HESI E2 HESI Exit Exam - Set 2 - Part 1

Correct Answer: Offer simple choices during care

Preschoolers face initiative versus guilt and need a sense of control. Offering simple choices restores autonomy lost through hospitalization and counteracts the regression of bedwetting without shaming the child or removing parental support. Option a is incorrect because restricting parents intensifies separation anxiety and undermines the trust foundation built in earlier stages. The 4-year-old still relies on consistent caregiver presence to feel safe enough to explore initiative and master scary procedures. Option b is incorrect because medical play is a developmentally appropriate strategy for preschoolers. Letting the child manipulate safe equipment reduces fear of body mutilation and channels initiative, so discouraging it removes a key coping tool during hospitalization. Option d is incorrect because forcing independent toileting after regression triggers shame, which is the maladaptive outcome of the prior autonomy stage. Regression is expected during hospital stress; the nurs

Correct Answer: 1300 milligrams per day

Pregnant adolescents 18 and younger need 1300 milligrams of calcium daily because their own skeletal growth continues while the fetus also lays down bone. Adult pregnant clients require 1000 milligrams, so age changes the prescription. Option b is incorrect because 1000 milligrams matches the recommendation for pregnant adults age 19 and older. Adolescent skeletons are still mineralizing, so this lower amount would shortchange the teen's own bone development while the fetus competes for calcium stores. Option c is incorrect because 600 milligrams corresponds to the folic acid recommendation in pregnancy, not calcium. Confusing the two nutrients would leave the adolescent profoundly calcium deficient and at risk for impaired peak bone mass and later osteoporosis. Option d is incorrect because 2000 milligrams exceeds the upper intake limit for calcium and offers no added benefit. Excessive supplementation can interfere with iron absorption and contribute to kidney stones without imp

Correct Answer: Assist the client to void

A fundus deviated to the right with no voiding suggests bladder distention displacing the uterus and preventing contraction. Emptying the bladder often restores midline position and tone, making it the first action before massage or medication. Option a is incorrect because oxytocin treats true atony, not displacement caused by a full bladder. Administering uterotonics while the bladder still holds the fundus aside wastes the drug and may mask the underlying mechanical cause of poor tone. Option b is incorrect because massage on a fundus pushed sideways by a distended bladder is ineffective and uncomfortable. The nurse must first remove the obstruction; massage becomes appropriate only if bogginess persists after the bladder has been emptied. Option c is incorrect because notifying the provider before attempting the simplest reversible intervention bypasses standard postpartum protocol. The nurse handles bladder-related fundal displacement independently and escalates only if voiding fa

Correct Answer: MMR, varicella, and PCV booster

The 12 to 15 month milestone is when MMR and varicella live vaccines are first given, along with the PCV booster and Hib booster. These complete protection against measles, mumps, rubella, chickenpox, and invasive pneumococcal disease. Option a is incorrect because Tdap and MenACWY are scheduled at 11 to 12 years of age. Administering adolescent vaccines to an infant does not match the CDC schedule and could trigger excessive reactogenicity without disease benefit. Option c is incorrect because the rotavirus series is completed by 8 months and cannot be initiated this late. Influenza alone misses the live-virus protection that the 12 to 15 month visit provides against measles and varicella. Option d is incorrect because hepatitis B is given at birth, 1 to 2 months, and 6 to 18 months. BCG is not part of routine US immunization, where targeted tuberculosis testing replaces universal BCG vaccination.

Correct Answer: Annual low-dose chest CT

Adults 50 to 80 with a 20 pack-year history who currently smoke or quit within the past 15 years qualify for annual low-dose CT lung cancer screening. This client meets every criterion and benefits from early detection while asymptomatic. Option a is incorrect because plain chest radiography is not recommended for lung cancer screening. Studies have shown it misses small early lesions; low-dose CT has replaced it and is the only modality endorsed by the USPSTF for this purpose. Option b is incorrect because sputum cytology lacks the sensitivity needed for asymptomatic screening. It plays no role in primary prevention and would delay diagnosis by failing to identify peripheral nodules that low-dose CT readily detects. Option d is incorrect because bronchoscopy is a diagnostic procedure reserved for evaluating known abnormalities. Using it as a screening tool exposes an asymptomatic adult to unnecessary sedation, bleeding, and pneumothorax risks without proven benefit.

Correct Answer: Reliable refrigerated insulin storage

Maslow places physiologic needs first, and insulin without proper storage degrades quickly, leaving the client unable to control glucose. Solving the storage problem with social work and shelter coordination must precede group support and long-term education. Option b is incorrect because peer support, while valuable, addresses love and belonging needs that sit above physiologic survival on Maslow's hierarchy. Without functional insulin, the client cannot benefit from group attendance because hyperglycemia will quickly disable him. Option c is incorrect because retinopathy education targets long-term complications that occur years later. The immediate problem is keeping the medication viable today; teaching about future eye disease without solving cold storage misses the priority. Option d is incorrect because choosing a primary provider sits in the safety and access tier of Maslow's framework. While important, this step depends on the client first being able to take insulin

Correct Answer: Document verbatim and notify provider

Spiral femur fractures in a non-ambulatory 4-month-old are inconsistent with the stated mechanism and raise high suspicion for abuse. Verbatim documentation preserves legal evidence, and provider notification triggers a skeletal survey and CPS report. Option a is incorrect because suggesting a parenting class trivializes a high-suspicion injury pattern. A 4-month-old cannot roll independently from a couch, and the response must trigger formal medical evaluation rather than educational counseling. Option b is incorrect because direct confrontation can endanger the infant and bias the investigation. Nurses gather objective findings, separate caregivers from the child if needed for assessment, and let trained CPS investigators address suspected perpetrators. Option c is incorrect because referring to outpatient orthopedics delays the urgent multidisciplinary workup. A skeletal survey, retinal exam, and CPS notification must happen before the infant leaves the ED, not at a future specialis

Correct Answer: Benzodiazepine such as lorazepam

A CIWA-Ar score above 18 marks severe withdrawal with high risk for seizures and delirium tremens. Benzodiazepines are the evidence-based first-line treatment because they cross-react with GABA receptors and prevent seizure progression. Option a is incorrect because SSRIs require weeks for therapeutic effect and have no role in acute autonomic withdrawal. Administering an SSRI now would do nothing to prevent the seizure and delirium risk the high CIWA score signals. Option b is incorrect because first-generation antipsychotics lower the seizure threshold and worsen alcohol withdrawal outcomes. They may be added later for refractory hallucinations only after benzodiazepines have stabilized autonomic and seizure risk. Option d is incorrect because beta-blockers mask the tachycardia used to track withdrawal severity without preventing seizures or delirium. They control symptoms superficially while the underlying GABA imbalance progresses unchecked toward dangerous complications.

Correct Answer: "Tell me more about your feelings."

An open-ended invitation to explore feelings allows the client to express grief and helps the nurse assess for hopelessness or suicidal ideation. It validates the disclosure without minimizing, advising, or shutting down further dialogue. Option a is incorrect because offering statistical reassurance dismisses the client's lived emotional reality. False reassurance shuts the conversation down by signaling that the nurse is uncomfortable sitting with grief and prefers to fix the feeling. Option c is incorrect because any response beginning with "why" sounds judgmental and demands the client justify their pain. The technique is listed as non-therapeutic and pushes the client to defend rather than explore what they feel. Option d is incorrect because giving advice steers the client toward the nurse's agenda rather than the client's own. Therapeutic communication leaves problem-solving to a later phase after feelings have been fully expressed and acknowledged.

Correct Answer: November 21, 2026

Naegele's rule subtracts 3 months and adds 7 days. February 14 minus 3 months is November 14, plus 7 days is November 21. The year remains 2026 because the subtraction did not cross into the previous calendar year. Option b is incorrect because December 7 results from subtracting only 2 months instead of 3 and then adding 7 days. The rule specifies a full 3-month subtraction, so this calculation skips a month and overshoots the true date. Option c is incorrect because November 7 reflects subtracting 3 months without adding the 7 days. The complete rule requires both steps, and omitting the second step yields a date one week too early for clinical planning purposes. Option d is incorrect because October 21 corresponds to subtracting 4 months and adding 7 days. Removing an extra month places the EDD too far back, which would prompt inappropriate concern about post-term gestation at routine visits.

Correct Answer: Iron and vitamin D

Breast milk is low in iron and vitamin D, so the American Academy of Pediatrics recommends vitamin D from birth and iron supplementation at about 4 to 6 months for exclusively breastfed infants. Both prevent rickets and iron-deficiency anemia. Option a is incorrect because breast milk provides adequate calcium for infants. Routine calcium supplementation is not indicated and could disrupt the careful mineral balance needed for normal bone formation during rapid infant growth. Option b is incorrect because breast milk contains sufficient vitamin C for term infants. Megadose vitamin C supplementation is unnecessary, may cause GI upset, and addresses no recognized deficiency in routine breastfeeding scenarios. Option d is incorrect because folic acid 400 micrograms is a preconception recommendation for women of childbearing age to prevent neural tube defects. Infants receive adequate folate through breast milk and require no separate folate supplement.

Correct Answer: "Our team works together to help you."

This recognizes the classic splitting defense without rewarding it. A unified team message reinforces consistent boundaries, prevents staff division, and tells the client that all team members share equal responsibility for her care. Option a is incorrect because agreeing to confront coworkers reinforces splitting and validates the client's all-good versus all-bad framing. It also damages team cohesion and invites further manipulation as the client tests boundaries. Option b is incorrect because probing for grievances feeds the splitting dynamic by inviting elaboration on which staff are bad. The nurse should redirect away from comparative judgments rather than collect ammunition the client will use later. Option c is incorrect because scolding the client increases shame and triggers the rejection sensitivity central to borderline pathology. It also misses the therapeutic opportunity to model boundary-setting through calm, factual team-unity language.

Correct Answer: Weekly tai chi balance classes

Group exercise programs emphasizing balance, such as tai chi, have the strongest randomized trial support for fall reduction in older adults. They improve strength and proprioception while providing social engagement that supports adherence. Option a is incorrect because passive distribution of printed material rarely changes behavior on its own. Without skill-building or supervised practice, brochures inform but do not improve balance or strength, which are the modifiable risk factors driving falls. Option c is incorrect because sedative-hypnotics appear on the Beers Criteria precisely because they increase fall risk. Prescribing one to prevent falls would worsen the outcome by adding sedation, ataxia, and morning hangover effects. Option d is incorrect because prolonged bed rest accelerates sarcopenia and orthostatic intolerance. Deconditioning from inactivity raises fall risk rather than lowering it, and contradicts current evidence favoring active mobility programs.

Correct Answer: Find a reason to separate them

The client must be interviewed alone to respond honestly without fear of retaliation. The nurse uses a routine reason, such as needing a urine specimen, to separate them and then conducts a focused abuse screening in private. Option a is incorrect because directly accusing a suspected abuser may escalate aggression and endanger the older adult after the visit. Investigation belongs to Adult Protective Services, not to the bedside nurse, who instead documents objective findings. Option b is incorrect because discharging without separating and assessing the client misses the only window of safety. The nurse is a mandatory reporter for elder abuse and must act on reasonable suspicion before the client leaves the clinic setting. Option d is incorrect because law enforcement is not the first referral pathway for suspected elder abuse. Adult Protective Services handles initial investigation, and police involvement without an immediate violent threat may compromise the APS process.

Correct Answer: Neuroleptic malignant syndrome; stop drug

Rigidity, hyperthermia, autonomic instability, mental status changes, and elevated creatine kinase form the classic NMS tetrad. Discontinuing the offending antipsychotic immediately, then providing dantrolene and cooling, is essential because mortality is high. Option b is incorrect because tardive dyskinesia presents as repetitive involuntary movements such as lip smacking and tongue protrusion months into therapy, not as acute rigidity with fever. Benztropine treats acute dystonia, not the NMS picture here. Option c is incorrect because serotonin syndrome arises from serotonergic agents and produces hyperreflexia and clonus rather than the lead-pipe rigidity of NMS. Haloperidol is dopaminergic, so the offending agent and antidote pattern do not fit. Option d is incorrect because akathisia is subjective motor restlessness without fever, rigidity, or creatine kinase elevation. Switching agents would delay the life-saving step of stopping the current antipsychotic and beginning supporti

Correct Answer: "It transfers antibodies to the newborn."

Tdap is given between 27 and 36 weeks of every pregnancy so maternal antibodies cross the placenta and protect the newborn against pertussis before the infant can be vaccinated. This passive immunity is most robust when given in this window. Option a is incorrect because the primary goal is neonatal protection, not maternal immunity for labor. While the mother does benefit, framing it as maternal protection alone misses the central pediatric rationale for the strict gestational timing. Option b is incorrect because no federal or state law mandates Tdap for hospital admission. The recommendation is a CDC guideline based on neonatal pertussis mortality data, not a legal requirement, and clients retain the right to decline the vaccine. Option c is incorrect because postpartum administration would still be safe but would miss the placental antibody transfer window. The recommendation is driven by timing for fetal benefit, not relative maternal safety between pregnancy and the postpartum pe

Correct Answer: Increase observation and reassess ideation

Sudden mood improvement, giving away possessions, and statements of peace in a previously suicidal client are classic warning signs that the person has decided to die. Increasing observation and direct reassessment of suicidal intent is essential. Option a is incorrect because rushing toward discharge precisely when warning signs cluster ignores the highest-risk window in the depression treatment course. Energy returns before mood normalizes, giving the client the means to act on a fixed plan. Option b is incorrect because reducing observation rewards the apparent improvement and removes the very safety net the client needs most right now. Decreasing supervision during a sudden mood lift is a textbook contributor to inpatient suicide events. Option d is incorrect because praising the gift behavior misreads the cue as social generosity. Giving away valued possessions in a suicidal client typically signals lethality, and the nurse should explore intent rather than reinforce the act.

Correct Answer: Adams forward bend test

The Adams forward bend test is the standard noninvasive screen for adolescent idiopathic scoliosis. The student bends forward at the waist while the examiner looks for rib hump asymmetry, and positive screens move on to radiographic workup. Option a is incorrect because chest x-rays are not a recommended screening tool for scoliosis. They expose the developing adolescent to unnecessary radiation, and dedicated spine films are reserved for after a positive bedside exam. Option c is incorrect because MRI is a costly second- or third-line test reserved for atypical curves, neurologic signs, or surgical planning. Routine screening with MRI would be financially and logistically impossible for population-level school programs. Option d is incorrect because Cobb angle measurement requires standing posteroanterior radiographs of the spine, not a bedside goniometer reading. It is the diagnostic and severity grading method used after the bend test identifies asymmetry.

Correct Answer: "These signs are expected end-of-life changes."

Cheyne-Stokes breathing, mottling, and low-grade fever are anticipated near death. Educating and reassuring the family that the client is not perceiving distress respects the hospice plan and supports anticipatory grief work at the bedside. Option a is incorrect because naloxone reverses opioid effects and would cause acute pain and severe withdrawal in a comfort-care client. Opioids are appropriately used for dyspnea in dying patients under the doctrine of double effect. Option b is incorrect because transferring a hospice client to the hospital contradicts the established goals of care. Aggressive workups of expected end-of-life signs disrupt the family's chance to be present and violate the hospice plan they elected. Option c is incorrect because calling 911 in a hospice setting often triggers unwanted resuscitation efforts against the client's wishes. The family was educated at hospice admission to call the hospice agency rather than emergency services.

Correct Answer: "Rear-facing as long as possible."

Current guidance recommends rear-facing in the back seat for as long as the child fits the seat's height and weight limits, often well past age 2. Rear-facing position protects the head and spine in a frontal crash. Option b is incorrect because the old "age 1 and 20 pounds" guidance has been replaced. Children should remain rear-facing as long as they fit the seat, protecting the cervical spine and reducing severe injury risk. Option c is incorrect because placing a rear-facing seat in the front exposes the infant to potentially fatal airbag deployment. The back seat is mandatory for all children under 13, with rear-facing infants positioned away from active airbags. Option d is incorrect because bulky coats compress in a crash and leave the harness too loose to restrain the child. Parents should buckle the child in light clothing and add a blanket over the harness for warmth instead.