This comprehensive test bank is designed for nursing students preparing for the NUR 112 HESI
exam. It covers fundamental concepts of nursing including pharmacology, medical-surgical nursing,
patient safety, nutrition, fluid/electrolyte balance, respiratory and cardiac care, diabetes
management, wound care, and prioritization/delegation. Each question includes multiple-choice
options, correct answer, and detailed rationale explaining the underlying nursing principles.
Perfect for self-assessment, review, and exam readiness. Build confidence and critical thinking
skills essential for success on the HESI and in clinical practice.
1. A hospitalized male client is receiving nasogastric tube feedings via a small-bore tube and a
continuous pump infusion. He reports that he had a bad bout of severe coughing a few minutes
ago, but feels fine now. What action is best for the nurse to take?
A. Record the coughing incident. No further action is required at this time.
B. Stop the feeding and check for gastric residual volume.
C. Auscultate for bowel sounds and assess for abdominal distention.
D. Check the placement of the feeding tube by aspirating gastric contents.
Correct Answer: D
Rationale: The client's severe coughing could have displaced the small-bore feeding tube,
potentially causing the tip to migrate into the respiratory tract. Since the client is receiving
continuous tube feedings, tube placement must be verified before resuming or continuing the
feeding. The most reliable method at the bedside is to aspirate gastric contents and check the pH,
along with measuring the external tube length and comparing to the initial placement
documentation. While documenting the coughing incident is appropriate, it is not sufficient without
verification of tube placement. Checking residual and auscultating for bowel sounds are important
but secondary to ensuring the tube is correctly positioned in the stomach.
2. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 2 L/min via
nasal cannula. The client's spouse asks the nurse why the oxygen flow rate is so low. What is the
best response by the nurse?
A. "Higher oxygen flow rates can actually decrease the client's respiratory drive."
B. "The client's lungs cannot handle higher flow rates without causing damage."
C. "This is the standard flow rate for all clients receiving oxygen therapy."
,D. "The flow rate will be increased as the client's condition improves."
Correct Answer: A
Rationale: Clients with COPD often have chronic hypercapnia (elevated carbon dioxide levels)
and depend on a hypoxic drive to stimulate breathing. High concentrations of oxygen can
eliminate this hypoxic stimulus, leading to respiratory depression and apnea. Low-flow oxygen
therapy (typically 1-3 L/min via nasal cannula) is carefully titrated to maintain oxygen saturation
at an acceptable level without eliminating the respiratory drive. The flow rate is individualized
based on the client's condition and oxygen saturation levels, not standardized for all clients.
3. The nurse is caring for a client with an indwelling urinary catheter. Which observation indicates
that the client may have developed a urinary tract infection?
A. The urine is dark yellow and concentrated.
B. The client reports flank pain and chills.
C. The urine output has decreased from 60 ml/hr to 30 ml/hr.
D. The client's temperature is 99.2°F (37.3°C).
Correct Answer: B
Rationale: Flank pain, chills, and fever are classic signs of a urinary tract infection that has
potentially ascended to the kidneys (pyelonephritis). Dark yellow concentrated urine may indicate
dehydration. Decreased urine output can have multiple causes including dehydration, renal
impairment, or obstruction. A temperature of 99.2°F is not significantly elevated to indicate
infection, although low-grade fever can occur. The nurse should monitor for other signs such as
cloudy urine, foul odor, sediment, and elevated white blood cell count.
4. A client is to receive cimetidine (Tagamet) 300 mg q6h IVPB. The preparation arrives from the
pharmacy diluted in 50 ml of 0.9% NaCl. The nurse plans to administer the IVPB dose over 20
minutes. For how many ml/hr should the infusion pump be set to deliver the secondary infusion?
A. 100 ml/hr
B. 125 ml/hr
C. 150 ml/hr
D. 175 ml/hr
Correct Answer: C
Rationale: The infusion rate is calculated using ratio proportion. The total volume is 50 ml to be
infused over 20 minutes. Set up the proportion: 50 ml / 20 min = X ml / 60 min. Cross multiply:
50 × 60 = 20X, so 3000 = 20X, and X = 150 ml/hr. Therefore, the pump should be set at 150
ml/hr to deliver the entire 50 ml volume over 20 minutes.
5. Twenty minutes after beginning a heat application, the client states that the heating pad no
longer feels warm enough. What is the best response by the nurse?
A. "That means you have derived the maximum benefit, and the heat can be removed."
B. "Your blood vessels are becoming dilated and removing the heat from the site."
C. "We will increase the temperature 5 degrees when the pad no longer feels warm."
D. "The body's receptors adapt over time as they are exposed to heat."
,Correct Answer: D
Rationale: This describes thermal adaptation, which typically occurs 20 to 30 minutes after the
initiation of heat application. The body's thermoreceptors become less sensitive to the constant
stimulus, leading to a decreased perception of warmth. The client has not necessarily derived
maximum benefit, and heat should not be removed solely based on this sensation. Vasodilation
does not "remove" heat from the site; it increases blood flow to the area. Increasing the
temperature is unsafe and could cause burns without being based on physiological principles.
6. The nurse is instructing a client with high cholesterol about diet and lifestyle modification. What
comment from the client indicates that the teaching has been effective?
A. "If I exercise at least two times weekly for one hour, I will lower my cholesterol."
B. "I need to avoid eating proteins, including red meat."
C. "I will limit my intake of beef to 4 ounces per week."
D. "My blood level of low density lipoproteins needs to increase."
Correct Answer: C
Rationale: Limiting saturated fat from animal food sources to no more than 4 ounces per week is
an important dietary modification for lowering cholesterol. To be effective in reducing cholesterol,
the client should exercise 30 minutes per day, or at least 4 to 6 times per week, not just twice
weekly. Red meat and all proteins do not need to be completely eliminated to lower cholesterol,
but should be restricted to lean cuts and smaller portions. Low-density lipoproteins (LDL) are the
"bad" cholesterol and need to decrease, not increase, for cardiovascular health.
7. 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 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.
Correct Answer: C
Rationale: The left-sided Sims' position allows the enema solution to follow the anatomical course
of the descending colon and rectum, promoting optimal flow and results. In Sims' position, the
client's weight is distributed to the anterior ilium, hip, and shoulder. The position described in
option A is incorrect and would not facilitate proper enema administration. While options B and D
contain elements of correct enema administration technique, the priority is to ensure the client is in
the correct position before proceeding with the procedure.
8. A client who is a Jehovah's Witness is admitted to the nursing unit. Which concern should the
nurse have for planning care in terms of the client's beliefs?
A. Autopsy of the body is prohibited.
B. Blood transfusions are forbidden.
C. Alcohol use in any form is not allowed.
D. A vegetarian diet must be followed.
Correct Answer: B
, Rationale: Blood transfusions are forbidden in the Jehovah's Witness religion based on biblical
interpretations that prohibit consuming blood. This has direct implications for nursing care,
particularly in surgical or trauma situations where blood loss may occur. Judaism prohibits autopsy
in many circumstances. Buddhism and some other traditions may restrict alcohol and drug use.
While some Jehovah's Witnesses may choose vegetarian diets, this is not a universal requirement
and does not have the same critical impact on emergency medical care as the blood transfusion
restriction.
9. The nurse observes that a male client has removed the covering from an ice pack applied to his
knee. What action should the nurse take first?
A. Observe the appearance of the skin under the ice pack.
B. Instruct the client regarding the need for the covering.
C. Reapply the covering after filling with fresh ice.
D. Ask the client how long the ice was applied to the skin.
Correct Answer: A
Rationale: The first action taken by the nurse should be to assess the skin for any possible thermal
injury such as frostbite, tissue damage, or skin breakdown. Direct application of ice without a
protective covering can cause severe tissue damage due to extreme cold. The assessment findings
will guide subsequent actions. If no injury has occurred, the nurse can then provide client
education, reapply the ice with proper covering, and assess the duration of application to ensure
safe use of cold therapy.
10. The nurse mixes 50 mg of Nipride in 250 ml of D5W and plans to administer the solution at a
rate of 5 mcg/kg/min to a client weighing 182 pounds. Using a drip factor of 60 gtt/ml, how
many drops per minute should the client receive?
A. 31 gtt/min.
B. 62 gtt/min.
C. 93 gtt/min.
D. 124 gtt/min.
Correct Answer: D
Rationale: Calculate the weight in kilograms: 182 lbs / 2.2 = 82.73 kg. Determine dosage: 5 mcg
× 82.73 = 413.65 mcg/min. The solution contains 50 mg in 250 ml, which is 50,000 mcg in 250
ml. Calculate concentration: 50,000 mcg / 250 ml = 200 mcg/ml. Calculate ml/min: 413.65
mcg/min / 200 mcg/ml = 2.07 ml/min. With drip factor of 60 gtt/ml: 2.07 ml/min × 60 gtt/ml
= 124.28 gtt/min. The nurse should set the drip rate to 124 gtt/min.
11. The nurse observes an unlicensed assistive personnel (UAP) taking a client's blood pressure
with a cuff that is too small, but the blood pressure reading obtained is within the client's usual
range. What action is most important for the nurse to implement?
A. Tell the UAP to use a larger cuff at the next scheduled assessment.
B. Reassess the client's blood pressure using a larger cuff.
C. Have the unit educator review this procedure with the UAPs.
D. Teach the UAP the correct technique for assessing blood pressure.
exam. It covers fundamental concepts of nursing including pharmacology, medical-surgical nursing,
patient safety, nutrition, fluid/electrolyte balance, respiratory and cardiac care, diabetes
management, wound care, and prioritization/delegation. Each question includes multiple-choice
options, correct answer, and detailed rationale explaining the underlying nursing principles.
Perfect for self-assessment, review, and exam readiness. Build confidence and critical thinking
skills essential for success on the HESI and in clinical practice.
1. A hospitalized male client is receiving nasogastric tube feedings via a small-bore tube and a
continuous pump infusion. He reports that he had a bad bout of severe coughing a few minutes
ago, but feels fine now. What action is best for the nurse to take?
A. Record the coughing incident. No further action is required at this time.
B. Stop the feeding and check for gastric residual volume.
C. Auscultate for bowel sounds and assess for abdominal distention.
D. Check the placement of the feeding tube by aspirating gastric contents.
Correct Answer: D
Rationale: The client's severe coughing could have displaced the small-bore feeding tube,
potentially causing the tip to migrate into the respiratory tract. Since the client is receiving
continuous tube feedings, tube placement must be verified before resuming or continuing the
feeding. The most reliable method at the bedside is to aspirate gastric contents and check the pH,
along with measuring the external tube length and comparing to the initial placement
documentation. While documenting the coughing incident is appropriate, it is not sufficient without
verification of tube placement. Checking residual and auscultating for bowel sounds are important
but secondary to ensuring the tube is correctly positioned in the stomach.
2. A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen at 2 L/min via
nasal cannula. The client's spouse asks the nurse why the oxygen flow rate is so low. What is the
best response by the nurse?
A. "Higher oxygen flow rates can actually decrease the client's respiratory drive."
B. "The client's lungs cannot handle higher flow rates without causing damage."
C. "This is the standard flow rate for all clients receiving oxygen therapy."
,D. "The flow rate will be increased as the client's condition improves."
Correct Answer: A
Rationale: Clients with COPD often have chronic hypercapnia (elevated carbon dioxide levels)
and depend on a hypoxic drive to stimulate breathing. High concentrations of oxygen can
eliminate this hypoxic stimulus, leading to respiratory depression and apnea. Low-flow oxygen
therapy (typically 1-3 L/min via nasal cannula) is carefully titrated to maintain oxygen saturation
at an acceptable level without eliminating the respiratory drive. The flow rate is individualized
based on the client's condition and oxygen saturation levels, not standardized for all clients.
3. The nurse is caring for a client with an indwelling urinary catheter. Which observation indicates
that the client may have developed a urinary tract infection?
A. The urine is dark yellow and concentrated.
B. The client reports flank pain and chills.
C. The urine output has decreased from 60 ml/hr to 30 ml/hr.
D. The client's temperature is 99.2°F (37.3°C).
Correct Answer: B
Rationale: Flank pain, chills, and fever are classic signs of a urinary tract infection that has
potentially ascended to the kidneys (pyelonephritis). Dark yellow concentrated urine may indicate
dehydration. Decreased urine output can have multiple causes including dehydration, renal
impairment, or obstruction. A temperature of 99.2°F is not significantly elevated to indicate
infection, although low-grade fever can occur. The nurse should monitor for other signs such as
cloudy urine, foul odor, sediment, and elevated white blood cell count.
4. A client is to receive cimetidine (Tagamet) 300 mg q6h IVPB. The preparation arrives from the
pharmacy diluted in 50 ml of 0.9% NaCl. The nurse plans to administer the IVPB dose over 20
minutes. For how many ml/hr should the infusion pump be set to deliver the secondary infusion?
A. 100 ml/hr
B. 125 ml/hr
C. 150 ml/hr
D. 175 ml/hr
Correct Answer: C
Rationale: The infusion rate is calculated using ratio proportion. The total volume is 50 ml to be
infused over 20 minutes. Set up the proportion: 50 ml / 20 min = X ml / 60 min. Cross multiply:
50 × 60 = 20X, so 3000 = 20X, and X = 150 ml/hr. Therefore, the pump should be set at 150
ml/hr to deliver the entire 50 ml volume over 20 minutes.
5. Twenty minutes after beginning a heat application, the client states that the heating pad no
longer feels warm enough. What is the best response by the nurse?
A. "That means you have derived the maximum benefit, and the heat can be removed."
B. "Your blood vessels are becoming dilated and removing the heat from the site."
C. "We will increase the temperature 5 degrees when the pad no longer feels warm."
D. "The body's receptors adapt over time as they are exposed to heat."
,Correct Answer: D
Rationale: This describes thermal adaptation, which typically occurs 20 to 30 minutes after the
initiation of heat application. The body's thermoreceptors become less sensitive to the constant
stimulus, leading to a decreased perception of warmth. The client has not necessarily derived
maximum benefit, and heat should not be removed solely based on this sensation. Vasodilation
does not "remove" heat from the site; it increases blood flow to the area. Increasing the
temperature is unsafe and could cause burns without being based on physiological principles.
6. The nurse is instructing a client with high cholesterol about diet and lifestyle modification. What
comment from the client indicates that the teaching has been effective?
A. "If I exercise at least two times weekly for one hour, I will lower my cholesterol."
B. "I need to avoid eating proteins, including red meat."
C. "I will limit my intake of beef to 4 ounces per week."
D. "My blood level of low density lipoproteins needs to increase."
Correct Answer: C
Rationale: Limiting saturated fat from animal food sources to no more than 4 ounces per week is
an important dietary modification for lowering cholesterol. To be effective in reducing cholesterol,
the client should exercise 30 minutes per day, or at least 4 to 6 times per week, not just twice
weekly. Red meat and all proteins do not need to be completely eliminated to lower cholesterol,
but should be restricted to lean cuts and smaller portions. Low-density lipoproteins (LDL) are the
"bad" cholesterol and need to decrease, not increase, for cardiovascular health.
7. 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 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.
Correct Answer: C
Rationale: The left-sided Sims' position allows the enema solution to follow the anatomical course
of the descending colon and rectum, promoting optimal flow and results. In Sims' position, the
client's weight is distributed to the anterior ilium, hip, and shoulder. The position described in
option A is incorrect and would not facilitate proper enema administration. While options B and D
contain elements of correct enema administration technique, the priority is to ensure the client is in
the correct position before proceeding with the procedure.
8. A client who is a Jehovah's Witness is admitted to the nursing unit. Which concern should the
nurse have for planning care in terms of the client's beliefs?
A. Autopsy of the body is prohibited.
B. Blood transfusions are forbidden.
C. Alcohol use in any form is not allowed.
D. A vegetarian diet must be followed.
Correct Answer: B
, Rationale: Blood transfusions are forbidden in the Jehovah's Witness religion based on biblical
interpretations that prohibit consuming blood. This has direct implications for nursing care,
particularly in surgical or trauma situations where blood loss may occur. Judaism prohibits autopsy
in many circumstances. Buddhism and some other traditions may restrict alcohol and drug use.
While some Jehovah's Witnesses may choose vegetarian diets, this is not a universal requirement
and does not have the same critical impact on emergency medical care as the blood transfusion
restriction.
9. The nurse observes that a male client has removed the covering from an ice pack applied to his
knee. What action should the nurse take first?
A. Observe the appearance of the skin under the ice pack.
B. Instruct the client regarding the need for the covering.
C. Reapply the covering after filling with fresh ice.
D. Ask the client how long the ice was applied to the skin.
Correct Answer: A
Rationale: The first action taken by the nurse should be to assess the skin for any possible thermal
injury such as frostbite, tissue damage, or skin breakdown. Direct application of ice without a
protective covering can cause severe tissue damage due to extreme cold. The assessment findings
will guide subsequent actions. If no injury has occurred, the nurse can then provide client
education, reapply the ice with proper covering, and assess the duration of application to ensure
safe use of cold therapy.
10. The nurse mixes 50 mg of Nipride in 250 ml of D5W and plans to administer the solution at a
rate of 5 mcg/kg/min to a client weighing 182 pounds. Using a drip factor of 60 gtt/ml, how
many drops per minute should the client receive?
A. 31 gtt/min.
B. 62 gtt/min.
C. 93 gtt/min.
D. 124 gtt/min.
Correct Answer: D
Rationale: Calculate the weight in kilograms: 182 lbs / 2.2 = 82.73 kg. Determine dosage: 5 mcg
× 82.73 = 413.65 mcg/min. The solution contains 50 mg in 250 ml, which is 50,000 mcg in 250
ml. Calculate concentration: 50,000 mcg / 250 ml = 200 mcg/ml. Calculate ml/min: 413.65
mcg/min / 200 mcg/ml = 2.07 ml/min. With drip factor of 60 gtt/ml: 2.07 ml/min × 60 gtt/ml
= 124.28 gtt/min. The nurse should set the drip rate to 124 gtt/min.
11. The nurse observes an unlicensed assistive personnel (UAP) taking a client's blood pressure
with a cuff that is too small, but the blood pressure reading obtained is within the client's usual
range. What action is most important for the nurse to implement?
A. Tell the UAP to use a larger cuff at the next scheduled assessment.
B. Reassess the client's blood pressure using a larger cuff.
C. Have the unit educator review this procedure with the UAPs.
D. Teach the UAP the correct technique for assessing blood pressure.
