Hesi RN Nursing Exam
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Free Hesi RN Nursing Exam Questions
A young adult female client who is planning to become pregnant asks the nurse if she can continue taking isotretinoin for cystic acne. Which information is most important for the nurse to provide this client?
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Breast feeding is not recommended while taking this medication.
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Do not take multiple vitamins that contain vitamin A while taking this drug.
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Discontinue this medication one month before attempting to conceive.
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Baseline liver function results needed before starting therapy.
Explanation
Correct Answer: (C) Discontinue this medication one month before attempting to conceive
Isotretinoin is a Category X teratogen, meaning it causes severe and life-threatening fetal abnormalities including craniofacial, cardiac, and central nervous system defects. It is absolutely contraindicated in pregnancy. The iPLEDGE program requires that female clients of childbearing potential use two forms of contraception and discontinue isotretinoin at least one month before attempting conception to ensure the drug is fully cleared from the body before pregnancy occurs. This is the most critical and life-saving information to provide.
Why the other options are incorrect:
A. Breast feeding is not recommended while taking this medication — While this is accurate information, it is not the most important concern for a client who is planning to become pregnant, as the immediate priority is preventing fetal exposure to a known teratogen.
B. Do not take multiple vitamins that contain vitamin A while taking this drug — Isotretinoin is a vitamin A derivative and concurrent use of vitamin A supplements increases toxicity risk. While this is important safety information, it is secondary to the critical teratogenicity warning for a client planning pregnancy.
D. Baseline liver function results needed before starting therapy — Liver function monitoring is required during isotretinoin therapy, but this client is already taking the medication. The most urgent and life-changing information needed at this point concerns safe discontinuation before conception.
Ferrous sulfate elixir is prescribed for a client with iron deficiency anemia. Which instruction should the nurse provide this client about taking the liquid medication?
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Use a straw to ingest.
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Mix with an antacid.
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Swallow undiluted.
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Take with a glass of milk.
Explanation
Correct Answer: (A) Use a straw to ingest.
Ferrous sulfate elixir is a liquid iron supplement that can stain the teeth permanently if it comes into direct contact with tooth enamel. Instructing the client to use a straw allows the medication to bypass the teeth, preventing discoloration. The client should also be advised to rinse the mouth with water after taking the medication for additional protection.
Why Other Options Are Incorrect:
B. Antacids reduce the acidity of the gastrointestinal environment, and since iron is best absorbed in an acidic medium, mixing ferrous sulfate with an antacid would significantly impair its absorption and reduce its therapeutic effectiveness.
C. Liquid ferrous sulfate should be diluted in water or juice before ingestion, not swallowed undiluted. Taking it undiluted increases the risk of gastrointestinal irritation and direct contact with the teeth, worsening the risk of staining.
D. Milk contains calcium, which binds to iron in the gastrointestinal tract and inhibits its absorption. Taking ferrous sulfate with milk would decrease the amount of iron available for the body to use and undermine the treatment of iron deficiency anemia.
Before administering the initial dose of sumatriptan succinate to a client with a migraine headache, it is most important to determine if the client's history includes which problem?
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Seasonal allergic rhinitis.
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Coronary artery disease.
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Type 2 diabetes mellitus.
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Irritable bowel syndrome.
Explanation
Correct Answer: (B) Coronary artery disease
Sumatriptan is a serotonin receptor agonist (triptan) that works by causing vasoconstriction of cranial blood vessels to relieve migraines. Because of its vasoconstrictive mechanism, it is contraindicated in clients with coronary artery disease, as it can precipitate myocardial ischemia, angina, or even a myocardial infarction. Assessing for this history before the first dose is a critical safety priority.
Why the other options are incorrect:
A. Seasonal allergic rhinitis has no known interaction with sumatriptan's vasoconstrictive mechanism and does not present a contraindication or safety concern prior to administration.
C. Type 2 diabetes mellitus is not a contraindication to sumatriptan. While clients with diabetes may have increased cardiovascular risk overall, the diagnosis alone does not preclude the use of this medication.
D. Irritable bowel syndrome does not affect vascular function and has no known interaction with sumatriptan, making it irrelevant to the pre-administration safety assessment.
A male client who has been taking a high-dose of a nonsteroidal antiinflammatory drug (NSAID) comes to the clinic reporting gastric pain and blood in his stool. The healthcare provider discontinues the NSAIDs and prescribes esomeprazole. Which information should the nurse include in this client's teaching plan?
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Resume a diet that consists of milk, cream, and bland foods.
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Once pain subsides, NSAID therapy can be resumed.
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Call the clinic if diarrhea or headache occur when taking esomeprazole.
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Notify the healthcare provider of the passage of black stools.
Explanation
Correct Answer: (D) Notify the healthcare provider of the passage of black stools.
Black, tarry stools are a sign of upper gastrointestinal bleeding, which is a serious complication of NSAID-induced gastric damage. Even while on esomeprazole, the client must be instructed to report this finding immediately as it indicates ongoing bleeding that requires prompt medical evaluation and intervention.
Why Other Options Are Incorrect:
A. Milk, cream, and bland diets were historically recommended for peptic ulcer disease but are no longer considered therapeutic. Milk actually stimulates acid secretion due to its protein and calcium content, potentially worsening the condition rather than relieving it.
B. NSAIDs were discontinued precisely because they caused gastric bleeding and pain in this client. Resuming NSAID therapy, even after pain resolves, would place the client at continued risk for gastrointestinal damage and is not appropriate without specific provider guidance.
C. While diarrhea and headache can occur with esomeprazole, they are generally mild and self-limiting side effects that do not require immediate clinic notification. Reporting black stools is a far more urgent and clinically significant instruction for this client.
When administering zolpidem to an older client, which computer documentation indicates that the desired outcome has been achieved?
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Sleeps soundly through the night.
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Improved ability to concentrate.
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Decreased episodes of incontinence.
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Exhibits fewer emotional outbursts.
Explanation
Correct Answer: (A) Sleeps soundly through the night.
Zolpidem is a sedative-hypnotic agent prescribed specifically for the treatment of insomnia. The primary therapeutic goal of zolpidem is to help the client initiate and maintain sleep. Documentation that the client sleeps soundly through the night directly reflects achievement of the intended therapeutic outcome and confirms the medication is working as prescribed.
Why Other Options Are Incorrect:
B. Improved ability to concentrate is not a therapeutic goal of zolpidem. Cognitive enhancement is associated with medications such as cholinesterase inhibitors used in dementia management, not sedative-hypnotics.
C. Decreased episodes of incontinence is unrelated to zolpidem's mechanism of action. Urinary incontinence management involves entirely different pharmacological agents and interventions.
D. Fewer emotional outbursts are outcomes associated with mood-stabilizing or antipsychotic medications. Zolpidem acts on GABA receptors to induce sleep and has no direct effect on emotional regulation or behavioral disturbances.
The nurse is providing discharge instructions for a client with metastatic cancer who is prescribed morphine for bone pain. Which information from the client indicates to the nurse an understanding of the medication?
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Observe bowel movement pattern and take a stool softener.
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Do not drink grapefruit juice after taking morphine.
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Take the benzodiazepine at the same time as taking the morphine.
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Watch for signs of agitation and record any insomnia.
Explanation
Correct Answer: (A) Observe bowel movement pattern and take a stool softener.
Constipation is the most common and predictable side effect of opioid analgesics such as morphine, occurring because opioids bind to receptors in the gastrointestinal tract and slow intestinal motility. Unlike many other opioid side effects, constipation does not diminish with continued use. The client demonstrating awareness of the need to monitor bowel patterns and use a stool softener proactively shows a clear and accurate understanding of morphine's expected effects and how to manage them safely at home.
Why the other options are incorrect:
B. Grapefruit juice interactions are primarily associated with medications metabolized by the CYP3A4 enzyme system, such as certain statins, calcium channel blockers, and immunosuppressants. Morphine is not significantly metabolized through this pathway, making this instruction clinically inaccurate for morphine therapy.
C. Taking a benzodiazepine concurrently with morphine is a dangerous combination. Both are central nervous system depressants, and combining them significantly increases the risk of respiratory depression, sedation, and death. This statement indicates a dangerous misunderstanding rather than correct medication knowledge.
D. Agitation and insomnia are not the primary side effects the client should be monitoring for with morphine. The more clinically significant concerns include constipation, respiratory depression, sedation, nausea, and urinary retention, making this response an inaccurate reflection of medication understanding.
Nurses' Notes 1400: Started continuous morphine infusion in the left antecubital vein peripheral intravenous line via patient-controlled pump (PCA). No redness, edema, or bleeding noted at the site. Vital signs: Heart rate 77 beats/minute, Respirations 16 breaths/minute, Blood pressure 118/74 mmHg, Oxygen saturation 97% on room air.
Orders 1400: Admit to the surgical floor. Clear liquid diet, advance as tolerated. Continuous cardiorespiratory monitoring. Morphine 1 mg/hr continuous IV infusion via patient controlled pump (PCA). Alert surgeon to signs of bleeding or infection in the surgical site.
Which other medications would the nurse expect the surgeon to prescribe along with morphine? Select all that apply.
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Ibuprofen
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Senna
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Propofol
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Docusate sodium
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Naloxone
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Methadone
Explanation
Opioids such as morphine cause predictable and well-documented side effects that require anticipatory management. Constipation is one of the most common and expected adverse effects of opioid therapy, occurring because opioids bind to receptors in the gastrointestinal tract and slow peristalsis. Senna is a stimulant laxative and docusate sodium is a stool softener, and both are routinely prescribed together alongside opioids to prevent and treat opioid-induced constipation. Naloxone is an opioid antagonist that reverses opioid toxicity including life-threatening respiratory depression and should always be available and prescribed for clients on continuous opioid infusions as a safety reversal agent.
Why the other options are incorrect:
A. Ibuprofen — While ibuprofen is an analgesic and anti-inflammatory, it is a nonsteroidal anti-inflammatory drug that carries significant risks in postoperative surgical clients including gastrointestinal bleeding, impaired platelet function, and delayed wound healing, making it generally avoided in this immediate postoperative setting.
C. Propofol — Propofol is an intravenous sedative and anesthetic agent used for procedural sedation and anesthesia induction. It is not indicated as a routine companion medication for opioid analgesia in a postoperative floor client.
F. Methadone — Methadone is a long-acting opioid used for chronic pain management and opioid use disorder treatment. Prescribing methadone alongside morphine in an acute postoperative setting would result in dangerous opioid stacking and increased risk of respiratory depression and overdose.
During a home visit, the nurse assesses a client with Alzheimer's disease who recently started a new prescription for rivastigmine. The caregiver reports that the client seems to be thinking more clearly but is not sleeping well at night. Which action should the nurse take?
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Advise the caregiver that the purpose of the medication is to promote sleep, so a change in medication may be needed.
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Notify the healthcare provider that the dosage of the medication may need to be increased to manage the client's insomnia.
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Explain to the caregiver that insomnia is a common and temporary side effect when the medication is first started.
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Instruct the caregiver to withhold the medication until the dosage can be decreased to ensure the client's safety.
Explanation
Correct Answer: (C) Explain to the caregiver that insomnia is a common and temporary side effect when the medication is first started.
Rivastigmine is a cholinesterase inhibitor used to slow cognitive decline in Alzheimer's disease. Insomnia is a well-documented, commonly occurring side effect that tends to resolve as the body adjusts to the medication. Since the client is already showing cognitive improvement, the appropriate nursing action is to educate the caregiver rather than alter or discontinue therapy.
Why the other options are incorrect:
A. Rivastigmine is not prescribed to promote sleep and advising the caregiver otherwise would provide inaccurate information. Its intended purpose is to improve cognitive function, and the caregiver's report of clearer thinking confirms it is working as expected.
B. Increasing the dosage is not an appropriate response to insomnia. Escalating the dose without clinical indication could intensify side effects and does not address the underlying concern, which is caregiver education.
D. Withholding a prescribed medication without a direct order from the healthcare provider is outside the nurse's independent scope of practice. Doing so could interrupt the client's cognitive improvement without any therapeutic justification.
A client with narcolepsy receives a new prescription for methylphenidate. Prior to administration of the medication, the nurse should review the medical record for which condition?
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Hypercholesterolemia.
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Bronchitis.
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Hypertension.
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Diabetes mellitus.
Explanation
Correct Answer: (C) Hypertension
Methylphenidate is a central nervous system stimulant used for narcolepsy and attention deficit hyperactivity disorder. It works by increasing dopamine and norepinephrine levels, which elevates heart rate and blood pressure as a direct pharmacological effect. Reviewing the medical record for pre-existing hypertension is essential because methylphenidate can significantly worsen blood pressure control and increase cardiovascular risk in hypertensive clients.
Why the other options are incorrect:
A. Hypercholesterolemia — Elevated cholesterol levels are not directly affected by methylphenidate and do not represent a primary safety concern prior to initiating this medication.
B. Bronchitis — Methylphenidate does not significantly affect respiratory function or bronchial inflammation, making bronchitis a low-priority consideration before administration.
D. Diabetes mellitus — While stimulant medications can have minor effects on appetite and metabolism, diabetes mellitus is not a primary contraindication or major safety concern that requires priority review before administering methylphenidate.
Nurses' Notes 1400: Started continuous morphine infusion in the left antecubital vein peripheral intravenous line via patient-controlled pump (PCA). No redness, edema, or bleeding noted at the site. Vital signs: Heart rate 77 beats/minute, Respirations 16 breaths/minute, Blood pressure 118/74 mmHg, Oxygen saturation 97% on room air.
Orders 1400: Admit to the surgical floor. Clear liquid diet, advance as tolerated. Continuous cardiorespiratory monitoring. Morphine 1 mg/hr continuous IV infusion via patient controlled pump (PCA). Alert surgeon to signs of bleeding or infection in the surgical site.
Orders 1500: Docusate sodium 240 mg PO every morning. Naloxone 2 mg IV push PRN for respiratory depression.
Which side effects of morphine could contribute to this client's fall risk? Select all that apply.
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Sedation
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Nausea
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Itching
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Seizures
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Orthostatic hypotension
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Euphoria
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Urinary retention
Explanation
Correct Answer: (A) Sedation, (B) Nausea, (E) Orthostatic hypotension, and (F) Euphoria
This client has already had a right above-the-knee amputation, which significantly increases her baseline fall risk due to altered mobility and balance. Morphine compounds this risk through several mechanisms. Sedation impairs alertness, reaction time, and coordination, making safe ambulation dangerous. Nausea can cause sudden dizziness and loss of balance, increasing the likelihood of a fall. Orthostatic hypotension from morphine-induced vasodilation causes blood pressure to drop when the client changes position, leading to lightheadedness and falls. Euphoria from opioid use impairs judgment and alters the client's perception of her own limitations, making her more likely to attempt unsafe movements without assistance.
Why the other options are incorrect:
C. Itching — Opioid-induced pruritus is an uncomfortable side effect caused by histamine release, but itching does not directly impair balance, coordination, or judgment in a way that contributes to fall risk.
D. Seizures — Seizures are not a typical or well-documented side effect of morphine at standard therapeutic doses. While opioid toxicity can cause neurological effects, seizures are not a primary concern at this client's prescribed dose of 1 mg/hr and are not a direct contributor to fall risk in this context.
G. Urinary retention — Morphine can cause urinary retention by relaxing the detrusor muscle and increasing urethral sphincter tone. While urinary retention is uncomfortable and requires monitoring, it does not directly contribute to fall risk unless the client is attempting to get up unassisted to use the bathroom, which would be addressed through fall prevention protocols rather than being attributed to the medication effect itself.
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