HESI A2 ADMISSION ASSESSMENT EXAM QUESTIONS AND ANSWERS ALREADY GRADED A+. 100%
VERIFIED SOLUTIONS | UPDATED PER LATEST GUIDELINES | GRADED A+
Question 1
A client reports experiencing sharp chest pain that intensifies with deep inspiration and is relieved when leaning
forward. The nurse auscultates a pericardial friction rub. Which condition is most consistent with these findings?
A. Myocardial infarction
B. Pleurisy
C. Pericarditis
D. Pulmonary embolism
🟢 Correct Answer:
C. Pericarditis
🔴 RATIONALE:
Pericarditis is characterized by sharp chest pain that is often pleuritic (worse with inspiration) and positional,
typically improving when the patient leans forward. A pericardial friction rub is a classic auscultatory finding.
Myocardial infarction pain is not typically relieved by position change. Pleurisy presents with a pleural friction
rub, not a pericardial one.
Question 2
A nurse is calculating the intake for a patient over 8 hours. The patient consumed 240 mL of coffee, 90 mL of
,juice, and 120 mL of milk. The patient also received IV fluids at 100 mL/hr. What is the total intake in mL?
A. 450 mL
B. 850 mL
C. 1250 mL
D. 650 mL
🟢 Correct Answer:
C. 1250 mL
🔴 RATIONALE:
First, calculate the oral intake: 240 mL + 90 mL + 120 mL = 450 mL. Next, calculate the IV intake: 100 mL/hr × 8
hrs = 800 mL. The total intake is 450 mL + 800 mL = 1250 mL.
Question 3
A patient with a history of chronic heart failure is prescribed furosemide. Which laboratory value should the
nurse monitor most closely?
A. Serum potassium
B. Serum calcium
C. Serum sodium
D. Serum magnesium
🟢 Correct Answer:
A. Serum potassium
,🔴 RATIONALE:
Furosemide is a loop diuretic that inhibits the reabsorption of sodium and potassium in the ascending loop of
Henle, leading to significant potassium loss. Hypokalemia is a major adverse effect that can predispose the
patient to cardiac arrhythmias. While sodium, calcium, and magnesium can be affected, potassium monitoring is
the most critical priority for patient safety.
Question 4
Which of the following is the most effective initial intervention to prevent skin breakdown in a bedridden
patient?
A. Massaging bony prominences
B. Applying moisturizing lotion daily
C. Repositioning the patient every 2 hours
D. Using an inflatable doughnut cushion
🟢 Correct Answer:
C. Repositioning the patient every 2 hours
🔴 RATIONALE:
Repositioning is the cornerstone of pressure ulcer prevention. It relieves pressure on bony prominences,
allowing for tissue reperfusion. Massaging bony prominences can damage capillaries and is no longer
recommended. Doughnut cushions can create a tourniquet effect and reduce blood flow to tissues.
, Question 5
A healthcare provider orders a medication to be administered "stat." How should the nurse interpret this order?
A. Give the medication before the patient goes to bed.
B. Give the medication with meals.
C. Give the medication immediately and once only.
D. Give the medication immediately but only after obtaining a second signature.
🟢 Correct Answer:
C. Give the medication immediately and once only.
🔴 RATIONALE:
In medical terminology, "stat" is derived from the Latin word "statim," meaning immediately. A stat order is a
single-dose order to be given at once for an urgent situation. It is distinct from routine, PRN (as needed), or
standing orders.
Question 6
A nurse is preparing to administer an intramuscular injection to a patient with a small muscle mass. Which
needle gauge is most appropriate to minimize tissue damage?
A. 18 gauge
B. 20 gauge
C. 22 gauge
D. 25 gauge
VERIFIED SOLUTIONS | UPDATED PER LATEST GUIDELINES | GRADED A+
Question 1
A client reports experiencing sharp chest pain that intensifies with deep inspiration and is relieved when leaning
forward. The nurse auscultates a pericardial friction rub. Which condition is most consistent with these findings?
A. Myocardial infarction
B. Pleurisy
C. Pericarditis
D. Pulmonary embolism
🟢 Correct Answer:
C. Pericarditis
🔴 RATIONALE:
Pericarditis is characterized by sharp chest pain that is often pleuritic (worse with inspiration) and positional,
typically improving when the patient leans forward. A pericardial friction rub is a classic auscultatory finding.
Myocardial infarction pain is not typically relieved by position change. Pleurisy presents with a pleural friction
rub, not a pericardial one.
Question 2
A nurse is calculating the intake for a patient over 8 hours. The patient consumed 240 mL of coffee, 90 mL of
,juice, and 120 mL of milk. The patient also received IV fluids at 100 mL/hr. What is the total intake in mL?
A. 450 mL
B. 850 mL
C. 1250 mL
D. 650 mL
🟢 Correct Answer:
C. 1250 mL
🔴 RATIONALE:
First, calculate the oral intake: 240 mL + 90 mL + 120 mL = 450 mL. Next, calculate the IV intake: 100 mL/hr × 8
hrs = 800 mL. The total intake is 450 mL + 800 mL = 1250 mL.
Question 3
A patient with a history of chronic heart failure is prescribed furosemide. Which laboratory value should the
nurse monitor most closely?
A. Serum potassium
B. Serum calcium
C. Serum sodium
D. Serum magnesium
🟢 Correct Answer:
A. Serum potassium
,🔴 RATIONALE:
Furosemide is a loop diuretic that inhibits the reabsorption of sodium and potassium in the ascending loop of
Henle, leading to significant potassium loss. Hypokalemia is a major adverse effect that can predispose the
patient to cardiac arrhythmias. While sodium, calcium, and magnesium can be affected, potassium monitoring is
the most critical priority for patient safety.
Question 4
Which of the following is the most effective initial intervention to prevent skin breakdown in a bedridden
patient?
A. Massaging bony prominences
B. Applying moisturizing lotion daily
C. Repositioning the patient every 2 hours
D. Using an inflatable doughnut cushion
🟢 Correct Answer:
C. Repositioning the patient every 2 hours
🔴 RATIONALE:
Repositioning is the cornerstone of pressure ulcer prevention. It relieves pressure on bony prominences,
allowing for tissue reperfusion. Massaging bony prominences can damage capillaries and is no longer
recommended. Doughnut cushions can create a tourniquet effect and reduce blood flow to tissues.
, Question 5
A healthcare provider orders a medication to be administered "stat." How should the nurse interpret this order?
A. Give the medication before the patient goes to bed.
B. Give the medication with meals.
C. Give the medication immediately and once only.
D. Give the medication immediately but only after obtaining a second signature.
🟢 Correct Answer:
C. Give the medication immediately and once only.
🔴 RATIONALE:
In medical terminology, "stat" is derived from the Latin word "statim," meaning immediately. A stat order is a
single-dose order to be given at once for an urgent situation. It is distinct from routine, PRN (as needed), or
standing orders.
Question 6
A nurse is preparing to administer an intramuscular injection to a patient with a small muscle mass. Which
needle gauge is most appropriate to minimize tissue damage?
A. 18 gauge
B. 20 gauge
C. 22 gauge
D. 25 gauge
