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Material
k9
EVOLVE HESI FUNDAMENTALS ACTUAL EXAM n n n n n
EXPERT VERIFIED WITH DETAILED ANSWERS AND n n n n n
RATIONALES| GUARANTEED PASS
n
k
9 n n
1. Anelderlyclientwithafracturedlefthipisonstrictbedrest.Whichnursing
9
k 9
k 9
k 9
k 9
k 9
k 9
k 9
k 9
k 9
k 9
k
k9 measure is essential tothe client's nursing care?
k9 k9 k9 k9 k9 k9 k9
A. Massageanyreddenedareasforatleastfiveminutes.
9
k 9
k 9
k 9
k 9
k 9
k 9
k 9
k
B. Encourageactiverangeofmotionexercisesonextremities.
9
k 9
k 9
k 9
k 9
k 9
k 9
k
C. Positiontheclientlaterally,prone,anddorsallyinsequence.
9
k 9
k 9
k 9
k 9
k
D. Gentlylifttheclientwhenmovingintoadesiredposition.
RATIONALE> Toavoidshearing forces when repositioning, the client should be lifted
n k9 k9 k9 k9 k9 k9 k9 k9
gentlyacrossasurface(D).Reddenedareasshouldnotbemassaged(A)sincethis may
k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9
increasethedamagetoalreadytraumatizedskin.Tocontrolpainandmuscle
k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9
,spasms,activerangeofmotion(B)maybelimitedontheaffectedleg.Theposition
k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9
k9 describedin(C)iscontraindicatedforaclientwithafracturedlefthip.
k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9
CorrectAnswer D k9 k9
2. The nurse isadministering medications through a nasogastric tube (NGT)
k9 k9 k9 k9 k9 k9 k9 k9
k9 which is connected to suction. After ensuring correct tube placement, what
k9 k9 k9 k9 k9 k9 k9 k9 k9 k9
k9 action should the nurse take next?
k9 k9 k9 k9 k9
A. Clampthetubefor20minutes. 9
k 9
k 9
k 9
k 9
k
B. Flushthetubewithwater. 9
k 9
k 9
k 9
k
C. Administerthemedicationsasprescribed. 9
k k9 k9 9
k
D. Crushthetabletsanddissolveinsterilewater.
9
k 9
k 9
k 9
k 9
k 9
k 9
k
RATIONALE> The NGT should be flushed before,afterandinbetweeneach n k 9 k 9 k 9 k 9 k 9
medicationadministered(B).Onceallmedicationsareadministered,theNGTshouldbe k9
clampedfor20minutes(A).(CandD)maybe implemented only after the tubing has
k9 k9 k9 k9 k9 k9 k9
beenflushed.
k9 k9
CorrectAnswer B k9 k9
,3. A client who is in hospice care complains of increasing amounts of pain. The
k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9
k9 healthcare provider prescribes ananalgesic everyfour hours asneeded. Which
k9 k9 k9 k9 k9 k9 k9
k9 action should the nurse implement?
k9 k9 k9 k9
A. Giveanaround-the-clockscheduleforadministrationofanalgesics.
9
k 9
k 9
k 9
k 9
k 9
k 9
k
B. Administeranalgesicmedicationasneededwhenthepainissevere.
9
k 9
k 9
k 9
k 9
k 9
k 9
k 9
k 9
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C. Providemedicationtokeeptheclientsedatedandunawareofstimuli.
9
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k 9
k 9
k 9
k 9
k 9
k 9
k 9
k 9
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D. Offeramedication-freeperiodsothattheclientcandodailyactivities.
RATIONALE> The mosteffectivemanagementofpainisachievedusinganaround-
n k9
the-clockschedulethatprovidesanalgesicmedicationsonaregularbasis(A)andina
k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9
k9 timelymanner.Analgesicsarelesseffectiveifpainpersistsuntilitissevere,soan analgesic
k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9
medicationshouldbeadministeredbeforetheclient'spainpeaks(B).
k9 k9 k9 k9 k9 k9 k9 k9 k9 k9
Providing
, comfortisa priority for the client whoisdying, but sedation that impairs the client'
k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9
ability to interactandexperience thetime before life ends should be minimized (C)
k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9
Offeringa medication-free period allows the serum drug level to fall,which is notan
k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9
effectivemethodtomanagechronicpain(D). k9 k9 k9 k9 k9 k9
CorrectAnswer A k9 k9
4. Whenassessingaclientwithwristrestraints,thenurseobservesthatthe
9
k 9
k 9
k 9
k 9
k 9
k 9
k 9
k 9
k 9
k
k9 fingersontherighthandareblue.Whatactionshouldthenurseimplement
9
k 9
k 9
k 9
k 9
k 9
k 9
k 9
k 9
k 9
k 9
k
k9 first?
A. Loosentherightwristrestraint. 9
k 9
k 9
k 9
k
B. Applyapulseoximetertotherighthand. 9
k 9
k 9
k 9
k 9
k 9
k 9
k
C. Comparehandcolorbilaterally. 9
k 9
k 9
k
D. Palpatetherightradialpulse.
RATIONALE>Theprioritynursingactionistorestorecirculationbylooseningthe k9 k9 k9
restraint(A),becausebluefingers(cyanosis)indicatesdecreasedcirculation.(CandD)
k9 k9 k9 k9 k9 k9 k9 k9
k9 arealsoimportantnursinginterventions,butdonothave
k9 k9 k9 k9 k9 k9 k9 k9
thepriorityof(A).Pulseoximetry(B)measuresthesaturationofhemoglobinwith
k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9
k9 k9 k9 k9 k9 k9 k9 k9 k9
Material
k9
EVOLVE HESI FUNDAMENTALS ACTUAL EXAM n n n n n
EXPERT VERIFIED WITH DETAILED ANSWERS AND n n n n n
RATIONALES| GUARANTEED PASS
n
k
9 n n
1. Anelderlyclientwithafracturedlefthipisonstrictbedrest.Whichnursing
9
k 9
k 9
k 9
k 9
k 9
k 9
k 9
k 9
k 9
k 9
k
k9 measure is essential tothe client's nursing care?
k9 k9 k9 k9 k9 k9 k9
A. Massageanyreddenedareasforatleastfiveminutes.
9
k 9
k 9
k 9
k 9
k 9
k 9
k 9
k
B. Encourageactiverangeofmotionexercisesonextremities.
9
k 9
k 9
k 9
k 9
k 9
k 9
k
C. Positiontheclientlaterally,prone,anddorsallyinsequence.
9
k 9
k 9
k 9
k 9
k
D. Gentlylifttheclientwhenmovingintoadesiredposition.
RATIONALE> Toavoidshearing forces when repositioning, the client should be lifted
n k9 k9 k9 k9 k9 k9 k9 k9
gentlyacrossasurface(D).Reddenedareasshouldnotbemassaged(A)sincethis may
k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9
increasethedamagetoalreadytraumatizedskin.Tocontrolpainandmuscle
k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9
,spasms,activerangeofmotion(B)maybelimitedontheaffectedleg.Theposition
k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9
k9 describedin(C)iscontraindicatedforaclientwithafracturedlefthip.
k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9
CorrectAnswer D k9 k9
2. The nurse isadministering medications through a nasogastric tube (NGT)
k9 k9 k9 k9 k9 k9 k9 k9
k9 which is connected to suction. After ensuring correct tube placement, what
k9 k9 k9 k9 k9 k9 k9 k9 k9 k9
k9 action should the nurse take next?
k9 k9 k9 k9 k9
A. Clampthetubefor20minutes. 9
k 9
k 9
k 9
k 9
k
B. Flushthetubewithwater. 9
k 9
k 9
k 9
k
C. Administerthemedicationsasprescribed. 9
k k9 k9 9
k
D. Crushthetabletsanddissolveinsterilewater.
9
k 9
k 9
k 9
k 9
k 9
k 9
k
RATIONALE> The NGT should be flushed before,afterandinbetweeneach n k 9 k 9 k 9 k 9 k 9
medicationadministered(B).Onceallmedicationsareadministered,theNGTshouldbe k9
clampedfor20minutes(A).(CandD)maybe implemented only after the tubing has
k9 k9 k9 k9 k9 k9 k9
beenflushed.
k9 k9
CorrectAnswer B k9 k9
,3. A client who is in hospice care complains of increasing amounts of pain. The
k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9
k9 healthcare provider prescribes ananalgesic everyfour hours asneeded. Which
k9 k9 k9 k9 k9 k9 k9
k9 action should the nurse implement?
k9 k9 k9 k9
A. Giveanaround-the-clockscheduleforadministrationofanalgesics.
9
k 9
k 9
k 9
k 9
k 9
k 9
k
B. Administeranalgesicmedicationasneededwhenthepainissevere.
9
k 9
k 9
k 9
k 9
k 9
k 9
k 9
k 9
k
C. Providemedicationtokeeptheclientsedatedandunawareofstimuli.
9
k 9
k 9
k 9
k 9
k 9
k 9
k 9
k 9
k 9
k
D. Offeramedication-freeperiodsothattheclientcandodailyactivities.
RATIONALE> The mosteffectivemanagementofpainisachievedusinganaround-
n k9
the-clockschedulethatprovidesanalgesicmedicationsonaregularbasis(A)andina
k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9
k9 timelymanner.Analgesicsarelesseffectiveifpainpersistsuntilitissevere,soan analgesic
k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9
medicationshouldbeadministeredbeforetheclient'spainpeaks(B).
k9 k9 k9 k9 k9 k9 k9 k9 k9 k9
Providing
, comfortisa priority for the client whoisdying, but sedation that impairs the client'
k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9
ability to interactandexperience thetime before life ends should be minimized (C)
k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9
Offeringa medication-free period allows the serum drug level to fall,which is notan
k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9
effectivemethodtomanagechronicpain(D). k9 k9 k9 k9 k9 k9
CorrectAnswer A k9 k9
4. Whenassessingaclientwithwristrestraints,thenurseobservesthatthe
9
k 9
k 9
k 9
k 9
k 9
k 9
k 9
k 9
k 9
k
k9 fingersontherighthandareblue.Whatactionshouldthenurseimplement
9
k 9
k 9
k 9
k 9
k 9
k 9
k 9
k 9
k 9
k 9
k
k9 first?
A. Loosentherightwristrestraint. 9
k 9
k 9
k 9
k
B. Applyapulseoximetertotherighthand. 9
k 9
k 9
k 9
k 9
k 9
k 9
k
C. Comparehandcolorbilaterally. 9
k 9
k 9
k
D. Palpatetherightradialpulse.
RATIONALE>Theprioritynursingactionistorestorecirculationbylooseningthe k9 k9 k9
restraint(A),becausebluefingers(cyanosis)indicatesdecreasedcirculation.(CandD)
k9 k9 k9 k9 k9 k9 k9 k9
k9 arealsoimportantnursinginterventions,butdonothave
k9 k9 k9 k9 k9 k9 k9 k9
thepriorityof(A).Pulseoximetry(B)measuresthesaturationofhemoglobinwith
k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9 k9
