HESI RN Adult Health (D444)
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Free HESI RN Adult Health (D444) Questions
The mother of a 2-day-old infant girl expresses concern about a "flea bite" type rash on her daughter's body. The nurse identifies a pink papular rash with vesicles superimposed over the thorax, back, buttocks, and abdomen. Which explanation should the nurse offer?
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The rash is due to distended oil glands that will resolve in a few weeks.
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This rash is characteristic of a medication reaction.
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The healthcare provider is being notified about the rash.
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This is a common newborn rash that will resolve after several days.
Explanation
Correct Answer:
D. This is a common newborn rash that will resolve after several days
Explanation
The described rash is erythema toxicum neonatorum, a benign and common newborn condition often referred to as a "flea bite rash." It appears as erythematous macules, papules, or pustules over the trunk and extremities, usually within the first few days of life. It is harmless, self-limiting, and requires no treatment—only reassurance for the parents.
Why Other Options Are Wrong
A. The rash is due to distended oil glands that will resolve in a few weeks
This describes milia, which presents as small white papules on the face, not a papular-vesicular rash on the trunk.
B. This rash is characteristic of a medication reaction
Medication reactions typically present as urticaria, generalized erythema, or exfoliative rashes, not the classic "flea bite" papules seen here.
C. The healthcare provider is being notified about the rash
Since this is a benign and expected newborn finding, no provider notification is necessary. The nurse’s role is reassurance and education.
In planning care for a client with early stage Alzheimer's disease, the nurse establishes the nursing problem of risk for injury related to impaired judgment. Which intervention is most important for the nurse to include in this client's plan of care?
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Engage the client in regularly scheduled activities during the day
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Offer the client frequent reassurance that he/she will be safe
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Arrange the client's environment so the client can move about freely.
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Assign a UAP to provide the client with total personal care
Explanation
Correct Answer:
C. Arrange the client's environment so the client can move about freely
Explanation
In the early stage of Alzheimer’s disease, the client still has some independence but impaired judgment increases the risk of injury. The most important intervention is to create a safe environment that minimizes hazards (removing clutter, ensuring good lighting, securing dangerous items). This allows the client to move about freely while reducing risk of falls or accidents, supporting both safety and independence.
Why Other Options Are Wrong
A. Engage the client in regularly scheduled activities during the day
While structured activities help reduce anxiety and restlessness, they do not directly address the highest priority of preventing injury.
B. Offer the client frequent reassurance that he/she will be safe
Reassurance may provide comfort but does not actively reduce the client’s risk of physical harm.
D. Assign a UAP to provide the client with total personal care
In early Alzheimer’s disease, the client should be encouraged to maintain independence in self-care. Assigning total care is premature and can lead to loss of function.
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 with chronic asthma is admitted to the PACU complaining of pain at a level of 8 on a 1 to 10 scale, with a blood pressure of 124/78 mm Hg, pulse of 88 beats/min, and respirations of 20 breaths/min. The PACU recovery prescription is "Morphine, 2 to 4 mg IV push, while in recovery for pain level over 5." Which intervention should the nurse implement
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Give the medication as prescribed to decrease the client's pain.
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Call the anesthesia provider for a different medication for pain.
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Use nonpharmacologic techniques before giving the medication.
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Reassess the pain level in 30 minutes and medicate if it remains elevated.
Explanation
Correct Answer A. Give the medication as prescribed to decrease the client's pain.
Explanation:
The client is reporting severe pain (8/10), and vital signs are stable. The provider has given a clear prescription for morphine 2–4 mg IV for pain greater than 5. There are no contraindications present, and the patient’s respiratory status is adequate. Prompt administration of prescribed analgesia is essential in the PACU to promote comfort, reduce stress, and support recovery.
Why Other Options Are Incorrect:
B. Call the anesthesia provider for a different medication for pain
There is no indication the prescribed medication is inappropriate or unsafe for this patient. Morphine can be safely administered in this context with monitoring.
C. Use nonpharmacologic techniques before giving the medication
While nonpharmacologic methods can complement pain management, they are not a substitute for prescribed opioids in cases of severe postoperative pain in the PACU.
D. Reassess the pain level in 30 minutes and medicate if it remains elevated
Delaying opioid administration in a patient with severe postoperative pain is inappropriate and can lead to unnecessary suffering and physiological stress.
While caring for a client after a small bowel resection, the nurse is informed that the client has a history of methicillin-resistant Staphylococcus aureus (MRSA). To reduce the risk of recurrence of the MRSA in the postoperative wound, which intervention is most important for the nurse to implement?
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Report any increase in the white blood cell count.
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Instruct the family to adhere to contact precautions.
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Change the surgical dressing readily when soiled.
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Wear a face mask while performing wound care
Explanation
Correct Answer:
B. Instruct the family to adhere to contact precautions
Explanation
MRSA is transmitted primarily through direct contact, and adherence to contact precautions is essential to prevent re-exposure of the client’s wound. Families and visitors must practice strict hand hygiene and use protective equipment such as gowns and gloves when appropriate. This reduces the chance of MRSA being reintroduced to the surgical site, making it the most important intervention to lower the risk of recurrence.
Why Other Options Are Wrong
A. Report any increase in the white blood cell count
This detects infection after it has already occurred but does nothing to prevent MRSA recurrence. Prevention through strict infection control is the higher priority.
C. Change the surgical dressing readily when soiled
While timely dressing changes are important for wound healing, MRSA prevention relies more heavily on breaking the chain of transmission. Dressing care alone cannot stop MRSA if family members are not observing contact precautions.
D. Wear a face mask while performing wound care
MRSA is not spread through airborne droplets; it is contact-transmitted. Masks may prevent respiratory droplet contamination but are not the key intervention for preventing MRSA recurrence.
The nurse on a medical-surgical unit is receiving a client from the postanesthesia care unit (PACU) with a Penrose drain. Before choosing a room for this client, which information is most important for the nurse to obtain
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If suctioning will be needed for drainage of the wound
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If the family would prefer a private or semiprivate room
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If the client also has a Hemovac in place
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If the client's wound is infected
Explanation
Correct Answer D. If the client's wound is infected
Explanation:
The most important consideration before room assignment is whether the client’s wound is infected. A Penrose drain is an open drainage system that can allow direct contact between drainage and the environment, increasing the risk of spreading infection. If the wound is infected, the client must be placed in a private room or with another client with the same infection (cohorting) to prevent cross-contamination.
Why Other Options Are Incorrect:
A. If suctioning will be needed for drainage of the wound
A Penrose drain functions via gravity, not suction, so suctioning is not relevant for its operation.
B. If the family would prefer a private or semiprivate room
Family preference may be considered later, but infection control and safety are higher priorities in determining placement.
C. If the client also has a Hemovac in place
The presence of a Hemovac (a closed drainage system) does not determine room placement in the same way an infection risk would.
A client who is receiving an angiotensin-converting enzyme (ACE) inhibitor for hypertension calls the clinic and reports the recent onset of a cough to the nurse. Which action should the nurse implement
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Advise the client to come to the clinic immediately for further assessment.
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Instruct the client to discontinue use of the drug and to make an appointment at the clinic.
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Suggest that the client learn to accept the cough as a side effect to a necessary prescription.
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Encourage the client to keep taking the drug until seen by the health care provider.
Explanation
Correct Answer D. Encourage the client to keep taking the drug until seen by the health care provider.
Explanation:
A persistent, dry cough is a common side effect of ACE inhibitors due to increased bradykinin levels. While it is often not dangerous, it can be bothersome and may require switching to another medication (such as an ARB). The nurse should advise the client to continue the medication until evaluated by the health care provider to avoid uncontrolled hypertension or other complications.
Why Other Options Are Incorrect:
A. Advise the client to come to the clinic immediately for further assessment.
An immediate visit is not required unless there are signs of a serious reaction such as angioedema, shortness of breath, or swelling of the face and throat.
B. Instruct the client to discontinue use of the drug and to make an appointment at the clinic.
Stopping the drug abruptly without medical supervision can lead to uncontrolled blood pressure and potential cardiovascular complications.
C. Suggest that the client learn to accept the cough as a side effect to a necessary prescription.
While the cough is a known side effect, it may be intolerable for some clients, and there are alternative medications. Dismissing the symptom is not appropriate without considering other options.
The nurse receives the client's next scheduled bag of TPN labeled with the additive NPH insulin. Which action should the nurse implement
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Hang the solution at the current rate.
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Refrigerate the solution until needed.
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Prepare the solution with new tubing.
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Return the solution to the pharmacy.
Explanation
Correct Answer D. Return the solution to the pharmacy
Explanation:
NPH insulin is an intermediate-acting insulin with a delayed onset and a peak effect. It is not appropriate to add NPH insulin to total parenteral nutrition (TPN) because its absorption and timing are unpredictable in this form, and it can create unsafe fluctuations in blood glucose. Only regular insulin, which has a predictable onset and duration, is appropriate for TPN admixture. Any TPN bag containing NPH should be returned to the pharmacy for correction before administration.
Why Other Options Are Incorrect:
A. Hang the solution at the current rate
Administering TPN containing inappropriate insulin could cause serious hypoglycemia or ineffective glucose control, making this unsafe.
B. Refrigerate the solution until needed
Refrigerating the bag will not fix the issue of an inappropriate additive. The solution still contains NPH insulin and should not be used.
C. Prepare the solution with new tubing
Changing the tubing does not address the problem with the contents of the TPN bag. The medication error remains present.
A client who recently received a prescription for ramelteon to treat sleep deprivation reports experiencing severe side effects since taking the drug. Which side effect should the nurse report to the healthcare provider?
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Dizziness reported after initial dose
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A change in the sleep-wake cycle
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Mild sedation
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Somnambulism
Explanation
Correct Answer:
D. Somnambulism
Explanation
Ramelteon is a melatonin receptor agonist used for insomnia related to sleep-onset difficulties. Common side effects include mild sedation, dizziness, or changes in sleep patterns. However, somnambulism (sleepwalking) is a severe adverse effect that poses safety risks to the client and requires prompt reporting to the healthcare provider. Monitoring and intervention are necessary because of the potential for injury during episodes of sleepwalking.
Why Other Options Are Wrong
A. Dizziness reported after initial dose
Dizziness is a common, usually mild, side effect of ramelteon. It does not require immediate reporting unless it worsens or leads to falls.
B. A change in the sleep-wake cycle
This is expected, as ramelteon alters circadian rhythm regulation to promote sleep. It is a therapeutic effect rather than a dangerous side effect.
C. Mild sedation
Sedation is the desired pharmacologic action of ramelteon, not a complication. It indicates the medication is working as intended.
While changing a client's postoperative dressing, the nurse observes purulent drainage at the wound. Before reporting this finding to the healthcare provider (HCP), the nurse should note which of the client's laboratory values
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Culture and sensitivity
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reactive protein level
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Serum blood glucose level
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Blood pH level
Explanation
Correct Answer A. Culture and sensitivity
Explanation:
When purulent drainage is noted in a postoperative wound, infection is suspected. Culture and sensitivity (C&S) testing identifies the causative organism and determines which antibiotics will be most effective. Noting whether cultures have already been taken helps the HCP decide the next steps, including starting or adjusting antibiotic therapy.
Why the other options are incorrect:
B. C-reactive protein level
C-reactive protein (CRP) is a nonspecific marker of inflammation. While it may be elevated with infection, it does not pinpoint the pathogen or guide antibiotic choice.
C. Serum blood glucose level
High blood glucose can impair wound healing and increase infection risk, but it is not the immediate priority before reporting purulent drainage.
D. Blood pH level
Blood pH assesses acid-base balance and is not directly relevant to assessing or managing wound infection.
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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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