NUR 112 - HESI Exam Study
Guide – Practice Questions
with Verified Answers with
rationales. GRADED A+. Latest
2026/2027 Update
The nurse teaches the use of a gait belt to a male caregiver whose wife has
right-sided weakness and needs assistance with ambulation. The caregiver
performs a return demonstration of the skill. Which observation indicates that
the caregiver has learned how to perform this procedure correctly?
-
A. Standing on his wife's strong side, the caregiver is ready to hold the gait belt
if any evidence of weakness is observed.
B. Standing on his wife's weak side, the caregiver provides security by holding
the gait belt from the back.
C. Standing behind his wife, the caregiver provides balance by holding both
sides of the gait belt.
D. Standing slightly in front and to the right of his wife, the caregiver guides her
forward by gently pulling on the gait belt.
B. Standing on his wife's weak side, the caregiver provides security by holding
the gait belt from the back.
-
His wife is most likely to lean toward the weak side and needs extra support on
that side and from the back to prevent falling. Options A, C, and D provide less
security for her.
,Which nursing diagnosis has the highest priority when planning care for a client
with an indwelling urinary catheter?
-
A. Self-care deficit
B. Functional incontinence
C. Fluid volume deficit
D. High risk for infection
D. High risk for infection
-
Indwelling urinary catheters are a major source of infection. Options A and B
are both problems that may require an indwelling catheter. Option C is not
affected by an indwelling catheter.
A client has a nursing diagnosis of Altered sleep patterns related to nocturia.
Which client instruction is important for the nurse to provide?
-
A. Decrease intake of fluids after the evening meal.
B. Drink a glass of cranberry juice every day.
C. Drink a glass of warm decaffeinated beverage at bedtime.
D. Consult the health care provider about a sleeping pill.
A. Decrease intake of fluids after the evening meal.
-
Nocturia is urination during the night. Option A is helpful to decrease the
production of urine, thus decreasing the need to void at night. Option B helps
prevent bladder infections. Option C may promote sleep, but the fluid will
contribute to nocturia. Option D may result in urinary incontinence if the client
is sedated and does not awaken to void.
While reviewing the side effects of a newly prescribed medication, a 72-year-
old client notes that one of the side effects is a reduction in sexual drive. Which
is the best response by the nurse?
-
A. "How will this affect your present sexual activity?"
B. "How active is your current sex life?"
,C. "How has your sex life changed as you have become older?"
D. "Tell me about your sexual needs as an older adult."
A. "How will this affect your present sexual activity?"
-
Option A offers an open-ended question most relevant to the client's
statement. Option B does not offer the client the opportunity to express
concerns. Options C and D are even less relevant to the client's statement.
The nurse is using the Glasgow Coma Scale to perform a neurologic
assessment. A comatose client winces and pulls away from a painful stimulus.
Which action should the nurse take next?
-
A. Document that the client responds to painful stimulus.
B. Observe the client's response to verbal stimulation.
C. Place the client on seizure precautions for 24 hours.
D. Report decorticate posturing to the health care provider
A. Document that the client responds to painful stimulus.
-
The client has demonstrated a purposeful response to pain, which should be
documented as such. Response to painful stimulus is assessed after response
to verbal stimulus, not before. There is no indication for placing the client on
seizure precautions. Reporting decorticate posturing to the health care
provider is nonpurposeful movement.
The nurse plans to administer diazepam, 4 mg IV push, to a client with severe
anxiety. How many milliliters should the nurse administer? (Round to the
nearest tenth.)
-
A. 0.2 mL
B. 0.8 mL
C. 1.25 mL
D. 2.0 mL
B. 0.8 mL
-
(1 mL × 4 mg)/5 mg = 0.8 mL
, The nurse prepares to insert a nasogastric tube in a client
with hyperemesis who is awake and alert. Which intervention(s) is(are)
correct? (Select all that apply.)
-
A. Place the client in a high Fowler position.
B. Help the client assume a left side-lying position.
C. Measure the tube from the tip of the nose to the umbilicus.
D. Instruct the client to swallow after the tube has passed the pharynx.
E. Assist the client in extending the neck back so the tube may enter the larynx.
A. Place the client in a high Fowler position.
D. Instruct the client to swallow after the tube has passed the pharynx.
-
(A and D) are the correct steps to follow during nasogastric intubation. Only the
unconscious or obtunded client should be placed in a left side-lying position
(B). The tube should be measured from the tip of the nose to behind the ear
and then from behind the ear to the xiphoid process (C). The neck should only
be extended back prior to the tube passing the pharynx and then the client
should be instructed to position the neck forward (E).
When performing sterile wound care in the acute care setting, the nurse
obtains a bottle of normal saline from the bedside table that is labeled
"opened" and dated 48 hours prior to the current date. Which is the best
action for the nurse to take?
-
A. Use the normal saline solution once more and then discard.
B. Obtain a new sterile syringe to draw up the labeled saline solution.
C. Use the saline solution and then relabel the bottle with the current date.
D. Discard the saline solution and obtain a new unopened bottle.
D. Discard the saline solution and obtain a new unopened bottle.
-
Solutions labeled as opened within 24 hours may be used for clean procedures,
but only newly opened solutions are considered sterile. This solution is not
Guide – Practice Questions
with Verified Answers with
rationales. GRADED A+. Latest
2026/2027 Update
The nurse teaches the use of a gait belt to a male caregiver whose wife has
right-sided weakness and needs assistance with ambulation. The caregiver
performs a return demonstration of the skill. Which observation indicates that
the caregiver has learned how to perform this procedure correctly?
-
A. Standing on his wife's strong side, the caregiver is ready to hold the gait belt
if any evidence of weakness is observed.
B. Standing on his wife's weak side, the caregiver provides security by holding
the gait belt from the back.
C. Standing behind his wife, the caregiver provides balance by holding both
sides of the gait belt.
D. Standing slightly in front and to the right of his wife, the caregiver guides her
forward by gently pulling on the gait belt.
B. Standing on his wife's weak side, the caregiver provides security by holding
the gait belt from the back.
-
His wife is most likely to lean toward the weak side and needs extra support on
that side and from the back to prevent falling. Options A, C, and D provide less
security for her.
,Which nursing diagnosis has the highest priority when planning care for a client
with an indwelling urinary catheter?
-
A. Self-care deficit
B. Functional incontinence
C. Fluid volume deficit
D. High risk for infection
D. High risk for infection
-
Indwelling urinary catheters are a major source of infection. Options A and B
are both problems that may require an indwelling catheter. Option C is not
affected by an indwelling catheter.
A client has a nursing diagnosis of Altered sleep patterns related to nocturia.
Which client instruction is important for the nurse to provide?
-
A. Decrease intake of fluids after the evening meal.
B. Drink a glass of cranberry juice every day.
C. Drink a glass of warm decaffeinated beverage at bedtime.
D. Consult the health care provider about a sleeping pill.
A. Decrease intake of fluids after the evening meal.
-
Nocturia is urination during the night. Option A is helpful to decrease the
production of urine, thus decreasing the need to void at night. Option B helps
prevent bladder infections. Option C may promote sleep, but the fluid will
contribute to nocturia. Option D may result in urinary incontinence if the client
is sedated and does not awaken to void.
While reviewing the side effects of a newly prescribed medication, a 72-year-
old client notes that one of the side effects is a reduction in sexual drive. Which
is the best response by the nurse?
-
A. "How will this affect your present sexual activity?"
B. "How active is your current sex life?"
,C. "How has your sex life changed as you have become older?"
D. "Tell me about your sexual needs as an older adult."
A. "How will this affect your present sexual activity?"
-
Option A offers an open-ended question most relevant to the client's
statement. Option B does not offer the client the opportunity to express
concerns. Options C and D are even less relevant to the client's statement.
The nurse is using the Glasgow Coma Scale to perform a neurologic
assessment. A comatose client winces and pulls away from a painful stimulus.
Which action should the nurse take next?
-
A. Document that the client responds to painful stimulus.
B. Observe the client's response to verbal stimulation.
C. Place the client on seizure precautions for 24 hours.
D. Report decorticate posturing to the health care provider
A. Document that the client responds to painful stimulus.
-
The client has demonstrated a purposeful response to pain, which should be
documented as such. Response to painful stimulus is assessed after response
to verbal stimulus, not before. There is no indication for placing the client on
seizure precautions. Reporting decorticate posturing to the health care
provider is nonpurposeful movement.
The nurse plans to administer diazepam, 4 mg IV push, to a client with severe
anxiety. How many milliliters should the nurse administer? (Round to the
nearest tenth.)
-
A. 0.2 mL
B. 0.8 mL
C. 1.25 mL
D. 2.0 mL
B. 0.8 mL
-
(1 mL × 4 mg)/5 mg = 0.8 mL
, The nurse prepares to insert a nasogastric tube in a client
with hyperemesis who is awake and alert. Which intervention(s) is(are)
correct? (Select all that apply.)
-
A. Place the client in a high Fowler position.
B. Help the client assume a left side-lying position.
C. Measure the tube from the tip of the nose to the umbilicus.
D. Instruct the client to swallow after the tube has passed the pharynx.
E. Assist the client in extending the neck back so the tube may enter the larynx.
A. Place the client in a high Fowler position.
D. Instruct the client to swallow after the tube has passed the pharynx.
-
(A and D) are the correct steps to follow during nasogastric intubation. Only the
unconscious or obtunded client should be placed in a left side-lying position
(B). The tube should be measured from the tip of the nose to behind the ear
and then from behind the ear to the xiphoid process (C). The neck should only
be extended back prior to the tube passing the pharynx and then the client
should be instructed to position the neck forward (E).
When performing sterile wound care in the acute care setting, the nurse
obtains a bottle of normal saline from the bedside table that is labeled
"opened" and dated 48 hours prior to the current date. Which is the best
action for the nurse to take?
-
A. Use the normal saline solution once more and then discard.
B. Obtain a new sterile syringe to draw up the labeled saline solution.
C. Use the saline solution and then relabel the bottle with the current date.
D. Discard the saline solution and obtain a new unopened bottle.
D. Discard the saline solution and obtain a new unopened bottle.
-
Solutions labeled as opened within 24 hours may be used for clean procedures,
but only newly opened solutions are considered sterile. This solution is not
