HESI Fundamentals Exam | Complete Review with Rationales -
249 Questions
This exam assesses advanced understanding of fundamental nursing concepts including evidence-based practice,
patient safety, infection control, fluid and electrolyte balance, medication administration, and clinical
decision-making. Questions require synthesis of theoretical knowledge with practical application in complex
clinical scenarios. It contains 249 multiple-choice questions, each with four distractors and a fully worked
rationale that explains why the keyed answer is correct. Content is organized into 10 focused sections:
Fundamentals of Nursing Practice, Safety and Infection Control, Health Promotion and Maintenance,
Psychosocial Integrity, Basic Care and Comfort, Pharmacological Therapies, Reduction of Risk Potential,
Physiological Adaptation, Professional Standards and Ethical Practice, Communication and Documentation.
Targeted learning outcomes include: Apply evidence-based practice to nursing interventions.; Analyze patient
data to prioritize care and prevent complications.; Evaluate the rationale behind nursing actions in diverse
clinical situations.. Every item has been reviewed for clinical accuracy, current guidelines, and clarity so that
students can study with confidence and self-correct as they work through the bank. Use it as a high-yield review
immediately before the exam, or as a structured practice tool during the unit - the rationales double as concise
teaching notes. The recommended writing time is 3 hours, with a passing score of 80%. Aligned with Meets AACN
and CCNE standards for baccalaureate nursing education; aligns with NCLEX-RN test plan. standards and
Section 1: Fundamentals of Nursing Practice (Questions 1-25)
1 A patient with a history of heart failure is receiving furosemide 40 mg IV
push. The nurse notes that the patient's urine output has been 20 mL/hour for
the past 4 hours. Which action should the nurse take first?
A) Administer a second dose of furosemide as prescribed.
B) Assess the patient for signs of fluid volume deficit.
C) Notify the healthcare provider of the low urine output.
D) Increase the IV fluid rate to promote urine output.
Answer: B
Rationale: The low urine output suggests possible dehydration or renal
hypoperfusion; assessing for fluid volume deficit is a priority before any
intervention. Administering more furosemide could worsen hypovolemia.
Notifying the provider is important but not the first action. Increasing IV fluids
without assessment could cause fluid overload.
2 A nurse is preparing to administer a blood transfusion to a patient. Which
action is most important for preventing a transfusion reaction?
A) Verify the patient's identity with two identifiers.
B) Check the blood product against the patient's medical record.
C) Ensure the blood is infused within 4 hours of removal from refrigeration.
D) Obtain baseline vital signs before starting the transfusion.
,Answer: A
Rationale: Verifying patient identity with two identifiers is the most critical step
to prevent a transfusion reaction due to misidentification. While checking the
blood product and obtaining vital signs are important, they are secondary to
correct patient identification. Transfusion time is important for safety but not
the primary prevention of reactions.
3 A patient with pneumonia has a prescription for levofloxacin 500 mg IV
once daily. The nurse notes that the patient has a history of prolonged QT
interval. Which action should the nurse take?
A) Administer the medication as prescribed.
B) Hold the medication and notify the prescriber.
C) Administer the medication with a cardiac monitor.
D) Change the prescription to an oral form.
Answer: B
Rationale: Levofloxacin is known to prolong the QT interval, and in a patient
with pre-existing prolonged QT, it increases the risk of life-threatening
arrhythmias. The nurse should hold the medication and notify the prescriber to
consider an alternative antibiotic. Administering it even with monitoring is
unsafe. Changing to oral form does not reduce the cardiac risk.
4 A nurse is assessing a patient who has a chest tube connected to a water seal
drainage system. The nurse notes continuous bubbling in the water seal
chamber. What does this finding indicate?
A) The chest tube is functioning properly.
B) There is an air leak in the system.
C) The patient has a pneumothorax.
D) The suction is set too high.
Answer: B
Rationale: Continuous bubbling in the water seal chamber indicates an air leak
in the system, which could be from a loose connection, a crack in the drainage
system, or a leak at the insertion site. Intermittent bubbling is normal with
expiration. A pneumothorax is the reason for the chest tube, not indicated by
continuous bubbling. Suction level is reflected in the suction control chamber.
,5 A nurse is providing discharge teaching to a patient who is prescribed
warfarin. Which statement by the patient indicates a need for further
teaching?
A) I will avoid eating large amounts of green leafy vegetables.
B) I will use a soft toothbrush to prevent gum bleeding.
C) I will take aspirin if I have a headache.
D) I will have my INR checked regularly as scheduled.
Answer: C
Rationale: Aspirin increases the risk of bleeding when taken with warfarin and
should be avoided. The patient should use acetaminophen instead. Avoiding
consistent large amounts of vitamin K-rich foods is appropriate. Using a soft
toothbrush minimizes gum trauma. Regular INR monitoring is essential for
safe anticoagulation.
6 A nurse is caring for a patient who has a nasogastric tube set to low
intermittent suction. Which assessment finding requires immediate action?
A) The patient reports a dry mouth.
B) The pH of gastric aspirate is 4.
C) The patient has a serum potassium level of 3.2 mEq/L.
D) The tube is draining 200 mL of greenish fluid per shift.
Answer: C
Rationale: A potassium level of 3.2 mEq/L indicates hypokalemia, which can
be exacerbated by gastric suction losses and can lead to cardiac dysrhythmias.
Dry mouth is common with NG suction and not immediately dangerous. A pH
of 4 is normal for gastric fluid. 200 mL output per shift is typical.
7 A nurse is preparing to insert an indwelling urinary catheter. Which
technique is most important for preventing catheter-associated urinary tract
infection (CAUTI)?
A) Use the smallest gauge catheter possible.
B) Apply sterile gloves and a sterile drape.
C) Cleanse the meatus with antiseptic solution from the meatus outward.
D) Inflate the catheter balloon before insertion to check for defects.
Answer: B
Rationale: Using sterile technique with sterile gloves and a sterile drape is the
most critical intervention to prevent CAUTI. Using the smallest catheter may
, reduce trauma but is not as important as sterility. Cleansing should be from the
meatus outward to prevent introducing organisms. Inflating the balloon before
insertion is incorrect and can cause trauma.
8 A patient with type 2 diabetes is scheduled for a magnetic resonance imaging
(MRI) scan. The nurse reviews the patient's medication list and notes
metformin. Which action should the nurse take?
A) Administer metformin as usual.
B) Hold the metformin for 48 hours before the MRI.
C) Notify the radiology department about the metformin.
D) Check the patient's blood glucose level before the MRI.
Answer: C
Rationale: Metformin should be held before MRI with contrast due to risk of
lactic acidosis; the radiology department needs to be aware to coordinate.
Holding metformin for 48 hours is not standard; it is usually held on the day of
the procedure and for 48 hours after if contrast is used. Checking blood glucose
is important but not the priority regarding metformin.
9 A nurse is assessing a patient who has a pressure injury on the sacrum. The
wound is covered with yellow slough and has a moderate amount of
drainage. Which dressing should the nurse apply?
A) Hydrocolloid dressing.
B) Transparent film dressing.
C) Alginate dressing.
D) Hydrogel dressing.
Answer: C
Rationale: Alginate dressings are highly absorbent and suitable for wounds with
moderate to heavy drainage and slough. Hydrocolloid dressings are for lightly
draining wounds. Transparent film is for superficial wounds without drainage.
Hydrogel dressings are for dry wounds to provide moisture.
10 A nurse is evaluating a patient's understanding of a low-sodium diet. Which
meal selection indicates the patient understands the teaching?
A) Grilled chicken sandwich with french fries and a pickle.
B) Baked salmon with steamed broccoli and a baked potato.
C) Ham and cheese sandwich with potato chips.
249 Questions
This exam assesses advanced understanding of fundamental nursing concepts including evidence-based practice,
patient safety, infection control, fluid and electrolyte balance, medication administration, and clinical
decision-making. Questions require synthesis of theoretical knowledge with practical application in complex
clinical scenarios. It contains 249 multiple-choice questions, each with four distractors and a fully worked
rationale that explains why the keyed answer is correct. Content is organized into 10 focused sections:
Fundamentals of Nursing Practice, Safety and Infection Control, Health Promotion and Maintenance,
Psychosocial Integrity, Basic Care and Comfort, Pharmacological Therapies, Reduction of Risk Potential,
Physiological Adaptation, Professional Standards and Ethical Practice, Communication and Documentation.
Targeted learning outcomes include: Apply evidence-based practice to nursing interventions.; Analyze patient
data to prioritize care and prevent complications.; Evaluate the rationale behind nursing actions in diverse
clinical situations.. Every item has been reviewed for clinical accuracy, current guidelines, and clarity so that
students can study with confidence and self-correct as they work through the bank. Use it as a high-yield review
immediately before the exam, or as a structured practice tool during the unit - the rationales double as concise
teaching notes. The recommended writing time is 3 hours, with a passing score of 80%. Aligned with Meets AACN
and CCNE standards for baccalaureate nursing education; aligns with NCLEX-RN test plan. standards and
Section 1: Fundamentals of Nursing Practice (Questions 1-25)
1 A patient with a history of heart failure is receiving furosemide 40 mg IV
push. The nurse notes that the patient's urine output has been 20 mL/hour for
the past 4 hours. Which action should the nurse take first?
A) Administer a second dose of furosemide as prescribed.
B) Assess the patient for signs of fluid volume deficit.
C) Notify the healthcare provider of the low urine output.
D) Increase the IV fluid rate to promote urine output.
Answer: B
Rationale: The low urine output suggests possible dehydration or renal
hypoperfusion; assessing for fluid volume deficit is a priority before any
intervention. Administering more furosemide could worsen hypovolemia.
Notifying the provider is important but not the first action. Increasing IV fluids
without assessment could cause fluid overload.
2 A nurse is preparing to administer a blood transfusion to a patient. Which
action is most important for preventing a transfusion reaction?
A) Verify the patient's identity with two identifiers.
B) Check the blood product against the patient's medical record.
C) Ensure the blood is infused within 4 hours of removal from refrigeration.
D) Obtain baseline vital signs before starting the transfusion.
,Answer: A
Rationale: Verifying patient identity with two identifiers is the most critical step
to prevent a transfusion reaction due to misidentification. While checking the
blood product and obtaining vital signs are important, they are secondary to
correct patient identification. Transfusion time is important for safety but not
the primary prevention of reactions.
3 A patient with pneumonia has a prescription for levofloxacin 500 mg IV
once daily. The nurse notes that the patient has a history of prolonged QT
interval. Which action should the nurse take?
A) Administer the medication as prescribed.
B) Hold the medication and notify the prescriber.
C) Administer the medication with a cardiac monitor.
D) Change the prescription to an oral form.
Answer: B
Rationale: Levofloxacin is known to prolong the QT interval, and in a patient
with pre-existing prolonged QT, it increases the risk of life-threatening
arrhythmias. The nurse should hold the medication and notify the prescriber to
consider an alternative antibiotic. Administering it even with monitoring is
unsafe. Changing to oral form does not reduce the cardiac risk.
4 A nurse is assessing a patient who has a chest tube connected to a water seal
drainage system. The nurse notes continuous bubbling in the water seal
chamber. What does this finding indicate?
A) The chest tube is functioning properly.
B) There is an air leak in the system.
C) The patient has a pneumothorax.
D) The suction is set too high.
Answer: B
Rationale: Continuous bubbling in the water seal chamber indicates an air leak
in the system, which could be from a loose connection, a crack in the drainage
system, or a leak at the insertion site. Intermittent bubbling is normal with
expiration. A pneumothorax is the reason for the chest tube, not indicated by
continuous bubbling. Suction level is reflected in the suction control chamber.
,5 A nurse is providing discharge teaching to a patient who is prescribed
warfarin. Which statement by the patient indicates a need for further
teaching?
A) I will avoid eating large amounts of green leafy vegetables.
B) I will use a soft toothbrush to prevent gum bleeding.
C) I will take aspirin if I have a headache.
D) I will have my INR checked regularly as scheduled.
Answer: C
Rationale: Aspirin increases the risk of bleeding when taken with warfarin and
should be avoided. The patient should use acetaminophen instead. Avoiding
consistent large amounts of vitamin K-rich foods is appropriate. Using a soft
toothbrush minimizes gum trauma. Regular INR monitoring is essential for
safe anticoagulation.
6 A nurse is caring for a patient who has a nasogastric tube set to low
intermittent suction. Which assessment finding requires immediate action?
A) The patient reports a dry mouth.
B) The pH of gastric aspirate is 4.
C) The patient has a serum potassium level of 3.2 mEq/L.
D) The tube is draining 200 mL of greenish fluid per shift.
Answer: C
Rationale: A potassium level of 3.2 mEq/L indicates hypokalemia, which can
be exacerbated by gastric suction losses and can lead to cardiac dysrhythmias.
Dry mouth is common with NG suction and not immediately dangerous. A pH
of 4 is normal for gastric fluid. 200 mL output per shift is typical.
7 A nurse is preparing to insert an indwelling urinary catheter. Which
technique is most important for preventing catheter-associated urinary tract
infection (CAUTI)?
A) Use the smallest gauge catheter possible.
B) Apply sterile gloves and a sterile drape.
C) Cleanse the meatus with antiseptic solution from the meatus outward.
D) Inflate the catheter balloon before insertion to check for defects.
Answer: B
Rationale: Using sterile technique with sterile gloves and a sterile drape is the
most critical intervention to prevent CAUTI. Using the smallest catheter may
, reduce trauma but is not as important as sterility. Cleansing should be from the
meatus outward to prevent introducing organisms. Inflating the balloon before
insertion is incorrect and can cause trauma.
8 A patient with type 2 diabetes is scheduled for a magnetic resonance imaging
(MRI) scan. The nurse reviews the patient's medication list and notes
metformin. Which action should the nurse take?
A) Administer metformin as usual.
B) Hold the metformin for 48 hours before the MRI.
C) Notify the radiology department about the metformin.
D) Check the patient's blood glucose level before the MRI.
Answer: C
Rationale: Metformin should be held before MRI with contrast due to risk of
lactic acidosis; the radiology department needs to be aware to coordinate.
Holding metformin for 48 hours is not standard; it is usually held on the day of
the procedure and for 48 hours after if contrast is used. Checking blood glucose
is important but not the priority regarding metformin.
9 A nurse is assessing a patient who has a pressure injury on the sacrum. The
wound is covered with yellow slough and has a moderate amount of
drainage. Which dressing should the nurse apply?
A) Hydrocolloid dressing.
B) Transparent film dressing.
C) Alginate dressing.
D) Hydrogel dressing.
Answer: C
Rationale: Alginate dressings are highly absorbent and suitable for wounds with
moderate to heavy drainage and slough. Hydrocolloid dressings are for lightly
draining wounds. Transparent film is for superficial wounds without drainage.
Hydrogel dressings are for dry wounds to provide moisture.
10 A nurse is evaluating a patient's understanding of a low-sodium diet. Which
meal selection indicates the patient understands the teaching?
A) Grilled chicken sandwich with french fries and a pickle.
B) Baked salmon with steamed broccoli and a baked potato.
C) Ham and cheese sandwich with potato chips.
