HESI LEVEL 1 PRACTICE EXAM QUESTIONS
AND ANSWERS 100% CORRECT!
,The nurse is caring for a client who is receiving 24-hour total parenteral nutrition (TPN)
via a central line at 54 ml/hr. When initially assessing the client, the nurse notes that the
TPN solution has run out and the next TPN solution is not available. What immediate
action should the nurse take?
A. Infuse normal saline at a keep vein open rate.
B. Discontinue the IV and flush the port with heparin.
C. Infuse 10% dextrose and water at 54 ml/hour.
D. Obtain a stat blood glucose level and notify the healthcare provider. - ANSWER C
A crying toddler has a blood pressure measurement of 120/70 mm Hg. What action
should the nurse implement?
A. Notify the healthcare provider of the measurement.
B. Quiet the child and retake the blood pressure.
C. Ask the parent if the child has a history of hypertension.
D. Document the finding and recheck in 4 hours. - ANSWER B
The mother of a neonate asks the nurse why it is so important to keep the infant warm.
What information should the nurse provide?
A. The kidneys and renal function are not fully developed.
B. Warmth promotes sleep so the infant will grow quickly.
C. A large body surface area favors heat loss to the environment.
D. The thick layer of subcutaneous fat is inadequate for insulation. - ANSWER C
What action by the nurse demonstrates culturally sensitive care?
A. Asks permission before touching a client.
B. Avoids questions about male-female relationships.
C. Explains the differences between Western medical care and cultural folk remedies.
D. Applies knowledge of a cultural group unless a client embraces Western customs. -
ANSWER A
A client has a nursing diagnosis of, "Spiritual distress related to a loss of hope,
secondary to impending death." What intervention is best for the nurse to implement
when caring for this client?
A. Help the client to accept the final stage of life.
B. Assist and support the client in establishing short-term goals.
C. Encourage the client to make future plans, even if they are unrealistic.
, D. Instruct the client's family to focus on positive aspects of the client's life. - ANSWER
B
In evaluating client care, which action should the nurse take first?
A. Determine if the expected outcomes of care were achieved.
B. Review the rationales used as the basis of nursing actions.
C. Document the care plan goals that were successfully met.
D. Prioritize interventions to be added to the client's plan of care. - ANSWER A
A female client asks the nurse to find someone who can translate her treatment
concerns into her native language. Which action should the nurse take?
A. Explain that anyone who speaks her language can answer her questions.
B. Provide a translator only in an emergency situation.
C. Ask a family member or friend of the client to translate.
D. Request and document the name of the certified translator. - ANSWER D
An unlicensed assistive personnel (UAP) places a client in a left lateral position prior to
administering a soap suds enema. Which instruction should the nurse provide the UAP?
A. Position the client on the right side of the bed in reverse Trendelenburg.
B. Fill the enema container with 1000 mL of warm water and 5 mL of castile soap.
C. Reposition in a Sims' position with the client's weight on the anterior ilium.
D. Raise the side rails on both sides of the bed and elevate the bed to waist level. -
ANSWER C
A child with a penetrating eye injury comes to the school clinic. What action should the
nurse implement?
A. Remove the object impaled in the eye and then apply a regular eye patch.
B. Place an ice bag over the eye until the healthcare provider is seen.
C. Irrigate the affected eye copiously with a cool sterile saline solution.
D. Apply a Fox shield to the affected eye and any type of patch to the other eye. -
ANSWER D
When making the bed of a client who needs a bed cradle, which action should the nurse
include?
A. Teach the client to call for help before getting out of bed.
B. Keep both the upper and lower side rails in a raised position.
C. Keep the bed in the lowest position while changing the sheets.
D. Drape the top sheet and covers loosely over the bed cradle. - ANSWER D
A male client with venous incompetence stands up and his blood pressure subsequently
drops. Which finding should the nurse identify as a compensatory response?
A. Bradycardia.
AND ANSWERS 100% CORRECT!
,The nurse is caring for a client who is receiving 24-hour total parenteral nutrition (TPN)
via a central line at 54 ml/hr. When initially assessing the client, the nurse notes that the
TPN solution has run out and the next TPN solution is not available. What immediate
action should the nurse take?
A. Infuse normal saline at a keep vein open rate.
B. Discontinue the IV and flush the port with heparin.
C. Infuse 10% dextrose and water at 54 ml/hour.
D. Obtain a stat blood glucose level and notify the healthcare provider. - ANSWER C
A crying toddler has a blood pressure measurement of 120/70 mm Hg. What action
should the nurse implement?
A. Notify the healthcare provider of the measurement.
B. Quiet the child and retake the blood pressure.
C. Ask the parent if the child has a history of hypertension.
D. Document the finding and recheck in 4 hours. - ANSWER B
The mother of a neonate asks the nurse why it is so important to keep the infant warm.
What information should the nurse provide?
A. The kidneys and renal function are not fully developed.
B. Warmth promotes sleep so the infant will grow quickly.
C. A large body surface area favors heat loss to the environment.
D. The thick layer of subcutaneous fat is inadequate for insulation. - ANSWER C
What action by the nurse demonstrates culturally sensitive care?
A. Asks permission before touching a client.
B. Avoids questions about male-female relationships.
C. Explains the differences between Western medical care and cultural folk remedies.
D. Applies knowledge of a cultural group unless a client embraces Western customs. -
ANSWER A
A client has a nursing diagnosis of, "Spiritual distress related to a loss of hope,
secondary to impending death." What intervention is best for the nurse to implement
when caring for this client?
A. Help the client to accept the final stage of life.
B. Assist and support the client in establishing short-term goals.
C. Encourage the client to make future plans, even if they are unrealistic.
, D. Instruct the client's family to focus on positive aspects of the client's life. - ANSWER
B
In evaluating client care, which action should the nurse take first?
A. Determine if the expected outcomes of care were achieved.
B. Review the rationales used as the basis of nursing actions.
C. Document the care plan goals that were successfully met.
D. Prioritize interventions to be added to the client's plan of care. - ANSWER A
A female client asks the nurse to find someone who can translate her treatment
concerns into her native language. Which action should the nurse take?
A. Explain that anyone who speaks her language can answer her questions.
B. Provide a translator only in an emergency situation.
C. Ask a family member or friend of the client to translate.
D. Request and document the name of the certified translator. - ANSWER D
An unlicensed assistive personnel (UAP) places a client in a left lateral position prior to
administering a soap suds enema. Which instruction should the nurse provide the UAP?
A. Position the client on the right side of the bed in reverse Trendelenburg.
B. Fill the enema container with 1000 mL of warm water and 5 mL of castile soap.
C. Reposition in a Sims' position with the client's weight on the anterior ilium.
D. Raise the side rails on both sides of the bed and elevate the bed to waist level. -
ANSWER C
A child with a penetrating eye injury comes to the school clinic. What action should the
nurse implement?
A. Remove the object impaled in the eye and then apply a regular eye patch.
B. Place an ice bag over the eye until the healthcare provider is seen.
C. Irrigate the affected eye copiously with a cool sterile saline solution.
D. Apply a Fox shield to the affected eye and any type of patch to the other eye. -
ANSWER D
When making the bed of a client who needs a bed cradle, which action should the nurse
include?
A. Teach the client to call for help before getting out of bed.
B. Keep both the upper and lower side rails in a raised position.
C. Keep the bed in the lowest position while changing the sheets.
D. Drape the top sheet and covers loosely over the bed cradle. - ANSWER D
A male client with venous incompetence stands up and his blood pressure subsequently
drops. Which finding should the nurse identify as a compensatory response?
A. Bradycardia.
