EVOLVE FUNDAMENTALS HESI ACTUAL
EXAMS QUESTION AND ANSWERS,100%
GUARANTEED PASS LATEST UPDATED
2025/2026
The nurse notices that the Hispanic parents of a toddler who returns from surgery offer
the child only the broth that comes on the clear liquid tray. Other liquids, including
gelatin, popsicles, and juices, remain untouched. What explanation is most appropriate
for this behavior?
A. The belief is held that the "evil eye" enters the child if anything cold is ingested.
B. After surgery the child probably has refused all foods except broth.
C. Eating broth strengthens the child's innate energy called "chi."
D. Hot remedies restore balance after surgery, which is considered a "cold" condition. -
CORRECT ANSWES -- Common parental practices and health beliefs among
Hispanic, Chinese, Filipino, and Arab cultures classify diseases, areas of the body, and
illnesses as "hot" or "cold" and must be balanced to maintain health and prevent illness.
The perception that surgery is a "cold" condition implies that only "hot" remedies, such
as soup, should be used to restore the healthy balance within the body, so (D) is the
correct interpretation. (A, B, and C) are not correct interpretations of the noted behavior.
"Chi" is a Chinese belief that an innate energy enters and leaves the body via certain
locations and pathways and maintains health. The "evil eye," or "mal ojo," is believed by
many cultures to be related to the balance of health and illness but is unrelated to
dietary practice.
Correct Answer: D
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. - CORRECT ANSWES --
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.
Correct Answer: D
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. - CORRECT ANSWES -- 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.
Correct Answer: B
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. - CORRECT
ANSWES -- 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).
Correct Answer: A
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. - CORRECT ANSWES -- 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).
Correct Answer: A
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. - CORRECT ANSWES -- 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.
Correct Answer: B
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. -
CORRECT ANSWES -- 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.
Correct Answer: D
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. - CORRECT ANSWES --
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.
Correct Answer: A
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. -
CORRECT ANSWES -- 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 Answer: B
The nurse observes an unlicensed assistive personnel (UAP) taking a client's blood
pressure with a cuff that is too small, but the blood pressure reading obtained is within
the client's usual range. What action is most important for the nurse to implement?
A. Tell the UAP to use a larger cuff at the next scheduled assessment.
B. Reassess the client's blood pressure using a larger cuff.
C. Have the unit educator review this procedure with the UAPs.
D. Teach the UAP the correct technique for assessing blood pressure. - CORRECT
ANSWES -- The most important action is to ensure that an accurate BP reading is
obtained. The nurse should reassess the BP with the correct size cuff (B).
Reassessment should not be postponed (A). Though (C and D) are likely indicated,
these actions do not have the priority of (B).
Correct Answer: B
Twenty minutes after beginning a heat application, the client states that the heating pad
no longer feels warm enough. What is the best response by the nurse?
A. "That means you have derived the maximum benefit, and the heat can be removed."
B. "Your blood vessels are becoming dilated and removing the heat from the site."
C. "We will increase the temperature 5 degrees when the pad no longer feels warm."
D. "The body's receptors adapt over time as they are exposed to heat." - CORRECT
ANSWES -- (D) describes thermal adaptation, which occurs 20 to 30 minutes after
EXAMS QUESTION AND ANSWERS,100%
GUARANTEED PASS LATEST UPDATED
2025/2026
The nurse notices that the Hispanic parents of a toddler who returns from surgery offer
the child only the broth that comes on the clear liquid tray. Other liquids, including
gelatin, popsicles, and juices, remain untouched. What explanation is most appropriate
for this behavior?
A. The belief is held that the "evil eye" enters the child if anything cold is ingested.
B. After surgery the child probably has refused all foods except broth.
C. Eating broth strengthens the child's innate energy called "chi."
D. Hot remedies restore balance after surgery, which is considered a "cold" condition. -
CORRECT ANSWES -- Common parental practices and health beliefs among
Hispanic, Chinese, Filipino, and Arab cultures classify diseases, areas of the body, and
illnesses as "hot" or "cold" and must be balanced to maintain health and prevent illness.
The perception that surgery is a "cold" condition implies that only "hot" remedies, such
as soup, should be used to restore the healthy balance within the body, so (D) is the
correct interpretation. (A, B, and C) are not correct interpretations of the noted behavior.
"Chi" is a Chinese belief that an innate energy enters and leaves the body via certain
locations and pathways and maintains health. The "evil eye," or "mal ojo," is believed by
many cultures to be related to the balance of health and illness but is unrelated to
dietary practice.
Correct Answer: D
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. - CORRECT ANSWES --
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.
Correct Answer: D
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. - CORRECT ANSWES -- 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.
Correct Answer: B
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. - CORRECT
ANSWES -- 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).
Correct Answer: A
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. - CORRECT ANSWES -- 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).
Correct Answer: A
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. - CORRECT ANSWES -- 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.
Correct Answer: B
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. -
CORRECT ANSWES -- 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.
Correct Answer: D
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. - CORRECT ANSWES --
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.
Correct Answer: A
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. -
CORRECT ANSWES -- 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 Answer: B
The nurse observes an unlicensed assistive personnel (UAP) taking a client's blood
pressure with a cuff that is too small, but the blood pressure reading obtained is within
the client's usual range. What action is most important for the nurse to implement?
A. Tell the UAP to use a larger cuff at the next scheduled assessment.
B. Reassess the client's blood pressure using a larger cuff.
C. Have the unit educator review this procedure with the UAPs.
D. Teach the UAP the correct technique for assessing blood pressure. - CORRECT
ANSWES -- The most important action is to ensure that an accurate BP reading is
obtained. The nurse should reassess the BP with the correct size cuff (B).
Reassessment should not be postponed (A). Though (C and D) are likely indicated,
these actions do not have the priority of (B).
Correct Answer: B
Twenty minutes after beginning a heat application, the client states that the heating pad
no longer feels warm enough. What is the best response by the nurse?
A. "That means you have derived the maximum benefit, and the heat can be removed."
B. "Your blood vessels are becoming dilated and removing the heat from the site."
C. "We will increase the temperature 5 degrees when the pad no longer feels warm."
D. "The body's receptors adapt over time as they are exposed to heat." - CORRECT
ANSWES -- (D) describes thermal adaptation, which occurs 20 to 30 minutes after
