HESI RN FUNDAMENTALS EXIT EXAM LATEST 2026-2027
ACTUAL EXAM 280 QUESTIONS AND CORRECT ANSWERS
WITH RATIOANLES (VERIFIED ANSWERS)
NEW!!!!!!!!!!!!!!!!!!!!!
The nurse is preparing to administer a new medication through an existing IV line
containing a vasopressor. What action must the nurse take first?
A.
Flush the line with normal saline at the same rate as the vasopressor.
B.
Administer the medication at the prescribed IV rate.
C.
Start a second IV line to administer the new medication.
D.
Call the health care provider to change the order for the new medication to po. -
ANS... -A
Rationale: The medication in the IV line between the post and the patient contains
the vasopressor medication. The nurse must continue to administer the vasopressor
medication at the prescribed rate by injecting normal saline at that rate. Once the
line is clear of the vasopressor medication, then the nurse can inject the new
medication at the prescribed rate. There is no need to start a second IV or change
the route of administration.
The nurse is working at a community-based clinic. Which client's spiritual well-
being concerns the nurse the most?
A.
Roman Catholic woman considering an abortion
B.
Jewish man considering hospice care for his wife
C.
Seventh-Day Adventist who needs a blood transfusion
D.
Muslim man who needs a total knee replacement - ANS... -A
Rationale: In the Roman Catholic religion, any type of abortion is prohibited, so
facing this decision may place the client at risk for spiritual distress. There is no
prohibition of hospice care for members of the Jewish faith. Jehovah's Witnesses,
,not Seventh-Day Adventists, prohibit blood transfusions. There is no conflict in the
Muslim faith with regard to joint replacement.
The mental health nurse plans to discuss a client's depression with the health care
provider in the emergency department. There are two clients sitting across from the
emergency department desk. Which nursing action is best?
A.
Only refer to the client by gender.
B.
Identify the client only by age.
C.
Avoid using the client's name.
D.
Discuss the client another time. - ANS... -D
Rationale: The best nursing action is to discuss the client another time.
Confidentiality must be observed at all times, so the nurse should not discuss the
client when the conversation can be overheard by others. Details of the client can
be identified when referring to the client by gender or age, even when not using the
client's name.
The nurse is teaching a client how to perform progressive muscle relaxation
techniques to relieve insomnia. A week later the client reports, "I am still unable to
sleep, despite following the same routine every night." Which action should the
nurse take next?
A.
Instruct the client to add regular exercise as a daily routine.
B.
Determine if the client has been keeping a sleep diary.
C.
Encourage the client to continue the routine until sleep is achieved.
D.
Ask the client to describe the routine he is currently following. - ANS... -D
Rationale: The nurse should first evaluate whether the client has been adhering to
the original instructions. A verbal report of the client's routine will provide more
specific information than the client's written diary. The nurse can then determine
which changes need to be made. The routine practiced by the client is clearly
unsuccessful, so encouragement alone is insufficient.
,A client is laughing at a television program when the evening nurse enters the
room. The client states, "My foot is hurting. I would like a pain pill." How should
the nurse respond?
A.
Ask the client to rate the pain using a 1 to 10 scale.
B.
Encourage the client to wait until bedtime for the pill.
C.
Attend to an acutely ill client's needs first because this client is laughing.
D.
Instruct the client in the use of deep breathing exercises for pain control. - ANS... -
A
Rationale: Obtaining a subjective estimate of the pain experience by asking the
client to rate his pain helps the nurse determine which pain medication should be
administered and also provides a baseline for evaluating the effectiveness of the
medication. Medicating for pain should not be delayed so that it can be used as a
sleep medication. Option C is judgmental. Option D should be used as an adjunct
to pain medication, not instead of medication.
Which action is most important for the nurse to include in the plan of care for a
client at high risk for the development of postoperative thrombus formation?
A.
Instruct in the use of the incentive spirometer.
B.
Elevate the head of the bed during all meals.
C.
Use aseptic technique to change the dressing.
D.
Encourage frequent ambulation in the hallway. - ANS... -D
Rationale: Thrombus (clot) formation can occur in the lower extremities of
immobile clients, so the nurse should plan to encourage activities to increase
mobility, such as frequent ambulation in the hallway. Option A helps promote
alveolar expansion, reducing the risk for atelectasis. Option B reduces the risk for
aspiration. Option C reduces the risk for postoperative infection.
A client has a nasogastric tube connected to low intermittent suction. When
administering medications through the nasogastric tube, which action should the
nurse do first?
A.
Clamp the nasogastric tube.
, B.
Confirm placement of the tube.
C.
Use a syringe to instill the medications.
D.
Turn off the intermittent suction device. - ANS... -D
Rationale: The nurse should first turn off the suction and then confirm placement
of the tube in the stomach before instilling the medications. To prevent immediate
removal of the instilled medications and allow absorption, the tube should be
clamped for a period of time before reconnecting the suction.
A client with frequent urinary tract infections (UTIs) asks the nurse to explain a
friend's advice about drinking a glass of juice daily to prevent future UTIs. Which
response is best for the nurse to provide?
A.
"Orange juice has vitamin C that deters bacterial growth."
B.
"Apple juice is the most useful in acidifying the urine."
C.
"Cranberry juice stops pathogens' adherence to the bladder."
D.
"Grapefruit juice increases absorption of most antibiotics." - ANS... -C
Rationale: Cranberry juice maintains urinary tract health by reducing the adherence
of Escherichia coli bacteria to cells within the bladder. Options A, B, and D have
not been shown to be as effective as cranberry juice in preventing UTIs.
After receiving written and verbal instructions from a clinic nurse about a newly
prescribed medication, a client asks the nurse what to do if questions arise about
the medication after getting home. How should the nurse respond?
A.
Provide the client with a list of Internet sites that answer frequently asked
questions about medications.
B.
Advise the client to obtain a current edition of a drug reference book from a local
bookstore or library.
C.
Reassure the client that information about the medication is included in the written
instructions.
D.
ACTUAL EXAM 280 QUESTIONS AND CORRECT ANSWERS
WITH RATIOANLES (VERIFIED ANSWERS)
NEW!!!!!!!!!!!!!!!!!!!!!
The nurse is preparing to administer a new medication through an existing IV line
containing a vasopressor. What action must the nurse take first?
A.
Flush the line with normal saline at the same rate as the vasopressor.
B.
Administer the medication at the prescribed IV rate.
C.
Start a second IV line to administer the new medication.
D.
Call the health care provider to change the order for the new medication to po. -
ANS... -A
Rationale: The medication in the IV line between the post and the patient contains
the vasopressor medication. The nurse must continue to administer the vasopressor
medication at the prescribed rate by injecting normal saline at that rate. Once the
line is clear of the vasopressor medication, then the nurse can inject the new
medication at the prescribed rate. There is no need to start a second IV or change
the route of administration.
The nurse is working at a community-based clinic. Which client's spiritual well-
being concerns the nurse the most?
A.
Roman Catholic woman considering an abortion
B.
Jewish man considering hospice care for his wife
C.
Seventh-Day Adventist who needs a blood transfusion
D.
Muslim man who needs a total knee replacement - ANS... -A
Rationale: In the Roman Catholic religion, any type of abortion is prohibited, so
facing this decision may place the client at risk for spiritual distress. There is no
prohibition of hospice care for members of the Jewish faith. Jehovah's Witnesses,
,not Seventh-Day Adventists, prohibit blood transfusions. There is no conflict in the
Muslim faith with regard to joint replacement.
The mental health nurse plans to discuss a client's depression with the health care
provider in the emergency department. There are two clients sitting across from the
emergency department desk. Which nursing action is best?
A.
Only refer to the client by gender.
B.
Identify the client only by age.
C.
Avoid using the client's name.
D.
Discuss the client another time. - ANS... -D
Rationale: The best nursing action is to discuss the client another time.
Confidentiality must be observed at all times, so the nurse should not discuss the
client when the conversation can be overheard by others. Details of the client can
be identified when referring to the client by gender or age, even when not using the
client's name.
The nurse is teaching a client how to perform progressive muscle relaxation
techniques to relieve insomnia. A week later the client reports, "I am still unable to
sleep, despite following the same routine every night." Which action should the
nurse take next?
A.
Instruct the client to add regular exercise as a daily routine.
B.
Determine if the client has been keeping a sleep diary.
C.
Encourage the client to continue the routine until sleep is achieved.
D.
Ask the client to describe the routine he is currently following. - ANS... -D
Rationale: The nurse should first evaluate whether the client has been adhering to
the original instructions. A verbal report of the client's routine will provide more
specific information than the client's written diary. The nurse can then determine
which changes need to be made. The routine practiced by the client is clearly
unsuccessful, so encouragement alone is insufficient.
,A client is laughing at a television program when the evening nurse enters the
room. The client states, "My foot is hurting. I would like a pain pill." How should
the nurse respond?
A.
Ask the client to rate the pain using a 1 to 10 scale.
B.
Encourage the client to wait until bedtime for the pill.
C.
Attend to an acutely ill client's needs first because this client is laughing.
D.
Instruct the client in the use of deep breathing exercises for pain control. - ANS... -
A
Rationale: Obtaining a subjective estimate of the pain experience by asking the
client to rate his pain helps the nurse determine which pain medication should be
administered and also provides a baseline for evaluating the effectiveness of the
medication. Medicating for pain should not be delayed so that it can be used as a
sleep medication. Option C is judgmental. Option D should be used as an adjunct
to pain medication, not instead of medication.
Which action is most important for the nurse to include in the plan of care for a
client at high risk for the development of postoperative thrombus formation?
A.
Instruct in the use of the incentive spirometer.
B.
Elevate the head of the bed during all meals.
C.
Use aseptic technique to change the dressing.
D.
Encourage frequent ambulation in the hallway. - ANS... -D
Rationale: Thrombus (clot) formation can occur in the lower extremities of
immobile clients, so the nurse should plan to encourage activities to increase
mobility, such as frequent ambulation in the hallway. Option A helps promote
alveolar expansion, reducing the risk for atelectasis. Option B reduces the risk for
aspiration. Option C reduces the risk for postoperative infection.
A client has a nasogastric tube connected to low intermittent suction. When
administering medications through the nasogastric tube, which action should the
nurse do first?
A.
Clamp the nasogastric tube.
, B.
Confirm placement of the tube.
C.
Use a syringe to instill the medications.
D.
Turn off the intermittent suction device. - ANS... -D
Rationale: The nurse should first turn off the suction and then confirm placement
of the tube in the stomach before instilling the medications. To prevent immediate
removal of the instilled medications and allow absorption, the tube should be
clamped for a period of time before reconnecting the suction.
A client with frequent urinary tract infections (UTIs) asks the nurse to explain a
friend's advice about drinking a glass of juice daily to prevent future UTIs. Which
response is best for the nurse to provide?
A.
"Orange juice has vitamin C that deters bacterial growth."
B.
"Apple juice is the most useful in acidifying the urine."
C.
"Cranberry juice stops pathogens' adherence to the bladder."
D.
"Grapefruit juice increases absorption of most antibiotics." - ANS... -C
Rationale: Cranberry juice maintains urinary tract health by reducing the adherence
of Escherichia coli bacteria to cells within the bladder. Options A, B, and D have
not been shown to be as effective as cranberry juice in preventing UTIs.
After receiving written and verbal instructions from a clinic nurse about a newly
prescribed medication, a client asks the nurse what to do if questions arise about
the medication after getting home. How should the nurse respond?
A.
Provide the client with a list of Internet sites that answer frequently asked
questions about medications.
B.
Advise the client to obtain a current edition of a drug reference book from a local
bookstore or library.
C.
Reassure the client that information about the medication is included in the written
instructions.
D.
