, the nurse should position the client prone 3 to 4 times per day for 20–30 minutes
, as this helps stretch the hip flexor muscles and maintain proper joint alignment. Elevating the stump on pillows (B) promotes flexion and contracture formation, turning to one side only (C) increases the risk of joint stiffness and pressure injury, and pushing the stump against a pillow (D) is used later in rehabilitation for desensitization, not early postoperative contracture prevention.

Therefore, intermittent prone positioning
is the most effective intervention to maintain hip extension and ensure optimal functional recovery following an AKA.


5.

The unlicensed assistive personnel (UAP) who is caring for a postoperative client reports to the charge nurse that the client is not using the incentive spirometer effectively. Which action should the charge nurse implement?

  • Encourage the UAP to demonstrate the effective use of the incentive spirometer to the client.

  • Schedule time later in the morning to review the use of the incentive spirometer with the client.

  • Ask the practical nurse assigned to care for the client to review the use of the spirometer with the client.

  • Advise the UAP that the respiratory therapist is responsible to supervise the client's use of the spirometer.

Explanation

Correct Answer: A. Encourage the UAP to demonstrate the effective use of the incentive spirometer to the client.

Explanation:

While initial teaching of incentive spirometer use is a nursing responsibility, it is appropriate for the UAP to demonstrate and reinforce the technique once the nurse has taught it. Reinforcement of skills already introduced by the nurse falls within the UAP’s scope of practice, particularly for postoperative clients who need frequent reminders and demonstrations to promote compliance. The charge nurse’s role is to support delegation and ensure the UAP understands correct technique, reinforcing accountability and patient safety.

Scheduling the review for later (B) delays care and increases the risk of atelectasis or pneumonia
. Having the PN review (C) duplicates tasks unnecessarily, and assigning this responsibility to the respiratory therapist (D) is not required for routine spirometer use. Thus, encouraging the UAP to demonstrate and reinforce the correct use promotes effective delegation, timely intervention, and continuity of postoperative pulmonary care.


6.

When assessing a recently delivered, multigravida client, the nurse finds that her vaginal bleeding is more than expected. Which factor in this client's history is related to this finding?

  • She is a gravida 6, para 5.

  • She received butorphanol 2 mg IV during labor.

  • She is over 35 years of age.

  • The second stage of labor lasted 10 minutes.

Explanation

Correct Answer: A. She is a gravida 6, para 5.

Explanation:

A multigravida client (gravida 6, para 5) is at increased risk for uterine atony, the most common cause of postpartum hemorrhage. Repeated uterine stretching from multiple pregnancies weakens uterine muscle tone, making it less effective at contracting after delivery. Poor uterine contraction allows continued bleeding from placental implantation sites. The nurse should closely monitor fundal firmness, massage the uterus as indicated, and be prepared to administer prescribed uterotonic agents such as oxytocin to control bleeding and prevent hemorrhagic shock.


7.

A client with a history of a bilateral adrenalectomy is admitted with a weak, irregular pulse, and hypotension. Which assessment finding warrants immediate intervention by the nurse?

  • Decreased urinary output

  • Profound weight gain

  • Low blood glucose levels

  • Ventricular arrhythmias

Explanation

Correct Answer: D. Ventricular arrhythmias

Explanation:

A bilateral adrenalectomy eliminates the body’s source of adrenal hormones, including aldosterone and cortisol. The resulting acute adrenal insufficiency (Addisonian crisis) can lead to severe hyperkalemia, which predisposes the client to life-threatening ventricular arrhythmias. This finding requires immediate intervention to prevent cardiac arrest. Treatment includes rapid IV administration of corticosteroids, fluid resuscitation with isotonic saline, and correction of electrolyte imbalances.


8.

Which finding requires further assessment?

  • 2 cm bluish purple area on the sacrum.

  • Edema present along the sagittal suture.

  • Respiratory rate of 59 breaths/minute.

  • Weight loss of 10 ounces since birth.

Explanation

Correct Answer:

D. Weight loss of 10 ounces since birth.

Explanation:

A 10-ounce weight loss in a 5-pound 5-ounce (85-ounce) newborn within 24 hours represents nearly 12% of total birth weight, exceeding the normal expected loss of 5–10% in the first few days after birth. Such excessive weight loss indicates possible dehydration, poor feeding, or inadequate fluid intake, requiring prompt evaluation of feeding technique, frequency, and urine output. Early intervention is crucial to prevent complications like electrolyte imbalance and hypoglycemia.


9.

The nurse leading a care team on a medical-surgical unit is assigning client care to a practical nurse (PN) and an unlicensed assistive personnel (UAP). Which activity should the nurse delegate to the UAP?

  • Prepare the sterile field for a urinary catheter insertion

  • Begin wound care for a client after an appendectomy

  • Monitor an IV infusion rate on an established schedule

  • Anchor an inserted urinary catheter in place with tape

Explanation

Correct Answer: D. Anchor an inserted urinary catheter in place with tape

Explanation:

Anchoring an already-inserted urinary catheter is a non-invasive, routine task that does not require sterile technique or clinical judgment, making it appropriate for a UAP. Proper securement reduces traction on the catheter and balloon, preventing urethral trauma, bladder spasms, accidental dislodgement, and leakage around the meatus. Following facility policy, the UAP secures the catheter to the client’s thigh (often lower abdomen or thigh for males) with a securement device or tape, leaving slight slack to avoid tension, coils tubing on the bed and tapes it to the sheet (never the side rail), keeps the drainage bag below bladder level without touching the floor, and checks skin under the anchor for irritation at scheduled intervals—all while maintaining a closed drainage system and performing hand hygiene. These steps enhance comfort and safety and help lower CAUTI risk, while assessment-dependent or sterile procedures remain the nurse’s responsibility.


10.

Which dietary intervention(s) should the nurse include in the plan of care for a client who had bariatric surgery? Select all that apply.

  • Separate fluids from meals.

  • Plan meals to include rice porridge.

  • Eliminate acidic food choices.

  • Offer more bread and cheese.

  • Provide small frequent meals.

Explanation

Correct Answers:

A. Separate fluids from meals.

E. Provide small frequent meals.


A: Separate fluids from meals.

After bariatric surgery, clients should avoid drinking fluids during meals and for about 30 minutes before and after eating. This helps prevent dumping syndrome, early satiety, and stretching of the surgical pouch. Separating fluids also promotes better digestion and nutrient absorption, ensuring the client receives adequate nutrition from smaller meal volumes.



E: Provide small frequent meals.

Clients should consume small, frequent meals (typically 6 per day) to prevent discomfort, nausea, and vomiting. The reduced gastric capacity requires portion control and slow eating to promote tolerance and prevent overfilling. This approach supports gradual digestion, adequate nutrient intake, and adaptation to the altered gastrointestinal anatomy following bariatric surgery.


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