HESI RN Leadership Exam

HESI RN Leadership Exam

VERSION 5

• A nurse preceptor is evaluating a newly licensed nurse‟s competency in assisting with a

sterile procedure. Which of the following actions indicates the newly licensed nurse is maintaining sterile technique? (SATA)

• Places sterile items within a 1.25 cm (0.5 in) border around the edges of the sterile

field

• Opens the sterile pack by first unfolding the top flap away from her body

• Prepares a container of sterile solution on the field after putting on sterile gloves 1 / 3

• Removes the outside packaging of a sterile instrument before dropping it

onto the sterile field

• Holds the sterile solution bottle with the label facing up

• A nurse enters a client‟s room and identifies that the client is receiving too much IV fluid

because the IV pump is not working properly. Which of the following actions should the nurse take first?

• Auscultate the client‟s lungs.

• Notify the provider.

• Place a faulty equipment tag on the pump.

• Complete an incident report.

• A nurse is planning care for a group of clients and can delegate care to a licensed

practical nurse (LPN) and an assistive personnel. Which of the following tasks should the nurse assign to the LPN?

• Reinforcing teaching with a client who is learning to self-administer insulin

• Ambulating a client who is scheduled for discharge later in the day

• Administering morphine IV bolus to a client who is hr postoperative

• Admitting a new client who has chronic back pain to the unit

• A nurse is supervising a newly licensed nurse who is performing surgical asepsis. After

donning a sterile gown and gloves, which of the following actions by the newly licensed nurse demonstrates correct aseptic technique?

• The nurse applies goggles.

• The nurse turns her back to the sterile field.

• The nurse holds her hands above her waist. 2 / 3

• The nurse puts on a face mask.

• A nurse who is caring for a group of clients delegates collection of vital signs to an

assistive personnel (AP). Which of the following actions should the nurse take to evaluate the delegated task?

• Review vital sign trends at the end of the shift.

• Recheck vital signs that are outside the expected reference range.

• Ask the AP to write a summary of the delegated tasks during the shift.

• Compare the vital signs the AP obtained with those taken by another AP on a

previous shift.

• A nurse is caring for four clients. Which of the following tasks can be delegated to an

assistive personnel?

• Obtaining a stool sample from a client who has renal failure

• Monitoring a client who has a fluid restriction

• Assessing a client who just returned from hemodialysis

• Reviewing dietary instructions for a client who has kidney stones

• A nurse is triaging a group of clients following a disaster. Which of the following clients

should the nurse recommend for treatment first?

• A client who has a neck injury and is unable to breathe spontaneously

• A client who has two open chest wounds with a left tracheal deviation

• A client who has major burns over 75% of her body surface area

• A client who has bipolar disorder and is exhibiting signs of hallucination (Class 3)
• / 3