HESI PN Fundamentals Exam Questions With
Correct Answers
An elderly client with a fractured left hip is on strict bedrest. Which nursing
| | | | | | | | | | | | | |
measure is essential to the client's nursing care?
| | | | | | |
A. Massage any reddened areas for at least five minutes.
| | | | | | | | |
B. Encourage active range of motion exercises on extremities.
| | | | | | | |
C. Position the client laterally, prone, and dorsally in sequence.
| | | | | | | | |
D. Gently lift the client when moving into a desired position.
| | | | | | | | | |
D. Gently lift the client when moving into a desired position.
| | | | | | | | | |
To avoid shearing forces when repositioning, the client should be lifted gently
| | | | | | | | | | | |
across a surface (D). Reddened areas should not be massaged (A) since this may
| | | | | | | | | | | | | |
increase the damage to already traumatized skin. To control pain and muscle
| | | | | | | | | | | |
spasms, active range of motion (B) may be limited on the affected leg. The
| | | | | | | | | | | | | |
position described in (C) is contraindicated for a client with a fractured left hip.
| | | | | | | | | | | | |
The nurse is administering medications through a nasogastric tube (NGT) which is
| | | | | | | | | | |
connected to suction. After ensuring correct tube placement, what action should
| | | | | | | | | | | |
the nurse take next?
| | |
A. Clamp the tube for 20 minutes.
| | | | | |
B. Flush the tube with water.
| | | | |
C. Administer the medications as prescribed.
| | | | |
D. Crush the tablets and dissolve in sterile water.
| | | | | | | |
B. Flush the tube with water.
| | | | |
The NGT should be flushed before, after and in between each medication
| | | | | | | | | | | |
administered (B). Once all medications are administered, the NGT should be
| | | | | | | | | | |
clamped for 20 minutes (A). (C and D) may be implemented only after the tubing
| | | | | | | | | | | | | | |
has been flushed.
| |
,A client who is in hospice care complains of increasing amounts of pain. The
| | | | | | | | | | | | | |
healthcare provider prescribes an analgesic every four hours as needed. Which
| | | | | | | | | | |
action should the nurse implement?
| | | |
A. Give an around-the-clock schedule for administration of analgesics.
| | | | | | | |
B. Administer analgesic medication as needed when the pain is severe.
| | | | | | | | | |
C. Provide medication to keep the client sedated and unaware of stimuli.
| | | | | | | | | | |
D. Offer a medication-free period so that the client can do daily activities.
| | | | | | | | | | | |
A. Give an around-the-clock schedule for administration of analgesics.
| | | | | | | |
The most effective management of pain is achieved using an around-the-clock
| | | | | | | | | | |
schedule that provides analgesic medications on a regular basis (A) and in a
| | | | | | | | | | | | |
timely manner. Analgesics are less effective if pain persists until it is severe, so an
| | | | | | | | | | | | | | |
analgesic medication should be administered before the client's pain peaks (B).
| | | | | | | | | | |
Providing comfort is a priority for the client who is dying, but sedation that
| | | | | | | | | | | | | |
impairs the client's ability to interact and experience the time before life ends
| | | | | | | | | | | | |
should be minimized (C). Offering a medication-free period allows the serum drug
| | | | | | | | | | | |
level to fall, which is not an effective method to manage chronic pain (D).
| | | | | | | | | | | | |
When assessing a client with wrist restraints, the nurse observes that the fingers
| | | | | | | | | | | | |
on the right hand are blue. What action should the nurse implement first?
| | | | | | | | | | | |
A. Loosen the right wrist restraint.
| | | | |
B. Apply a pulse oximeter to the right hand.
| | | | | | | |
C. Compare hand color bilaterally.
| | | |
D. Palpate the right radial pulse.
| | | | |
A. Loosen the right wrist restraint.
| | | | |
The priority nursing action is to restore circulation by loosening the restraint (A),
| | | | | | | | | | | | |
because blue fingers (cyanosis) indicates decreased circulation. (C and D) are also
| | | | | | | | | | | |
important nursing interventions, but do not have the priority of (A). Pulse
| | | | | | | | | | | |
oximetry (B) measures the saturation of hemoglobin with oxygen and is not
| | | | | | | | | | | |
indicated in situations where the cyanosis is related to mechanical compression
| | | | | | | | | | |
(the restraints).
|
,The nurse is assessing the nutritional status of several clients. Which client has
| | | | | | | | | | | | |
the greatest nutritional need for additional intake of protein?
| | | | | | | |
A. A college-age track runner with a sprained ankle.
| | | | | | | |
B. A lactating woman nursing her 3-day-old infant.
| | | | | | |
C. A school-aged child with Type 2 diabetes.
| | | | | | |
D. An elderly man being treated for a peptic ulcer.
| | | | | | | | |
B. A lactating woman nursing her 3-day-old infant.
| | | | | | |
A lactating woman (B) has the greatest need for additional protein intake. (A, C,
| | | | | | | | | | | | | |
and D) are all conditions that require protein, but do not have the increased
| | | | | | | | | | | | | |
metabolic protein demands of lactation. | | | |
A client is in the radiology department at 0900 when the prescription levofloxacin
| | | | | | | | | | | |
(Levaquin) 500 mg IV q24h is scheduled to be administered. The client returns to
| | | | | | | | | | | | | | |
the unit at 1300. What is the best intervention for the nurse to implement?
| | | | | | | | | | | | |
A. Contact the healthcare provider and complete a medication variance form.
| | | | | | | | | |
B. Administer the Levaquin at 1300 and resume the 0900 schedule in the
| | | | | | | | | | | | |
morning.
C. Notify the charge nurse and complete an incident report to explain the missed
| | | | | | | | | | | | | |
dose.
D. Give the missed dose at 1300 and change the schedule to administer daily at
| | | | | | | | | | | | | | |
1300.
D. Give the missed dose at 1300 and change the schedule to administer daily at
| | | | | | | | | | | | | | |
1300.
To ensure that a therapeutic level of medication is maintained, the nurse should
| | | | | | | | | | | | |
administer the missed dose as soon as possible, and revise the administration
| | | | | | | | | | | |
schedule accordingly to prevent dangerously increasing the level of the
| | | | | | | | | |
medication in the bloodstream (D). The nurse should document the reason for the
| | | | | | | | | | | |
|late dose, but (A and C) are not warranted. (B) could result in increased blood
| | | | | | | | | | | | | | |
levels of the drug. | | |
, While instructing a male client's wife in the performance of passive range-of-
| | | | | | | | | | |
motion exercises to his contracted shoulder, the nurse observes that she is
| | | | | | | | | | | |
holding his arm above and below the elbow. What nursing action should the
| | | | | | | | | | | | |
nurse implement? |
A. Acknowledge that she is supporting the arm correctly.
| | | | | | | |
B. Encourage her to keep the joint covered to maintain warmth.
| | | | | | | | | |
C. Reinforce the need to grip directly under the joint for better support.
| | | | | | | | | | | |
D. Instruct her to grip directly over the joint for better motion.
| | | | | | | | | | |
A. Acknowledge that she is supporting the arm correctly.
| | | | | | | |
The wife is performing the passive ROM correctly, therefore the nurse should
| | | | | | | | | | | |
acknowledge this fact (A). The joint that is being exercised should be uncovered| | | | | | | | | | | | |
(B) while the rest of the body should remain covered for warmth and privacy. (C
| | | | | | | | | | | | | | |
and D) do not provide adequate support to the joint while still allowing for joint
| | | | | | | | | | | | | | |
movement.
What is the most important reason for starting intravenous infusions in the upper
| | | | | | | | | | | |
extremities rather than the lower extremities of adults?
| | | | | | | |
A. It is more difficult to find a superficial vein in the feet and ankles.
| | | | | | | | | | | | | |
B. A decreased flow rate could result in the formation of a thrombosis.
| | | | | | | | | | | |
C. A cannulated extremity is more difficult to move when the leg or foot is used.
| | | | | | | | | | | | | | |
D. Veins are located deep in the feet and ankles, resulting in a more painful
| | | | | | | | | | | | | | |
procedure.
B. A decreased flow rate could result in the formation of a thrombosis.
| | | | | | | | | | | |
Venous return is usually better in the upper extremities. Cannulation of the veins
| | | | | | | | | | | | |
in the lower extremities increases the risk of thrombus formation (B) which, if
| | | | | | | | | | | | |
dislodged, could be life-threatening. Superficial veins are often very easy (A) to
| | | | | | | | | | | |
find in the feet and legs. Handling a leg or foot with an IV (C) is probably not any
| | | | | | | | | | | | | | | | | | |
more difficult than handling an arm or hand. Even if the nurse did believe moving
| | | | | | | | | | | | | | |
a cannulated leg was more difficult, this is not the most important reason for
| | | | | | | | | | | | | |
using the upper extremities. Pain (D) is not a consideration.
| | | | | | | | |
Correct Answers
An elderly client with a fractured left hip is on strict bedrest. Which nursing
| | | | | | | | | | | | | |
measure is essential to the client's nursing care?
| | | | | | |
A. Massage any reddened areas for at least five minutes.
| | | | | | | | |
B. Encourage active range of motion exercises on extremities.
| | | | | | | |
C. Position the client laterally, prone, and dorsally in sequence.
| | | | | | | | |
D. Gently lift the client when moving into a desired position.
| | | | | | | | | |
D. Gently lift the client when moving into a desired position.
| | | | | | | | | |
To avoid shearing forces when repositioning, the client should be lifted gently
| | | | | | | | | | | |
across a surface (D). Reddened areas should not be massaged (A) since this may
| | | | | | | | | | | | | |
increase the damage to already traumatized skin. To control pain and muscle
| | | | | | | | | | | |
spasms, active range of motion (B) may be limited on the affected leg. The
| | | | | | | | | | | | | |
position described in (C) is contraindicated for a client with a fractured left hip.
| | | | | | | | | | | | |
The nurse is administering medications through a nasogastric tube (NGT) which is
| | | | | | | | | | |
connected to suction. After ensuring correct tube placement, what action should
| | | | | | | | | | | |
the nurse take next?
| | |
A. Clamp the tube for 20 minutes.
| | | | | |
B. Flush the tube with water.
| | | | |
C. Administer the medications as prescribed.
| | | | |
D. Crush the tablets and dissolve in sterile water.
| | | | | | | |
B. Flush the tube with water.
| | | | |
The NGT should be flushed before, after and in between each medication
| | | | | | | | | | | |
administered (B). Once all medications are administered, the NGT should be
| | | | | | | | | | |
clamped for 20 minutes (A). (C and D) may be implemented only after the tubing
| | | | | | | | | | | | | | |
has been flushed.
| |
,A client who is in hospice care complains of increasing amounts of pain. The
| | | | | | | | | | | | | |
healthcare provider prescribes an analgesic every four hours as needed. Which
| | | | | | | | | | |
action should the nurse implement?
| | | |
A. Give an around-the-clock schedule for administration of analgesics.
| | | | | | | |
B. Administer analgesic medication as needed when the pain is severe.
| | | | | | | | | |
C. Provide medication to keep the client sedated and unaware of stimuli.
| | | | | | | | | | |
D. Offer a medication-free period so that the client can do daily activities.
| | | | | | | | | | | |
A. Give an around-the-clock schedule for administration of analgesics.
| | | | | | | |
The most effective management of pain is achieved using an around-the-clock
| | | | | | | | | | |
schedule that provides analgesic medications on a regular basis (A) and in a
| | | | | | | | | | | | |
timely manner. Analgesics are less effective if pain persists until it is severe, so an
| | | | | | | | | | | | | | |
analgesic medication should be administered before the client's pain peaks (B).
| | | | | | | | | | |
Providing comfort is a priority for the client who is dying, but sedation that
| | | | | | | | | | | | | |
impairs the client's ability to interact and experience the time before life ends
| | | | | | | | | | | | |
should be minimized (C). Offering a medication-free period allows the serum drug
| | | | | | | | | | | |
level to fall, which is not an effective method to manage chronic pain (D).
| | | | | | | | | | | | |
When assessing a client with wrist restraints, the nurse observes that the fingers
| | | | | | | | | | | | |
on the right hand are blue. What action should the nurse implement first?
| | | | | | | | | | | |
A. Loosen the right wrist restraint.
| | | | |
B. Apply a pulse oximeter to the right hand.
| | | | | | | |
C. Compare hand color bilaterally.
| | | |
D. Palpate the right radial pulse.
| | | | |
A. Loosen the right wrist restraint.
| | | | |
The priority nursing action is to restore circulation by loosening the restraint (A),
| | | | | | | | | | | | |
because blue fingers (cyanosis) indicates decreased circulation. (C and D) are also
| | | | | | | | | | | |
important nursing interventions, but do not have the priority of (A). Pulse
| | | | | | | | | | | |
oximetry (B) measures the saturation of hemoglobin with oxygen and is not
| | | | | | | | | | | |
indicated in situations where the cyanosis is related to mechanical compression
| | | | | | | | | | |
(the restraints).
|
,The nurse is assessing the nutritional status of several clients. Which client has
| | | | | | | | | | | | |
the greatest nutritional need for additional intake of protein?
| | | | | | | |
A. A college-age track runner with a sprained ankle.
| | | | | | | |
B. A lactating woman nursing her 3-day-old infant.
| | | | | | |
C. A school-aged child with Type 2 diabetes.
| | | | | | |
D. An elderly man being treated for a peptic ulcer.
| | | | | | | | |
B. A lactating woman nursing her 3-day-old infant.
| | | | | | |
A lactating woman (B) has the greatest need for additional protein intake. (A, C,
| | | | | | | | | | | | | |
and D) are all conditions that require protein, but do not have the increased
| | | | | | | | | | | | | |
metabolic protein demands of lactation. | | | |
A client is in the radiology department at 0900 when the prescription levofloxacin
| | | | | | | | | | | |
(Levaquin) 500 mg IV q24h is scheduled to be administered. The client returns to
| | | | | | | | | | | | | | |
the unit at 1300. What is the best intervention for the nurse to implement?
| | | | | | | | | | | | |
A. Contact the healthcare provider and complete a medication variance form.
| | | | | | | | | |
B. Administer the Levaquin at 1300 and resume the 0900 schedule in the
| | | | | | | | | | | | |
morning.
C. Notify the charge nurse and complete an incident report to explain the missed
| | | | | | | | | | | | | |
dose.
D. Give the missed dose at 1300 and change the schedule to administer daily at
| | | | | | | | | | | | | | |
1300.
D. Give the missed dose at 1300 and change the schedule to administer daily at
| | | | | | | | | | | | | | |
1300.
To ensure that a therapeutic level of medication is maintained, the nurse should
| | | | | | | | | | | | |
administer the missed dose as soon as possible, and revise the administration
| | | | | | | | | | | |
schedule accordingly to prevent dangerously increasing the level of the
| | | | | | | | | |
medication in the bloodstream (D). The nurse should document the reason for the
| | | | | | | | | | | |
|late dose, but (A and C) are not warranted. (B) could result in increased blood
| | | | | | | | | | | | | | |
levels of the drug. | | |
, While instructing a male client's wife in the performance of passive range-of-
| | | | | | | | | | |
motion exercises to his contracted shoulder, the nurse observes that she is
| | | | | | | | | | | |
holding his arm above and below the elbow. What nursing action should the
| | | | | | | | | | | | |
nurse implement? |
A. Acknowledge that she is supporting the arm correctly.
| | | | | | | |
B. Encourage her to keep the joint covered to maintain warmth.
| | | | | | | | | |
C. Reinforce the need to grip directly under the joint for better support.
| | | | | | | | | | | |
D. Instruct her to grip directly over the joint for better motion.
| | | | | | | | | | |
A. Acknowledge that she is supporting the arm correctly.
| | | | | | | |
The wife is performing the passive ROM correctly, therefore the nurse should
| | | | | | | | | | | |
acknowledge this fact (A). The joint that is being exercised should be uncovered| | | | | | | | | | | | |
(B) while the rest of the body should remain covered for warmth and privacy. (C
| | | | | | | | | | | | | | |
and D) do not provide adequate support to the joint while still allowing for joint
| | | | | | | | | | | | | | |
movement.
What is the most important reason for starting intravenous infusions in the upper
| | | | | | | | | | | |
extremities rather than the lower extremities of adults?
| | | | | | | |
A. It is more difficult to find a superficial vein in the feet and ankles.
| | | | | | | | | | | | | |
B. A decreased flow rate could result in the formation of a thrombosis.
| | | | | | | | | | | |
C. A cannulated extremity is more difficult to move when the leg or foot is used.
| | | | | | | | | | | | | | |
D. Veins are located deep in the feet and ankles, resulting in a more painful
| | | | | | | | | | | | | | |
procedure.
B. A decreased flow rate could result in the formation of a thrombosis.
| | | | | | | | | | | |
Venous return is usually better in the upper extremities. Cannulation of the veins
| | | | | | | | | | | | |
in the lower extremities increases the risk of thrombus formation (B) which, if
| | | | | | | | | | | | |
dislodged, could be life-threatening. Superficial veins are often very easy (A) to
| | | | | | | | | | | |
find in the feet and legs. Handling a leg or foot with an IV (C) is probably not any
| | | | | | | | | | | | | | | | | | |
more difficult than handling an arm or hand. Even if the nurse did believe moving
| | | | | | | | | | | | | | |
a cannulated leg was more difficult, this is not the most important reason for
| | | | | | | | | | | | | |
using the upper extremities. Pain (D) is not a consideration.
| | | | | | | | |
