HESI RN Adult Health (D444)
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Free HESI RN Adult Health (D444) Questions
A client with cancer is admitted to the oncology unit and tells the nurse that he is in the hospital for palliative care measures. The nurse notes that the client's admission prescriptions include radiation therapy. Which action should the nurse implement?
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Notify the radiation department to withhold the treatments for now
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Ask the client about his expected goals for this hospitalization.
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Determine if the client wishes to cancel further radiation treatments
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Explain that palliative care measures can be provided at home.
Explanation
Correct Answer:
B. Ask the client about his expected goals for this hospitalization
Explanation
Palliative care focuses on improving quality of life and aligning treatments with the patient’s goals, values, and preferences. Radiation therapy can be a valid palliative intervention, often prescribed to relieve symptoms such as pain, bleeding, or obstruction. The nurse should first clarify the client’s understanding and expectations for hospitalization, ensuring that the care plan supports the client’s specific goals. This therapeutic approach empowers the client while maintaining a holistic, patient-centered perspective.
Why Other Options Are Wrong
A. Notify the radiation department to withhold the treatments for now
The nurse should not unilaterally cancel or delay prescribed therapy. Without first understanding the client’s goals and discussing them with the provider, withholding treatment could inappropriately interfere with care that might improve comfort.
C. Determine if the client wishes to cancel further radiation treatments
This approach presumes that radiation is inconsistent with palliative care. However, radiation may still meet palliative goals, such as pain relief. The first priority is to explore the client’s goals before presenting treatment options.
D. Explain that palliative care measures can be provided at home
While true, this does not address the client’s current hospitalization. The immediate responsibility is to clarify goals of care in the hospital, not to redirect the discussion toward home-based options.
The nurse is teaching a mother of a newborn with a cleft lip how to bottle feed her baby using a special feeding device that has a valve to control the release of milk and a slit nipple opening. The nurse discusses placing the nipple's elongated tip in the back of the oral cavity. Which instructions should the nurse provide the mother about feedings?
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Squeeze the nipple base to introduce milk into the mouth.
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Position the baby in the left lateral position after feeding.
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Alternate milk with water during the feeding
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Hold the newborn in an upright position
Explanation
Correct Answer:
D. Hold the newborn in an upright position.
Explanation
The most important feeding principle for infants with cleft lip is preventing aspiration. Because of the oral defect, these infants are at greater risk of regurgitation and aspiration during feedings. Holding the infant in an upright position helps milk flow down by gravity, reduces nasal regurgitation, and promotes safer swallowing. Special bottles and nipples are designed to aid feeding, but positioning is critical for safety and effective nutrition.
Why Other Options Are Wrong
A. Squeeze the nipple base to introduce milk into the mouth
Manually squeezing milk into the mouth can increase the risk of aspiration because the infant may not be able to coordinate swallowing effectively. Controlled flow with the special nipple is safer.
B. Position the baby in the left lateral position after feeding
While side-lying may sometimes help with reflux, it is not the safest feeding position for cleft lip infants. Upright positioning best reduces aspiration risk.
C. Alternate milk with water during the feeding
Water should not be alternated with milk during feedings in newborns. This can cause electrolyte imbalances and does not reduce aspiration risk. Breast milk or formula should be the only nutrition provided.
The nurse is caring for a client with type 2 diabetes and coronary artery disease who is experiencing episodes of confusion. Which finding alerts the nurse that the client may be experiencing a complication?
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Blood pressure 130/80 mm Hg.
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Cervical spine stiffness.
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Dark yellow urine
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Excessive perspiration
Explanation
Correct Answer:
B. Cervical spine stiffness
Explanation
Cervical spine stiffness, when paired with confusion, is a red-flag neurological symptom that can indicate meningeal irritation. In a client with diabetes, this could suggest central nervous system infection such as meningitis, which requires immediate recognition and urgent intervention. Confusion alone can have many causes, but when combined with neck stiffness, it signals a serious complication beyond metabolic issues, warranting rapid evaluation and treatment.
Why Other Options Are Wrong
A. Blood pressure 130/80 mm Hg
This is a normal reading for an adult and does not indicate a complication. It would not explain the episodes of confusion.
C. Dark yellow urine
This finding may indicate mild dehydration but is not a direct cause of acute confusion and does not represent a serious complication in this scenario.
D. Excessive perspiration
While sweating can indicate hypoglycemia in diabetes, it is not present in this option’s scenario. Cervical spine stiffness carries a higher risk for a life-threatening complication compared to perspiration alone.
A male tells the clinic nurse that he is experiencing burning on urination, and assessment reveals that he had sexual intercourse four days ago with a woman he casually met. Which action should the nurse implement
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Assess for perineal itching, erythema, and excoriation
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Obtain a specimen of urethral drainage for culture
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Observe the perineal area for a chancroid-like lesion
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Identify all sexual partners in the last four days
Explanation
Correct Answer B. Obtain a specimen of urethral drainage for culture
Explanation:
Burning on urination (dysuria) after recent unprotected sexual contact strongly suggests a sexually transmitted infection (STI) such as gonorrhea or chlamydia. The most important first nursing action is to obtain a urethral drainage specimen for culture and nucleic acid amplification testing (NAAT) before initiating antibiotic therapy. This ensures correct identification of the causative pathogen, allows for targeted treatment, and supports contact tracing. Testing prior to treatment also prevents false-negative results due to early antimicrobial use.
Why Other Options Are Incorrect:
A. Assess for perineal itching, erythema, and excoriation:
While assessment for skin irritation is appropriate in cases like candidiasis or dermatitis, these symptoms are not the primary concern in acute STI evaluation with urethral burning. The priority is diagnostic specimen collection for accurate identification of the pathogen.
C. Observe the perineal area for a chancroid-like lesion:
Chancroid lesions (painful ulcers caused by Haemophilus ducreyi) and syphilitic chancres are possible causes of genital symptoms, but the client’s primary complaint is dysuria without mention of visible lesions. A genital exam may follow, but culture collection takes priority to guide urgent treatment.
D. Identify all sexual partners in the last four days:
Partner notification is an important public health measure, but it occurs after diagnosis is confirmed and initial treatment is planned. It is not the first immediate action when a patient presents with acute dysuria and possible urethritis.
A client who is one day postpartum tells the nurse that her baby cannot latch onto the breast.
The nurse determines that the client's nipples are inverted. Which action should the nurse implement?
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Encourage the use of ice on the areola
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Teach about the use of a breast pump
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Offer supplemental formula feedings
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Recommend using a breast shield.
Explanation
Correct Answer:
B. Teach about the use of a breast pump
Explanation
For clients with inverted nipples, using a breast pump can help draw out the nipples and make latching easier for the newborn. This intervention not only aids in nipple eversion but also helps establish and maintain milk supply. Teaching the client about breast pump use provides a practical, immediate strategy to overcome latching difficulties and support successful breastfeeding.
Why Other Options Are Wrong
A. Encourage the use of ice on the areola
Ice causes vasoconstriction, which makes nipple protrusion and latching more difficult instead of improving the situation.
C. Offer supplemental formula feedings
Formula supplementation is not the first-line intervention for latching issues. It can interfere with breastfeeding establishment and decrease maternal milk production.
D. Recommend using a breast shield
Nipple shields may help some women but should be used cautiously and typically under lactation consultant guidance. Pumping is the safer, more effective first intervention for nipple eversion.
The nurse is caring for a client with a chest tube to water seal drainage that was inserted 10 days ago because of a ruptured bullae and pneumothorax. Which finding should the nurse report to the health care provider before the chest tube is removed
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Tidaling of water in water seal chamber
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Bilateral muffled breath sounds at bases
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Temperature of 101° F
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Absence of chest tube drainage for 2 days
Explanation
Correct Answer C. Temperature of 101° F
Explanation:
A temperature of 101° F suggests a possible infection, which should be evaluated before removing the chest tube. Infection at the insertion site or within the pleural space (empyema) can complicate recovery. Removal of the tube without addressing the infection could worsen the patient’s condition. Prompt reporting allows for diagnostic work-up and appropriate management before proceeding.
Why Other Options Are Incorrect:
A. Tidaling of water in water seal chamber
Tidaling (movement of fluid with respiration) is normal until the lung has fully re-expanded. This alone is not a reason to delay removal unless accompanied by other concerning signs.
B. Bilateral muffled breath sounds at bases
This could be related to shallow breathing, fluid, or atelectasis, but it is not necessarily an immediate contraindication to chest tube removal unless it’s new or worsening and linked to other symptoms.
D. Absence of chest tube drainage for 2 days
No drainage is often a positive sign indicating resolution of the pneumothorax and healing. It is expected before removal and does not require reporting as a problem.
A client with colon cancer had surgery for resection of the tumor and creation of a colostomy. During the 6-week postoperative checkup, the nurse teaches the client about nutrition. Which response by the client indicates learning has taken place
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I should follow a diet that is rich in protein.
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I should follow a diet that is low in sodium content
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I should follow a diet that is as close to normal as possible.
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I should follow a diet that is higher is calories than before
Explanation
Correct Answer C. I should follow a diet that is as close to normal as possible.
Explanation:
After a colostomy, the nutritional goal is to maintain a balanced diet similar to the client’s preoperative eating habits, unless there are specific complications or restrictions. This promotes normal bowel function, prevents unnecessary dietary limitations, and helps the client gradually adapt to life with a colostomy. Any long-term modifications are based on tolerance and individual response to certain foods.
Why the Other Options Are Incorrect:
A. I should follow a diet that is rich in protein.
While protein is important for healing in the immediate postoperative period, at 6 weeks post-op, the client can generally resume a normal diet unless otherwise indicated. This statement is too narrow to reflect the overall teaching goal.
B. I should follow a diet that is low in sodium content.
A low-sodium diet is not specifically required for a client with a colostomy unless they also have conditions like hypertension or heart failure.
D. I should follow a diet that is higher in calories than before.
Increased calorie intake is only needed if the client is underweight or in a hypermetabolic state. For most clients, maintaining previous caloric intake is sufficient.
A construction worker sustains a puncture wound from a rusty nail and the last immunization for tetanus is unknown. The primary health care provider prescribes tetanus immune globulin. Which type of protection does this immunization offer
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Lifelong passive immunity
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Long-lasting active protection
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Stimulation of antibody production
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Immediate passive short-term immunity
Explanation
Correct Answer D. Immediate passive short-term immunity
Explanation:
Tetanus immune globulin provides passive immunity by supplying ready-made antibodies against the tetanus toxin. This protection is immediate but short-term, lasting only a few weeks to months, because the body is not producing its own antibodies. It is used when rapid protection is needed, such as after a high-risk injury in someone with unknown or incomplete immunization history.
Why Other Options Are Incorrect:
A. Lifelong passive immunity
Passive immunity is always temporary; antibodies will degrade over time. It never provides lifelong protection.
B. Long-lasting active protection
Active protection occurs when the body produces its own antibodies after vaccination or illness, which tetanus immune globulin does not stimulate.
C. Stimulation of antibody production
This describes active immunity from a tetanus toxoid vaccine, not immune globulin. Immune globulin only transfers existing antibodies; it does not trigger production of new ones.
The nurse is triaging several children as they present to the emergency room after a school bus accident. Which child requires the most immediate intervention by the nurse?
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A 12-year-old reporting neck, arm, and lower back discomfort.
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An 8-year-old with a full leg air splint for a possible broken tibia
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A 6-year-old with multiple superficial lacerations of all extremities
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An 11-year-old with a headache, nausea, and projectile vomiting.
Explanation
Correct Answer:
D. An 11-year-old with a headache, nausea, and projectile vomiting
Explanation
Projectile vomiting following a head injury is a red flag for increased intracranial pressure (ICP). This can rapidly become life-threatening if not addressed immediately. The child requires urgent intervention to prevent brain herniation or further neurologic deterioration.
Why Other Options Are Wrong
A. A 12-year-old reporting neck, arm, and lower back discomfort
This child may have a musculoskeletal injury or possible spinal involvement, which requires evaluation, but the presentation is stable and not immediately life-threatening compared to signs of increased ICP.
B. An 8-year-old with a full leg air splint for a possible broken tibia
The splint suggests stabilization is already in place. This is a serious but not emergent condition compared to neurologic compromise.
C. A 6-year-old with multiple superficial lacerations of all extremities
Although painful and requiring wound care, superficial lacerations are not immediately life-threatening.
A patient has severe Alzheimer's disease. The nurse knows the medication most commonly prescribed for severe AD is
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Donepezil
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Memantine
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Galantamine
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Rivastigmine
Explanation
Correct Answer B. Memantine
Explanation:
Memantine is an NMDA (N-methyl-D-aspartate) receptor antagonist commonly prescribed for moderate to severe Alzheimer’s disease. It works by regulating the activity of glutamate, a neurotransmitter involved in learning and memory, thereby helping to slow the progression of symptoms such as cognitive decline and functional loss. It can be used alone or in combination with cholinesterase inhibitors in advanced stages of AD.
Why Other Options Are Incorrect:
A. Donepezil
A cholinesterase inhibitor primarily used for mild to moderate Alzheimer’s disease, though it can be continued in severe cases, it is not the primary drug started for severe disease.
C. Galantamine
Another cholinesterase inhibitor used mainly for mild to moderate Alzheimer’s disease, not typically initiated in severe stages.
D. Rivastigmine
A cholinesterase inhibitor used for mild to moderate Alzheimer’s and Parkinson’s-related dementia, not primarily for severe Alzheimer’s disease.
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The guide contains over 300 exam-aligned practice questions, designed to help students prepare for the HESI RN D444 Adult Health exam.
Topics include cardiovascular care, respiratory care, renal health, endocrine disorders, gastrointestinal health, patient assessments, pharmacology, and nursing interventions.
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