EVOLVE HESI FUNDAMENTALS REAL EXAM TEST
BANK/RN HESI EVOLVE FUNDAMENTALS COMPLETE
ALL QUESTIONS AND CORRECT ANSWERS WITH
RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED
A+ - 150 Questions
Section 1: Management of Care (Questions 1-19)
1 A charge nurse on a medical-surgical unit is making assignments for the upcoming shift. Which patient should
be assigned to the most experienced registered nurse (RN)?
A) A patient with a newly placed percutaneous endoscopic gastrostomy (PEG) tube requiring tube feeding
initiation and monitoring.
B) A patient with a stage 3 pressure injury requiring a complex wound dressing change and negative pressure
wound therapy.
C) A patient with a history of chronic obstructive pulmonary disease (COPD) admitted for pneumonia, currently
stable on supplemental oxygen.
D) A patient with a new diagnosis of diabetes mellitus requiring insulin dose adjustments and self-management
education.
Answer: B
Rationale: Correct: The patient with a stage 3 pressure injury requiring negative pressure wound therapy is the most
complex and unstable, needing expert assessment and intervention. Option A involves a new PEG tube but is more
routine. Option C is stable. Option D requires education but is less acute. Assigning the most experienced RN to
the highest-acuity patient is a key management principle.
2 A nurse manager is implementing a new evidence-based protocol for fall prevention. Which strategy best
promotes staff adoption of the change?
A) Distribute a memo detailing the protocol and rationale to all staff.
B) Conduct a mandatory training session and post reminders in the unit.
C) Involve staff in the adaptation of the protocol to unit workflow and provide real-time feedback.
D) Assign a single champion to monitor compliance and report deviations.
Answer: C
Rationale: Correct: Evidence shows that engaging staff in the change process and providing feedback increases
buy-in and sustained practice change. Option A and B are passive and less effective. Option D places responsibility
on one person, which may not foster team ownership. Collaborative adaptation and feedback are core to quality
improvement.
3 A registered nurse (RN) delegates the task of ambulating a patient with a history of falls to a nursing assistant
(NA). What is the RN's primary responsibility after delegation?
A) Document that the task was delegated in the patient's record.
B) Verify the NA's ability to perform the task safely and provide supervision.
C) Reassess the patient's fall risk after ambulation.
D) Report the delegation to the charge nurse for approval.
Answer: B
,Rationale: Correct: The RN retains accountability for patient safety and must ensure the delegatee is competent and
supervised. Option A is documentation, not primary. Option C is important but not the immediate responsibility.
Option D is unnecessary; delegation is within the RN's scope. The five rights of delegation include right task,
circumstance, person, direction/communication, and supervision.
4 A nurse is caring for four patients. Which patient should the nurse assess first?
A) A patient with a chest tube connected to water seal who reports mild discomfort at the insertion site.
B) A patient with a nasogastric tube on low intermittent suction who has a drop in output from 100 mL/hr to 30
mL/hr.
C) A patient with a new tracheostomy who has a heart rate of 110/min and oxygen saturation of 90% on room
air.
D) A patient with a urinary catheter who has no urine output for 4 hours and complains of suprapubic pain.
Answer: C
Rationale: Correct: The patient with a new tracheostomy, tachycardia, and low SpO2 is at risk for airway
obstruction or respiratory distress, which is the highest priority. Option D indicates possible catheter obstruction,
which is urgent but not immediately life-threatening. Option B shows decreased output, but not acute. Option A is
stable. Prioritization follows the ABCs (airway, breathing, circulation).
5 A nurse is preparing to administer a blood transfusion to a patient. The patient has a history of multiple
transfusions and a known antibody. Which action is most important for the nurse to take?
A) Verify the patient's identity using two identifiers and check the blood product with another nurse.
B) Obtain a signed informed consent for the transfusion.
C) Ensure the blood is crossmatched for the specific antibody.
D) Premedicate the patient with diphenhydramine and acetaminophen.
Answer: C
Rationale: Correct: A patient with known antibodies requires blood that is crossmatched to avoid a hemolytic
reaction. Option A is standard but not specific to this risk. Option B is important for consent but not the most
critical safety measure. Option D may be used for prevention of febrile reactions but does not address the antibody
issue. The priority is preventing a transfusion reaction.
6 A nurse is leading a quality improvement project to reduce catheter-associated urinary tract infections
(CAUTIs). Which intervention should be implemented first?
A) Change the catheter tubing and bag every 72 hours.
B) Implement a nurse-driven protocol for daily assessment of catheter necessity.
C) Use a silver-alloy coated catheter for all patients.
D) Increase the frequency of perineal care to every 4 hours.
Answer: B
Rationale: Correct: The most effective strategy to reduce CAUTIs is to remove unnecessary catheters. Daily
assessment and prompt removal are evidence-based. Option A is not recommended; routine changes increase
infection risk. Option C may reduce infection but is not the first step. Option D is good hygiene but less impactful.
Quality improvement should target the root cause: unnecessary catheter use.
7 A nurse discovers that a colleague has been documenting assessments that were not performed. What is the
nurse's first action?
A) Report the colleague to the nursing supervisor immediately.
B) Confront the colleague privately and discuss the incident.
C) Ignore the incident because it is not the nurse's responsibility.
,D) Document the discrepancy in the patient's chart and inform the charge nurse.
Answer: B
Rationale: Correct: The first action should be to address the issue directly with the colleague, as it may be a
one-time error or misunderstanding. Option A may be necessary if the colleague continues, but immediate
reporting may damage trust. Option C is unethical. Option D is incorrect because documenting in the chart without
addressing the colleague could create legal issues. Professional communication is key.
8 A patient with end-stage renal disease refuses dialysis despite understanding the consequences. The healthcare
team believes dialysis is medically necessary. What is the nurse's best action?
A) Respect the patient's decision and provide palliative care.
B) Obtain a court order to mandate dialysis.
C) Convince the patient to accept dialysis by explaining the risks of refusal.
D) Consult the ethics committee to review the case.
Answer: A
Rationale: Correct: A competent adult has the right to refuse treatment, even if it leads to death. The nurse must
support the patient's autonomy. Option B violates ethical principles. Option C may be coercive. Option D is
appropriate if there is conflict or uncertainty, but the patient's decision is clear. The ethical principle of autonomy
takes precedence.
9 A nurse is caring for a patient who is a victim of domestic violence. The patient does not want to report the
incident to law enforcement. Which action is most appropriate?
A) Inform the patient that the nurse is legally required to report.
B) Respect the patient's wishes and maintain confidentiality.
C) Encourage the patient to report and offer to stay with them during the process.
D) Notify the hospital social worker to intervene.
Answer: C
Rationale: Correct: While mandatory reporting laws vary by state for domestic violence, many do not require
reporting unless there is injury from a weapon or child/elder abuse. The nurse should support the patient's
autonomy and offer assistance. Option A may be inaccurate and could deter the patient from seeking help. Option
B may be appropriate if no legal mandate exists, but offering support is better. Option D may be helpful but the
nurse should first engage with the patient.
10 A charge nurse is evaluating the effectiveness of a new handoff communication tool. Which outcome indicates
successful implementation?
A) Decrease in overtime hours for nursing staff.
B) Reduction in adverse events during shift transitions.
C) Increased patient satisfaction scores.
D) Higher compliance with hand hygiene protocols.
Answer: B
Rationale: Correct: The primary goal of improving handoff communication is to reduce errors and adverse events
during care transitions. Option A may be a secondary benefit but not the main outcome. Option C is related but not
specific. Option D is unrelated. Effective handoff tools like SBAR have been shown to improve patient safety.
11 A nurse manager is reviewing the principles of delegation with the nursing team. Which statement by a staff
nurse indicates a need for further teaching regarding the delegation of tasks to unlicensed assistive personnel
(UAP)?
A) "I will delegate vital sign measurement for a stable postoperative patient to the UAP."
, B) "I will ask the UAP to report any abnormal vital signs immediately."
C) "I will delegate the initial assessment of a newly admitted patient to the UAP."
D) "I will supervise the UAP's performance of a delegated task."
Answer: C
Rationale: The initial assessment of a newly admitted patient requires the professional nurse's clinical judgment and
cannot be delegated to UAP. Delegation involves transferring authority to perform a specific task, but the nurse
retains accountability. Options A, B, and D describe appropriate delegation practices.
12 A charge nurse is assigning patient care to a team consisting of a registered nurse (RN), a licensed practical
nurse (LPN), and a nursing assistant (NA). Which patient assignment best utilizes the skills of each team
member?
A) Assign the RN to a patient with a new tracheostomy requiring frequent suctioning, the LPN to a patient with a
stable wound requiring a dressing change, and the NA to a patient requiring assistance with bathing.
B) Assign the RN to a patient requiring a blood transfusion, the LPN to a patient with a chest tube, and the NA to
a patient requiring hourly vital signs.
C) Assign the RN to a patient requiring discharge teaching, the LPN to a patient requiring a complex medication
regimen, and the NA to a patient requiring ambulation.
D) Assign the RN to a patient requiring a central line dressing change, the LPN to a patient requiring a urinary
catheter insertion, and the NA to a patient requiring intake and output monitoring.
Answer: A
Rationale: Option A correctly matches the RN to a complex patient requiring assessment and skilled care
(tracheostomy suctioning), the LPN to a stable patient requiring a technical skill (dressing change), and the NA to a
basic care task (bathing). This respects each team member's scope of practice and maximizes efficiency.
13 A nurse is caring for a group of patients and must prioritize care. Using the concept of triage, which patient
should the nurse assess first?
A) A patient with a history of diabetes reporting a blood glucose level of 90 mg/dL.
B) A patient with a new onset of chest pain and diaphoresis.
C) A patient with a leg cast complaining of mild discomfort.
D) A patient scheduled for a routine surgical procedure in 2 hours.
Answer: B
Rationale: Chest pain with diaphoresis suggests a potential acute myocardial infarction, which is life-threatening
and requires immediate assessment and intervention. The other patients are stable or have non-urgent needs. This
prioritization follows the ABC (airway, breathing, circulation) and triage principles.
14 A nurse is delegating tasks to a licensed practical nurse (LPN) and a nursing assistant (NA). Which task is
appropriate for the nurse to delegate to the LPN?
A) Administer a nasogastric tube feeding to a patient.
B) Assess the lung sounds of a patient with pneumonia.
C) Develop the plan of care for a newly admitted patient.
D) Perform a sterile dressing change on a surgical wound.
Answer: A
Rationale: Administering a nasogastric tube feeding is within the LPN's scope of practice in many states, as it is a
stable, predictable procedure. Assessing lung sounds and developing the plan of care require the RN's assessment
and critical thinking skills. Sterile dressing changes may be delegated to LPNs depending on state regulations, but
option A is clearly within LPN scope.
BANK/RN HESI EVOLVE FUNDAMENTALS COMPLETE
ALL QUESTIONS AND CORRECT ANSWERS WITH
RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED
A+ - 150 Questions
Section 1: Management of Care (Questions 1-19)
1 A charge nurse on a medical-surgical unit is making assignments for the upcoming shift. Which patient should
be assigned to the most experienced registered nurse (RN)?
A) A patient with a newly placed percutaneous endoscopic gastrostomy (PEG) tube requiring tube feeding
initiation and monitoring.
B) A patient with a stage 3 pressure injury requiring a complex wound dressing change and negative pressure
wound therapy.
C) A patient with a history of chronic obstructive pulmonary disease (COPD) admitted for pneumonia, currently
stable on supplemental oxygen.
D) A patient with a new diagnosis of diabetes mellitus requiring insulin dose adjustments and self-management
education.
Answer: B
Rationale: Correct: The patient with a stage 3 pressure injury requiring negative pressure wound therapy is the most
complex and unstable, needing expert assessment and intervention. Option A involves a new PEG tube but is more
routine. Option C is stable. Option D requires education but is less acute. Assigning the most experienced RN to
the highest-acuity patient is a key management principle.
2 A nurse manager is implementing a new evidence-based protocol for fall prevention. Which strategy best
promotes staff adoption of the change?
A) Distribute a memo detailing the protocol and rationale to all staff.
B) Conduct a mandatory training session and post reminders in the unit.
C) Involve staff in the adaptation of the protocol to unit workflow and provide real-time feedback.
D) Assign a single champion to monitor compliance and report deviations.
Answer: C
Rationale: Correct: Evidence shows that engaging staff in the change process and providing feedback increases
buy-in and sustained practice change. Option A and B are passive and less effective. Option D places responsibility
on one person, which may not foster team ownership. Collaborative adaptation and feedback are core to quality
improvement.
3 A registered nurse (RN) delegates the task of ambulating a patient with a history of falls to a nursing assistant
(NA). What is the RN's primary responsibility after delegation?
A) Document that the task was delegated in the patient's record.
B) Verify the NA's ability to perform the task safely and provide supervision.
C) Reassess the patient's fall risk after ambulation.
D) Report the delegation to the charge nurse for approval.
Answer: B
,Rationale: Correct: The RN retains accountability for patient safety and must ensure the delegatee is competent and
supervised. Option A is documentation, not primary. Option C is important but not the immediate responsibility.
Option D is unnecessary; delegation is within the RN's scope. The five rights of delegation include right task,
circumstance, person, direction/communication, and supervision.
4 A nurse is caring for four patients. Which patient should the nurse assess first?
A) A patient with a chest tube connected to water seal who reports mild discomfort at the insertion site.
B) A patient with a nasogastric tube on low intermittent suction who has a drop in output from 100 mL/hr to 30
mL/hr.
C) A patient with a new tracheostomy who has a heart rate of 110/min and oxygen saturation of 90% on room
air.
D) A patient with a urinary catheter who has no urine output for 4 hours and complains of suprapubic pain.
Answer: C
Rationale: Correct: The patient with a new tracheostomy, tachycardia, and low SpO2 is at risk for airway
obstruction or respiratory distress, which is the highest priority. Option D indicates possible catheter obstruction,
which is urgent but not immediately life-threatening. Option B shows decreased output, but not acute. Option A is
stable. Prioritization follows the ABCs (airway, breathing, circulation).
5 A nurse is preparing to administer a blood transfusion to a patient. The patient has a history of multiple
transfusions and a known antibody. Which action is most important for the nurse to take?
A) Verify the patient's identity using two identifiers and check the blood product with another nurse.
B) Obtain a signed informed consent for the transfusion.
C) Ensure the blood is crossmatched for the specific antibody.
D) Premedicate the patient with diphenhydramine and acetaminophen.
Answer: C
Rationale: Correct: A patient with known antibodies requires blood that is crossmatched to avoid a hemolytic
reaction. Option A is standard but not specific to this risk. Option B is important for consent but not the most
critical safety measure. Option D may be used for prevention of febrile reactions but does not address the antibody
issue. The priority is preventing a transfusion reaction.
6 A nurse is leading a quality improvement project to reduce catheter-associated urinary tract infections
(CAUTIs). Which intervention should be implemented first?
A) Change the catheter tubing and bag every 72 hours.
B) Implement a nurse-driven protocol for daily assessment of catheter necessity.
C) Use a silver-alloy coated catheter for all patients.
D) Increase the frequency of perineal care to every 4 hours.
Answer: B
Rationale: Correct: The most effective strategy to reduce CAUTIs is to remove unnecessary catheters. Daily
assessment and prompt removal are evidence-based. Option A is not recommended; routine changes increase
infection risk. Option C may reduce infection but is not the first step. Option D is good hygiene but less impactful.
Quality improvement should target the root cause: unnecessary catheter use.
7 A nurse discovers that a colleague has been documenting assessments that were not performed. What is the
nurse's first action?
A) Report the colleague to the nursing supervisor immediately.
B) Confront the colleague privately and discuss the incident.
C) Ignore the incident because it is not the nurse's responsibility.
,D) Document the discrepancy in the patient's chart and inform the charge nurse.
Answer: B
Rationale: Correct: The first action should be to address the issue directly with the colleague, as it may be a
one-time error or misunderstanding. Option A may be necessary if the colleague continues, but immediate
reporting may damage trust. Option C is unethical. Option D is incorrect because documenting in the chart without
addressing the colleague could create legal issues. Professional communication is key.
8 A patient with end-stage renal disease refuses dialysis despite understanding the consequences. The healthcare
team believes dialysis is medically necessary. What is the nurse's best action?
A) Respect the patient's decision and provide palliative care.
B) Obtain a court order to mandate dialysis.
C) Convince the patient to accept dialysis by explaining the risks of refusal.
D) Consult the ethics committee to review the case.
Answer: A
Rationale: Correct: A competent adult has the right to refuse treatment, even if it leads to death. The nurse must
support the patient's autonomy. Option B violates ethical principles. Option C may be coercive. Option D is
appropriate if there is conflict or uncertainty, but the patient's decision is clear. The ethical principle of autonomy
takes precedence.
9 A nurse is caring for a patient who is a victim of domestic violence. The patient does not want to report the
incident to law enforcement. Which action is most appropriate?
A) Inform the patient that the nurse is legally required to report.
B) Respect the patient's wishes and maintain confidentiality.
C) Encourage the patient to report and offer to stay with them during the process.
D) Notify the hospital social worker to intervene.
Answer: C
Rationale: Correct: While mandatory reporting laws vary by state for domestic violence, many do not require
reporting unless there is injury from a weapon or child/elder abuse. The nurse should support the patient's
autonomy and offer assistance. Option A may be inaccurate and could deter the patient from seeking help. Option
B may be appropriate if no legal mandate exists, but offering support is better. Option D may be helpful but the
nurse should first engage with the patient.
10 A charge nurse is evaluating the effectiveness of a new handoff communication tool. Which outcome indicates
successful implementation?
A) Decrease in overtime hours for nursing staff.
B) Reduction in adverse events during shift transitions.
C) Increased patient satisfaction scores.
D) Higher compliance with hand hygiene protocols.
Answer: B
Rationale: Correct: The primary goal of improving handoff communication is to reduce errors and adverse events
during care transitions. Option A may be a secondary benefit but not the main outcome. Option C is related but not
specific. Option D is unrelated. Effective handoff tools like SBAR have been shown to improve patient safety.
11 A nurse manager is reviewing the principles of delegation with the nursing team. Which statement by a staff
nurse indicates a need for further teaching regarding the delegation of tasks to unlicensed assistive personnel
(UAP)?
A) "I will delegate vital sign measurement for a stable postoperative patient to the UAP."
, B) "I will ask the UAP to report any abnormal vital signs immediately."
C) "I will delegate the initial assessment of a newly admitted patient to the UAP."
D) "I will supervise the UAP's performance of a delegated task."
Answer: C
Rationale: The initial assessment of a newly admitted patient requires the professional nurse's clinical judgment and
cannot be delegated to UAP. Delegation involves transferring authority to perform a specific task, but the nurse
retains accountability. Options A, B, and D describe appropriate delegation practices.
12 A charge nurse is assigning patient care to a team consisting of a registered nurse (RN), a licensed practical
nurse (LPN), and a nursing assistant (NA). Which patient assignment best utilizes the skills of each team
member?
A) Assign the RN to a patient with a new tracheostomy requiring frequent suctioning, the LPN to a patient with a
stable wound requiring a dressing change, and the NA to a patient requiring assistance with bathing.
B) Assign the RN to a patient requiring a blood transfusion, the LPN to a patient with a chest tube, and the NA to
a patient requiring hourly vital signs.
C) Assign the RN to a patient requiring discharge teaching, the LPN to a patient requiring a complex medication
regimen, and the NA to a patient requiring ambulation.
D) Assign the RN to a patient requiring a central line dressing change, the LPN to a patient requiring a urinary
catheter insertion, and the NA to a patient requiring intake and output monitoring.
Answer: A
Rationale: Option A correctly matches the RN to a complex patient requiring assessment and skilled care
(tracheostomy suctioning), the LPN to a stable patient requiring a technical skill (dressing change), and the NA to a
basic care task (bathing). This respects each team member's scope of practice and maximizes efficiency.
13 A nurse is caring for a group of patients and must prioritize care. Using the concept of triage, which patient
should the nurse assess first?
A) A patient with a history of diabetes reporting a blood glucose level of 90 mg/dL.
B) A patient with a new onset of chest pain and diaphoresis.
C) A patient with a leg cast complaining of mild discomfort.
D) A patient scheduled for a routine surgical procedure in 2 hours.
Answer: B
Rationale: Chest pain with diaphoresis suggests a potential acute myocardial infarction, which is life-threatening
and requires immediate assessment and intervention. The other patients are stable or have non-urgent needs. This
prioritization follows the ABC (airway, breathing, circulation) and triage principles.
14 A nurse is delegating tasks to a licensed practical nurse (LPN) and a nursing assistant (NA). Which task is
appropriate for the nurse to delegate to the LPN?
A) Administer a nasogastric tube feeding to a patient.
B) Assess the lung sounds of a patient with pneumonia.
C) Develop the plan of care for a newly admitted patient.
D) Perform a sterile dressing change on a surgical wound.
Answer: A
Rationale: Administering a nasogastric tube feeding is within the LPN's scope of practice in many states, as it is a
stable, predictable procedure. Assessing lung sounds and developing the plan of care require the RN's assessment
and critical thinking skills. Sterile dressing changes may be delegated to LPNs depending on state regulations, but
option A is clearly within LPN scope.
