1|Page
HESI FUNDAMENTALS EXAM SPRING 2026 VERIFIED
TEST BANK UPDATED 100% CORRECT
ANSWERS||NEWEST UPDATE!!!!
The home health nurse visits an elderly female client who
had a brain attack three months ago and is now able to
ambulate with the assistance of the quad cane. Which
assessment finding has the greatest implications for this
clients care? - Answer-The nurse notes that there are
numerous scatter rugs throughout the house. Scatter rugs
pose a safety hazard because the client can trip on them
when ambulating, so this finding has the greatest
significance in planning this client's care
The nurse is digitally removing a fecal impaction for a
client. The nurse should stop the procedure and take
corrective action if which client reaction is noted? -
Answer-Pulse rate decreases from 78 to 52 beats/min.
Parasympathetic reactions can occur as a result of digital
stimulation of the anal sphincter, which should be stopped
if the client experiences a vagal response, such as
bradycardia
,2|Page
The nurse is providing passive range of motion exercises
to the hip and knee for a client who is unconscious. After
supporting the client's knee with one hand, what action
should the nurse take next? - Answer-Cradle the client's
heel.
Passive ROM exercise for the hip and knee is provided by
supporting the joints of the knee and ankle and gently
moving the limb in a slow, smooth, firm but gentle manner,
followed by bending the knee and moving it toward the
chest as far as it will go. Bed should be raised to a
comfortable working level first
A client who has moderate, persistent, chronic neuropathic
pain due to diabetic neuropathy takes gabapentin
(neurontin) and ibuprofen daily. If step 2 of the WHO pain
relief ladder is prescribed, which drug protocol should be
implemented? - Answer-Continue gabapentin
*step 1 drugs are nonopioid analgesics
*step 2 and 3 are narcotics and should be given around
the clock rather than by the clients PRN requests
,3|Page
The nurse is preparing to irrigate a client's indwelling
urinary catheter using an open technique. What action
should the nurse take after applying gloves? - Answer-
Draw up the irrigating solution into the syringe.
To irrigate an indwelling urinary catheter, the nurse should
first apply gloves, then draw up the irrigating solution into
the syringe. The syringe is then attached to the catheter
and the fluid instilled, using aseptic technique. Once the
irrigating solution is instilled, the client's catheter should be
secured to the drainage tubing. The urinary drainage bag
can be emptied whenever intake and output measurement
is indicated, and the instilled irrigating fluid can be
subtracted from the output at that time.
Which client care requires the nurse to wear barrier gloves
as required by the protocol for standard precautions? -
Answer-Emptying the urinary catheter drainage bag for a
client with Alzheimer's disease
*possible contact with body secretions, excretions, or
broken skin is an indication for wearing barrier gloves.
Emptying a urine drainage bag requires the use of gloves.
, 4|Page
What action should the nurse implement to prevent the
formation of a sacral ulcer for a client who is immobile? -
Answer-Position prone with a small pillow below the
diaphragm
*this maintains alignment and provides the best pressure
relief over the sacral bony prominence
What intervention should the nurse include in the plan of
care for a client who is being treated with an Unna's paste
boot for leg ulcers due to chronic venous insufficiency? -
Answer-Check capillary refill of toes on lower extremity
with Unna's paste boot
*it becomes rigid after it dries so it is important to check
distally for adequate circulation
The nurse is administering an intermittent infusion of an
antibiotic to a client whose intravenous access is an
antecubital saline lock. After the nurse opens the roller
clamp on the IV tubing, the alarm on the infusion pump
indicates an obstruction. What action should the nurse
take first? - Answer-Reposition the client's arm.
HESI FUNDAMENTALS EXAM SPRING 2026 VERIFIED
TEST BANK UPDATED 100% CORRECT
ANSWERS||NEWEST UPDATE!!!!
The home health nurse visits an elderly female client who
had a brain attack three months ago and is now able to
ambulate with the assistance of the quad cane. Which
assessment finding has the greatest implications for this
clients care? - Answer-The nurse notes that there are
numerous scatter rugs throughout the house. Scatter rugs
pose a safety hazard because the client can trip on them
when ambulating, so this finding has the greatest
significance in planning this client's care
The nurse is digitally removing a fecal impaction for a
client. The nurse should stop the procedure and take
corrective action if which client reaction is noted? -
Answer-Pulse rate decreases from 78 to 52 beats/min.
Parasympathetic reactions can occur as a result of digital
stimulation of the anal sphincter, which should be stopped
if the client experiences a vagal response, such as
bradycardia
,2|Page
The nurse is providing passive range of motion exercises
to the hip and knee for a client who is unconscious. After
supporting the client's knee with one hand, what action
should the nurse take next? - Answer-Cradle the client's
heel.
Passive ROM exercise for the hip and knee is provided by
supporting the joints of the knee and ankle and gently
moving the limb in a slow, smooth, firm but gentle manner,
followed by bending the knee and moving it toward the
chest as far as it will go. Bed should be raised to a
comfortable working level first
A client who has moderate, persistent, chronic neuropathic
pain due to diabetic neuropathy takes gabapentin
(neurontin) and ibuprofen daily. If step 2 of the WHO pain
relief ladder is prescribed, which drug protocol should be
implemented? - Answer-Continue gabapentin
*step 1 drugs are nonopioid analgesics
*step 2 and 3 are narcotics and should be given around
the clock rather than by the clients PRN requests
,3|Page
The nurse is preparing to irrigate a client's indwelling
urinary catheter using an open technique. What action
should the nurse take after applying gloves? - Answer-
Draw up the irrigating solution into the syringe.
To irrigate an indwelling urinary catheter, the nurse should
first apply gloves, then draw up the irrigating solution into
the syringe. The syringe is then attached to the catheter
and the fluid instilled, using aseptic technique. Once the
irrigating solution is instilled, the client's catheter should be
secured to the drainage tubing. The urinary drainage bag
can be emptied whenever intake and output measurement
is indicated, and the instilled irrigating fluid can be
subtracted from the output at that time.
Which client care requires the nurse to wear barrier gloves
as required by the protocol for standard precautions? -
Answer-Emptying the urinary catheter drainage bag for a
client with Alzheimer's disease
*possible contact with body secretions, excretions, or
broken skin is an indication for wearing barrier gloves.
Emptying a urine drainage bag requires the use of gloves.
, 4|Page
What action should the nurse implement to prevent the
formation of a sacral ulcer for a client who is immobile? -
Answer-Position prone with a small pillow below the
diaphragm
*this maintains alignment and provides the best pressure
relief over the sacral bony prominence
What intervention should the nurse include in the plan of
care for a client who is being treated with an Unna's paste
boot for leg ulcers due to chronic venous insufficiency? -
Answer-Check capillary refill of toes on lower extremity
with Unna's paste boot
*it becomes rigid after it dries so it is important to check
distally for adequate circulation
The nurse is administering an intermittent infusion of an
antibiotic to a client whose intravenous access is an
antecubital saline lock. After the nurse opens the roller
clamp on the IV tubing, the alarm on the infusion pump
indicates an obstruction. What action should the nurse
take first? - Answer-Reposition the client's arm.
