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HES] COMPASS COMPREHENSIVE EXIT EXAM 2025/2026 AND PRACTICE EXAM TEST BANK WITH A STUDY GUIDE | ALL VERSIONS OF THE EXAM WITH ALL MODULES COVERED | ACCURATE AND VERIFIED QUESTIONS AND ANSWERS FOR GUARANTEED PASS | LATEST UPDATE The nurse is caring for a client with a cerebrovascular accident (CVA) who is receiving enteral tube feedings. Which task performed by the UAP requires immediate intervention by the nurse? A.Suctions oral secretions from mouth B.Positions head of bed flat when changing sheets C.Takes temperature using the axillary method D.Keeps head of bed elevated at 30 degrees - answerB When caring for a postsurgical client who has undergone multiple blo od transfusions, which serum laboratory finding is of most concern to the nurse? A.Sodium level, 137 mEq/L B.Potassium level, 5.5 mEq/L C.Blood urea nitrogen (BUN) level, 18 mg/dL D.Calcium level, 10 mEq/L - answerB Which vaccination should the nurse administer to a newborn? A.Hepatitis B B.Human papilloma virus (HPV) C.Varicella D.Meningococcal vaccine - answerA PA) IV. Which action(s) should the nurse expect to implement? (Selec tall that apply.) A.Administer aspirin with tissue plasminogen activator (t-PA). B.Complete the National Institute of Health Stroke Scale (NIHSS). C.Assess the client for signs of bleeding during and after the infusion. D.Start t-PA within 6 hours after the onset of stroke symptoms. E.Initiate multidisciplinary consult for potential rehabilitation. - When caring for a client in labor, which finding is most important to r eport to the primary health care provider? A.Maternal heart rate, 90 beats/min. B.Fetal heart rate, 100 beats/min C.Maternal blood pressure, 140/86 mm Hg D.Maternal temperature, 100.0° F - answerB The nurse is caring for a client with heart failure who develops respir atory distress and coughs up pink frothy sputum. Which action shoul d the nurse take first? A.Draw arterial blood gases. B.Notify the primary health care provider. C.Position in a high Fowler's position with the legs down. D.Obtain a chest X-ray. - answerC Anurse is interviewing a mother during a well- child visit. Which finding would alert the nurse to continue further as sessment of the infant? A.Two-month-old who is unable to roll from back to abdomen B.Ten-month-old who cannot sit without support C.Nine-month-old who cries when his mother leaves the room D.Eight-month-old who has not yet begun to speak words - answerB Rationale: As a developmental milestone, infants should sit unsupported by 8 m onths (B). The milestone of rolling over is achieved at 5 to 6 months fo r most infants (A). Stranger anxiety is common from 7 to 9 months (C) . Speaking a few words is expected at about 12 months (D). Which intervention should be included in the plan of care for a client admitted to the hospital with ulcerative colitis? A.Administer stool softeners. B.Place the client on fluid restriction. C.Provide a low-residue diet. D.Add a milk product to each meal. - answerC Rationale: Alow- residue diet (C) will help decrease symptoms of diarrhea, which are cl inical manifestations of ulcerative colitis. (A, B, and D) are contraindic ated and could worsen the condition. The nurse is caring for a client with deep vein thrombosis who is ona continuous IV heparin infusion. The activated partial prothrombin ti me (aPTT) is 120 seconds. Which action should the nurse take? A.Increase the rate of the heparin infusion using a nomogram. B.Decrease the heparin infusion rate and give vitamin K IM. C.Continue the heparin infusion at the current prescribed rate. D.Stop the heparin drip and prepare to administer protamine sulfate. - answerD Rationale: AnaPTT more than 100 seconds is a critically high value; therefore, t he heparin should be stopped. The antidote for heparin is protamine sulfate (D). Increasing the rate would increase the risk for hemorrhag e (A). The infusion should be stopped, and vitamin K is the antidote fo Which instruction(s) should the nurse include in the discharge teachi ng plan of a male client who has had a myocardial infarction and who has a new prescription for nitroglycerin (NTG)? (Select all that apply. ) A.Keep the medication in your pocket so that it can be accessed quickl y. B.Call 911 if chest pain is not relieved after one nitroglycerin. C.Store the medication in its original container and protect it from lig ht. D.Activate the emergency medical system after three doses of medica tion. E.Do not use within 1 hour of taking sildenafil citrate (Viagra). - answerB,C Rationale: Emergency action should be taken if chest pain is not relieved after 0 ne nitroglycerin tablet (B). The medication should be kept in the origi nal container to protect from light (C). Keeping the medication in the shirt pocket provides an environment that is too warm (A). The newe st guidelines recommend calling 911 after one nitroglycerin tablet ifc hest pain is not relieved (D). Nitroglycerin and other nitrates should n ever be taken with Viagra (E). The nurse prepares to administer 3 units of regular insulin and 20 uni ts of NPH insulin subcutaneously to a client with an elevated blood gl ucose level. Which procedure is correct? A.Using one syringe, first insert air into the regular vial and then inser tair into the NPH vial. B.Using one syringe, add the regular insulin into the syringe and then add the NPH insulin. C.Avoid combining the two insulins because incompatibility could ca use an adverse reaction. D.Administer the regular insulin subcutaneously and then give the N PH IV to prevent a separate stick. - answerB Rationale: The regular or "clear" insulin should be withdrawn into the syringe fi rst, followed by the NPH (B). Air should first be injected into the NPH vial and then air should be inserted into the regular vial (A). NPH and regular insulin are compatible, and combining will reduce the numbe r of injections (C). The insulin is ordered subcutaneously and NPH ca nnot be given IV (D). rapeutic range and the child is not showing signs of toxicity (C). Thec hild's pulse rate is within normal range for her age group (D). The nurse prepares to administer acetaminophen oral suspension to achild who weighs 66 pounds. The prescription reads: Administer 15 mg/kg every 6 hours by mouth. The Tylenol is available 150 mg/5 ml . Which is the correct dosage indicated on the image? A.30ml B.15ml C.10ml D.5ml - answerB Rationale: 66 lb/(2.2 kg/Ib) = 30 kg 30 kg x (15 mg/kg) = 450 mg (5 mL/150 mg) x 450 mg= 15 mL or (450 mg/150 mg) x5 mL=15 mL When assessing the laboratory findings of a 38-year- old client with tuberculosis who is taking rifampin (Rifadin), which la boratory finding would be most important to report to the primary h ealth care provider immediately? A.Orange-colored urine B.Potassium level, 4.9 mEq/L C.Elevated liver enzyme levels D.Blood urea nitrogen (BUN) level, 12 mg/dL - answerC Rationale: Rifampin can cause hepatoxicity, so elevated liver enzyme levels nee dto be closely monitored and reported to the health care provider (C) . Orange discoloration of the urine is an expected side effect of this me dication (A). The potassium level (B) is normal. A BUN level of 12 mg/ dL is within defined parameters (D). Aclient is receiving propylthiouracil (PTU) prior to thyroid surgery. Which diagnostic test results indicate that the medication is producin g the desired effect? A.Increased hemoglobin and hematocrit levels B.Increased serum calcium level Rationale: Anthrax can be transmitted by the inhalation, cutaneous, and digestiv e routes (A, B, D, and E); however, the disease is not spread from pers on to person (C). The nurse assesses a woman in the emergency room who is in her thi rd trimester of pregnancy. Which finding(s) is(are) indicative of abru ptio placentae? (Select all that apply.) A.Dark red vaginal bleeding B.Rigid boardlike abdomen C.Soft abdomen on palpation D.Complaints of severe abdominal pain E.Painless bright red vaginal bleeding - answerA,B,D Rationale: These are all signs of abruptio placentae (A, B, and D). The others are signs of placenta previa (C and E). Which vital sign in a pediatric client is most important to report to the primary health care provider? A.Newborn with a heart rate of 140 beats/min B.Three-year-old with a respiratory rate of 28 breaths/min C.Six-year-old with a heart rate of 130 beats/min D.Twelve-year-old with a respiratory rate of 16 breaths/min - answerC Rationale: The normal heart rate for a 6- to 10-year- old is 70 to 110 beats/min (C). The others are all within normal range for those ages (A, B, and D). Which finding should be reported to the primary health care provider when caring for a client who has a continuous bladder irrigation afte ratransurethral resection of the prostate gland (TURP)? A.The client reports a continuous feeling of needing to void. B.Urinary drainage is pink 24 hours after surgery. C.The hemoglobin level is 8.4 g/dL 3 days postoperatively. D.Sterile saline is being used for bladder irrigation. - answerC Rationale: B.A client with substance abuse must not take any oral medications. C.There will continue to be a risk of alcohol and drug interaction. D.Support groups are only helpful for substance abuse treatment. - answerC Rationale: Alcohol enhances the side effects of Prolixin. The half- life of Prolixin PO is 8 hours, whereas the half- life of the Prolixin Decanoate IM is 2 to 4 weeks. Therefore, the side ef fects of drinking alcohol are far more severe when the client drinks al cohol after taking the long- acting Prolixin Decanoate IM (C). (A, B, and D) provide incorrect infor mation. Aclient comes to the obstetric clinic for her first prenatal visit and co mplains of feeling nauseated every morning. The client tells the nurse , I'm having second thoughts about wanting to have this baby.” Whic hresponse is best for the nurse to make? A."It's normal to feel ambivalent about a pregnancy when you are not feeling well." B."I think you should discuss these feelings with your health care pro vider." C."How does the father of your child feel about your having this baby? D."Tell me about these second thoughts you are having about this pre gnancy." - answerD Rationale: Although ambivalence is normal during the first trimester, (D) is the best nursing response at this time. It is reflective and keeps the lines 0 f communication open. (A) is not the best response because it offers f alse reassurance. (B) dismisses the client's feelings. The nurse should use communication skills that encourage this type of discussion, nots hift responsibility to the care provider. (C) may eventually be discuss ed, but it is not the most important information to obtain at this time. Anurse performs an initial admission assessment of a 56-year- old client. Which factor(s) would indicate that the client is at risk for metabolic syndrome? (Select all that apply.) A.Abdominal obesity B.Sedentary lifestyle C.History of hypoglycemia D.Hispanic or Asian ethnicity 
