HESI FUNDAMENTALS PRACTICE QUESTIONS
AND RIGHT ACTUAL ANSWERS.
*A,client's,blood,pressure,reading,is,156/94,mm,Hg.,Which,action,should,the,nurse,take,first?*
A.,Tell,the,client,that,the,blood,pressure,is,high,and,that,the,reading,needs,to,be,verified,by,another,nu
rse.
B.,Contact,the,health,care,provider,to,report,the,reading,and,obtain,a,prescription,for,an,antihypertens
ive,medication.
C.,Replace,the,cuff,with,a,larger,one,to,ensure,an,ample,fit,for,the,client,to,increase,arm,comfort.
D.,Compare,the,current,reading,with,the,client's,previously,documented,blood,pressure,readings.,,,ANS
,-D.,Compare,the,current,reading,with,the,client's,previously,documented,blood,pressure,readings.
Rationale:,Comparing,this,reading,with,previous,readings,will,provide,information,about,what,is,normal
,for,this,client;,this,action,should,be,taken,first.,Option,A,might,unnecessarily,alarm,the,client.,Option,B
,is,premature.,Further,assessment,is,needed,to,determine,if,the,reading,is,abnormal,for,this,client.,Opti
on,C,could,falsely,decrease,the,reading,and,is,not,the,correct,procedure,for,obtaining,a,blood,pressure,
reading.
*In,assisting,an,older,adult,client,prepare,to,take,a,tub,bath,,which,nursing,action,is,most,important?*
A.,Check,the,bath,water,temperature.
B.,Shut,the,bathroom,door.
C.,Ensure,that,the,client,has,voided.
D.,Provide,extra,towels,,,ANS,-A.,Check,the,bath,water,temperature
Rationale:,To,prevent,burns,or,excessive,chilling,,the,nurse,must,check,the,bath,water,temperature.,Op
tions,B,,C,,and,D,promote,comfort,and,privacy,and,are,important,interventions,but,are,of,less,priority,t
han,promoting,safety.
*The,nurse,who,is,preparing,to,give,a,14-year-
old,client,a,prescribed,antipsychotic,medication,notes,that,parental,consent,has,not,been,obtained.,Wh
ich,action,should,the,nurse,take?*
,A.,Review,the,chart,for,a,signed,consent,for,hospitalization.
B.,Get,the,health,care,provider's,permission,to,give,the,medication.
C.,Do,not,give,the,medication,and,document,the,reason.
D.,Complete,an,incident,report,and,notify,the,parents.,,,ANS,-
C.,Do,not,give,the,medication,and,document,the,reason.
Rationale:,The,nurse,should,not,give,the,medication,and,should,document,the,reason,because,the,clien
t,is,a,minor,and,needs,a,guardian's,permission,to,receive,medications.,Permission,to,give,medications,is
,not,granted,by,a,signed,hospital,consent,or,a,health,care,provider's,permission,,unless,conditions,are,
met,to,justify,coerced,treatment.,Option,D,is,not,necessary,unless,the,medication,had,previously,been,
administered.
*A,client,with,frequent,urinary,tract,infections,(UTIs),asks,the,nurse,to,explain,a,friend's,advice,about,d
rinking,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.,"Cranberry,juice,stops,pathogens',adherence,to,the,bladder."
Rationale:,Cranberry,juice,maintains,urinary,tract,health,by,reducing,the,adherence,of,Escherichia,coli,b
acteria,to,cells,within,the,bladder.,Options,A,,B,,and,D,have,not,been,shown,to,be,as,effective,as,cranb
erry,juice,in,preventing,UTIs.
*After,the,nurse,tells,an,older,client,that,an,IV,line,needs,to,be,inserted,,the,client,becomes,very,appre
hensive,,loudly,verbalizing,a,dislike,for,all,health,care,providers,and,nurses.,How,should,the,nurse,resp
ond?*
A.,Ask,the,client,to,remain,quiet,so,the,procedure,can,be,performed,safely.
B.,Concentrate,on,completing,the,insertion,as,efficiently,as,possible.
C.,Calmly,reassure,the,client,that,the,discomfort,will,be,temporary.
,D.,Tell,the,client,a,joke,as,a,means,of,distraction,from,the,procedure.,,,ANS,-
C.Calmly,reassure,the,client,that,the,discomfort,will,be,temporary.
Rationale:,The,nurse,should,respond,with,a,calm,demeanor,to,help,reduce,the,client's,apprehension.,Af
ter,responding,calmly,to,the,client's,apprehension,,the,nurse,may,implement,to,ensure,safe,completion
,of,the,procedure.
*Which,fluid,will,the,nurse,select,to,administer,with,the,prescribed,blood,transfusion?*
A.,5%,Dextrose,and,water
B.,Normal,saline
C.,Lactated,Ringers,solution
D.,5%,Dextrose,and,lactated,ringers,,,ANS,-B.Normal,saline
Rationale:Normal,saline,solution,is,the,only,solution,that,is,compatible,with,blood.
*The,nurse,is,teaching,an,obese,client,,newly,diagnosed,with,arteriosclerosis,,about,reducing,the,risk,of
,a,heart,attack,or,stroke.,Which,health,promotion,brochure,is,most,important,for,the,nurse,to,provide,t
o,this,client?*
A."Monitoring,Your,Blood,Pressure,at,Home"
B."Smoking,Cessation,as,a,Lifelong,Commitment"
C."Decreasing,Cholesterol,Levels,Through,Diet"
D."Stress,Management,for,a,Healthier,You",,,ANS,-C."Decreasing,Cholesterol,Levels,Through,Diet"
Rationale:,A,health,promotion,brochure,about,decreasing,cholesterol,is,most,important,to,provide,this,
client,,because,the,most,significant,risk,factor,contributing,to,development,of,arteriosclerosis,is,excess,
dietary,fat,,particularly,saturated,fat,and,cholesterol.,Option,A,does,not,address,the,underlying,causes,
of,arteriosclerosis.,Options,B,and,D,are,also,important,factors,for,reversing,arteriosclerosis,but,are,not,
as,important,as,lowering,cholesterol.
, *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,sho
uld,the,nurse,respond?*
A.,Provide,the,client,with,a,list,of,Internet,sites,that,answer,frequently,asked,questions,about,medicati
ons.
B.,Advise,the,client,to,obtain,a,current,edition,of,a,drug,reference,book,from,a,local,bookstore,or,librar
y.
C.,Reassure,the,client,that,information,about,the,medication,is,included,in,the,written,instructions.
D.,Encourage,the,client,to,call,the,clinic,nurse,or,health,care,provider,if,any,questions,arise.,,,ANS,-
D.,Encourage,the,client,to,call,the,clinic,nurse,or,health,care,provider,if,any,questions,arise.
Rationale:To,ensure,safe,medication,use,,the,nurse,should,encourage,the,client,to,call,the,nurse,or,hea
lth,care,provider,if,any,questions,arise.,Options,A,,B,,and,C,may,all,include,useful,information,,but,thes
e,sources,of,information,cannot,evaluate,the,nature,of,the,client's,questions,and,the,follow-up,needed.
*The,nurse,evaluates,the,insertion,site,of,an,IV,catheter,and,suspects,the,IV,is,infiltrated.,Which,finding
s,support,the,evaluation?,(Select,all,that,apply.)*
A.,The,area,around,the,insertion,site,is,swollen.
B.,There,is,bruising,1,inch,below,the,insertion,site.
C.,The,insertion,site,is,cool,to,the,touch.
D.,The,client,complains,of,a,burning,pain,at,the,site.
E.,Redness,is,noted,in,the,area,of,the,insertion,site.
F.,Blood,is,noted,in,the,IV,tubing,when,the,IV,bag,is,lowered.,,,ANS,-
A.The,area,around,the,insertion,site,is,swollen.
C.The,insertion,site,is,cool,to,the,touch.
D.The,client,complains,of,a,burning,pain,at,the,site.
E.Redness,is,noted,in,the,area,of,the,insertion,site.
Rationale:,Bruising,is,an,accumulation,of,blood,under,the,skin,,most,likely,from,oozing,with,the,insertio
n,of,the,IV.,When,blood,is,noted,in,the,IV,tubing,when,the,IV,bag,is,lowered,,that,is,a,sign,of,patency.,T
he,remaining,signs,are,related,to,infiltration.
AND RIGHT ACTUAL ANSWERS.
*A,client's,blood,pressure,reading,is,156/94,mm,Hg.,Which,action,should,the,nurse,take,first?*
A.,Tell,the,client,that,the,blood,pressure,is,high,and,that,the,reading,needs,to,be,verified,by,another,nu
rse.
B.,Contact,the,health,care,provider,to,report,the,reading,and,obtain,a,prescription,for,an,antihypertens
ive,medication.
C.,Replace,the,cuff,with,a,larger,one,to,ensure,an,ample,fit,for,the,client,to,increase,arm,comfort.
D.,Compare,the,current,reading,with,the,client's,previously,documented,blood,pressure,readings.,,,ANS
,-D.,Compare,the,current,reading,with,the,client's,previously,documented,blood,pressure,readings.
Rationale:,Comparing,this,reading,with,previous,readings,will,provide,information,about,what,is,normal
,for,this,client;,this,action,should,be,taken,first.,Option,A,might,unnecessarily,alarm,the,client.,Option,B
,is,premature.,Further,assessment,is,needed,to,determine,if,the,reading,is,abnormal,for,this,client.,Opti
on,C,could,falsely,decrease,the,reading,and,is,not,the,correct,procedure,for,obtaining,a,blood,pressure,
reading.
*In,assisting,an,older,adult,client,prepare,to,take,a,tub,bath,,which,nursing,action,is,most,important?*
A.,Check,the,bath,water,temperature.
B.,Shut,the,bathroom,door.
C.,Ensure,that,the,client,has,voided.
D.,Provide,extra,towels,,,ANS,-A.,Check,the,bath,water,temperature
Rationale:,To,prevent,burns,or,excessive,chilling,,the,nurse,must,check,the,bath,water,temperature.,Op
tions,B,,C,,and,D,promote,comfort,and,privacy,and,are,important,interventions,but,are,of,less,priority,t
han,promoting,safety.
*The,nurse,who,is,preparing,to,give,a,14-year-
old,client,a,prescribed,antipsychotic,medication,notes,that,parental,consent,has,not,been,obtained.,Wh
ich,action,should,the,nurse,take?*
,A.,Review,the,chart,for,a,signed,consent,for,hospitalization.
B.,Get,the,health,care,provider's,permission,to,give,the,medication.
C.,Do,not,give,the,medication,and,document,the,reason.
D.,Complete,an,incident,report,and,notify,the,parents.,,,ANS,-
C.,Do,not,give,the,medication,and,document,the,reason.
Rationale:,The,nurse,should,not,give,the,medication,and,should,document,the,reason,because,the,clien
t,is,a,minor,and,needs,a,guardian's,permission,to,receive,medications.,Permission,to,give,medications,is
,not,granted,by,a,signed,hospital,consent,or,a,health,care,provider's,permission,,unless,conditions,are,
met,to,justify,coerced,treatment.,Option,D,is,not,necessary,unless,the,medication,had,previously,been,
administered.
*A,client,with,frequent,urinary,tract,infections,(UTIs),asks,the,nurse,to,explain,a,friend's,advice,about,d
rinking,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.,"Cranberry,juice,stops,pathogens',adherence,to,the,bladder."
Rationale:,Cranberry,juice,maintains,urinary,tract,health,by,reducing,the,adherence,of,Escherichia,coli,b
acteria,to,cells,within,the,bladder.,Options,A,,B,,and,D,have,not,been,shown,to,be,as,effective,as,cranb
erry,juice,in,preventing,UTIs.
*After,the,nurse,tells,an,older,client,that,an,IV,line,needs,to,be,inserted,,the,client,becomes,very,appre
hensive,,loudly,verbalizing,a,dislike,for,all,health,care,providers,and,nurses.,How,should,the,nurse,resp
ond?*
A.,Ask,the,client,to,remain,quiet,so,the,procedure,can,be,performed,safely.
B.,Concentrate,on,completing,the,insertion,as,efficiently,as,possible.
C.,Calmly,reassure,the,client,that,the,discomfort,will,be,temporary.
,D.,Tell,the,client,a,joke,as,a,means,of,distraction,from,the,procedure.,,,ANS,-
C.Calmly,reassure,the,client,that,the,discomfort,will,be,temporary.
Rationale:,The,nurse,should,respond,with,a,calm,demeanor,to,help,reduce,the,client's,apprehension.,Af
ter,responding,calmly,to,the,client's,apprehension,,the,nurse,may,implement,to,ensure,safe,completion
,of,the,procedure.
*Which,fluid,will,the,nurse,select,to,administer,with,the,prescribed,blood,transfusion?*
A.,5%,Dextrose,and,water
B.,Normal,saline
C.,Lactated,Ringers,solution
D.,5%,Dextrose,and,lactated,ringers,,,ANS,-B.Normal,saline
Rationale:Normal,saline,solution,is,the,only,solution,that,is,compatible,with,blood.
*The,nurse,is,teaching,an,obese,client,,newly,diagnosed,with,arteriosclerosis,,about,reducing,the,risk,of
,a,heart,attack,or,stroke.,Which,health,promotion,brochure,is,most,important,for,the,nurse,to,provide,t
o,this,client?*
A."Monitoring,Your,Blood,Pressure,at,Home"
B."Smoking,Cessation,as,a,Lifelong,Commitment"
C."Decreasing,Cholesterol,Levels,Through,Diet"
D."Stress,Management,for,a,Healthier,You",,,ANS,-C."Decreasing,Cholesterol,Levels,Through,Diet"
Rationale:,A,health,promotion,brochure,about,decreasing,cholesterol,is,most,important,to,provide,this,
client,,because,the,most,significant,risk,factor,contributing,to,development,of,arteriosclerosis,is,excess,
dietary,fat,,particularly,saturated,fat,and,cholesterol.,Option,A,does,not,address,the,underlying,causes,
of,arteriosclerosis.,Options,B,and,D,are,also,important,factors,for,reversing,arteriosclerosis,but,are,not,
as,important,as,lowering,cholesterol.
, *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,sho
uld,the,nurse,respond?*
A.,Provide,the,client,with,a,list,of,Internet,sites,that,answer,frequently,asked,questions,about,medicati
ons.
B.,Advise,the,client,to,obtain,a,current,edition,of,a,drug,reference,book,from,a,local,bookstore,or,librar
y.
C.,Reassure,the,client,that,information,about,the,medication,is,included,in,the,written,instructions.
D.,Encourage,the,client,to,call,the,clinic,nurse,or,health,care,provider,if,any,questions,arise.,,,ANS,-
D.,Encourage,the,client,to,call,the,clinic,nurse,or,health,care,provider,if,any,questions,arise.
Rationale:To,ensure,safe,medication,use,,the,nurse,should,encourage,the,client,to,call,the,nurse,or,hea
lth,care,provider,if,any,questions,arise.,Options,A,,B,,and,C,may,all,include,useful,information,,but,thes
e,sources,of,information,cannot,evaluate,the,nature,of,the,client's,questions,and,the,follow-up,needed.
*The,nurse,evaluates,the,insertion,site,of,an,IV,catheter,and,suspects,the,IV,is,infiltrated.,Which,finding
s,support,the,evaluation?,(Select,all,that,apply.)*
A.,The,area,around,the,insertion,site,is,swollen.
B.,There,is,bruising,1,inch,below,the,insertion,site.
C.,The,insertion,site,is,cool,to,the,touch.
D.,The,client,complains,of,a,burning,pain,at,the,site.
E.,Redness,is,noted,in,the,area,of,the,insertion,site.
F.,Blood,is,noted,in,the,IV,tubing,when,the,IV,bag,is,lowered.,,,ANS,-
A.The,area,around,the,insertion,site,is,swollen.
C.The,insertion,site,is,cool,to,the,touch.
D.The,client,complains,of,a,burning,pain,at,the,site.
E.Redness,is,noted,in,the,area,of,the,insertion,site.
Rationale:,Bruising,is,an,accumulation,of,blood,under,the,skin,,most,likely,from,oozing,with,the,insertio
n,of,the,IV.,When,blood,is,noted,in,the,IV,tubing,when,the,IV,bag,is,lowered,,that,is,a,sign,of,patency.,T
he,remaining,signs,are,related,to,infiltration.
