HESI CRITICAL THINKING 2026 FINAL PAPER
QUESTIONS AND SOLUTIONS PREMIUM
REVISION COMPILATION
◉ 50. A nurse overhears two other nurses talking about a client in
the hospital dining room. Which action should the nurse implement
first?
1. Notify the HIPAA officer about the breach of confidentiality.
2. Immediately report the two nurses to their clinical manager.
3. Document the situation in writing and submit to the Chief Nursing
Officer (CNO). 4. Tell the two nurses they are violating the client's
confidentiality.
Answer: 1. .The HIPAA officer can be notified of the breach of
confidentiality, but the nurse must first confront the two nurses and
correct the behavior.
2. The nurses can be reported to their clinical manager, but the
nurse must first confront the two nurses and correct the behavior.
3. The situation can be documented in writing and turned into the
HIPAA officer (not the CNO), but the nurse must first confront the
two nurses and correct the behavior.
**4. This is a violation of HIPAA; therefore, the nurse must first
confront the two nurses and correct the behavior.
,◉ 49. The nurse needs to perform anthropometric measures of an
80-year-old man who is confined to a wheelchair. Which of the
following is true in this situation?
A) Changes in fat distribution will affect the waist-to-hip ratio.
B) Height measurements may not be accurate because of changes in
bone.
C) Declining muscle mass will affect the triceps skinfold measure.
D) Mid-arm circumference is difficult to obtain because of loss of
skin elasticity.
Answer: B) Height measurements may not be accurate because of
changes in bone.
Page: 191. Height measures may not be accurate in individuals
confined to a bed or wheelchair or those over 60 years of age
because of osteoporotic changes.
◉ 51. The nurse is caring for newborns in the nursery. Which
newborn warrants immediate intervention by the nurse?
1. The 8-hour-old newborn who has not passed meconium.
2. The 15-hour-old newborn who is slightly jaundiced.
3. The 4-hour-old newborn who is jittery and irritable. 4. The 10-
hour-old newborn who will not stop crying.
,Answer: 1.The nurse would not be concerned about not passing
meconium until at least 24 hours after delivery.
2. The nurse would not be concerned about a newborn who is
slightly jaundiced until after 24 hours after delivery, at which point
the HCP would investigate to determine whether the jaundice is
pathological.
**3. A newborn who is jittery and irritable needs to be assessed first
for possible hypoglycemia. The nurse could feed the newborn
glucose water or provide more frequent, regular feedings.
4. Although the nurse should determine why the newborn will not
stop crying, the new- born who is showing signs of hypoglycemia
warrants immediate intervention.
◉ 50. The nurse is performing a nutritional assessment on an 80-
year-old patient. The nurse knows that physiological changes that
directly affect the nutritional status of the elderly include:
A) slowed gastrointestinal motility.
B) hyperstimulation of the salivary glands.
C) an increased sensitivity to spicy and aromatic foods.
D) decreased gastrointestinal absorption causing esophageal reflux.
Answer: A) slowed gastrointestinal motility.
Page: 176. Normal physiological changes in aging adults that affect
nutritional status include slowed gastrointestinal motility, decreased
, gastrointestinal absorption, diminished olfactory and taste
sensitivity, decreased saliva production, decreased visual acuity, and
poor dentition.
◉ 53. The nurse who has never worked on the maternity ward has
been pulled from the surgical unit to work in the newborn nursery.
Which assignment would be most appropriate for the nurse to
accept?
1. Perform an assessment on the newborn.
2. Assist the pediatrician with a circumcision. 3. Gavage feed a
newborn who is 8 hours old. 4. Transport newborns to the mothers'
room.
Answer: 1.The nurse should not accept any assign- ment for which
he or she is unqualified.
A newborn assessment requires specialized knowledge and skills to
detect potential complications.
2. The nurse who is not familiar with the pro- cedure or the unit
should not be assigned to assist a pediatrician to perform a
procedure.
3. This is a dangerous procedure because the nurse must insert a
tube into the newborn's stomach. A nurse who is not familiar with
this procedure should refuse the assignment.
**4. Any nurse can take an infant to the mother's room and check the
bands to ensure the right infant is with the right mother. This is an
appropriate task for a nurse who has never worked in the nursery.
QUESTIONS AND SOLUTIONS PREMIUM
REVISION COMPILATION
◉ 50. A nurse overhears two other nurses talking about a client in
the hospital dining room. Which action should the nurse implement
first?
1. Notify the HIPAA officer about the breach of confidentiality.
2. Immediately report the two nurses to their clinical manager.
3. Document the situation in writing and submit to the Chief Nursing
Officer (CNO). 4. Tell the two nurses they are violating the client's
confidentiality.
Answer: 1. .The HIPAA officer can be notified of the breach of
confidentiality, but the nurse must first confront the two nurses and
correct the behavior.
2. The nurses can be reported to their clinical manager, but the
nurse must first confront the two nurses and correct the behavior.
3. The situation can be documented in writing and turned into the
HIPAA officer (not the CNO), but the nurse must first confront the
two nurses and correct the behavior.
**4. This is a violation of HIPAA; therefore, the nurse must first
confront the two nurses and correct the behavior.
,◉ 49. The nurse needs to perform anthropometric measures of an
80-year-old man who is confined to a wheelchair. Which of the
following is true in this situation?
A) Changes in fat distribution will affect the waist-to-hip ratio.
B) Height measurements may not be accurate because of changes in
bone.
C) Declining muscle mass will affect the triceps skinfold measure.
D) Mid-arm circumference is difficult to obtain because of loss of
skin elasticity.
Answer: B) Height measurements may not be accurate because of
changes in bone.
Page: 191. Height measures may not be accurate in individuals
confined to a bed or wheelchair or those over 60 years of age
because of osteoporotic changes.
◉ 51. The nurse is caring for newborns in the nursery. Which
newborn warrants immediate intervention by the nurse?
1. The 8-hour-old newborn who has not passed meconium.
2. The 15-hour-old newborn who is slightly jaundiced.
3. The 4-hour-old newborn who is jittery and irritable. 4. The 10-
hour-old newborn who will not stop crying.
,Answer: 1.The nurse would not be concerned about not passing
meconium until at least 24 hours after delivery.
2. The nurse would not be concerned about a newborn who is
slightly jaundiced until after 24 hours after delivery, at which point
the HCP would investigate to determine whether the jaundice is
pathological.
**3. A newborn who is jittery and irritable needs to be assessed first
for possible hypoglycemia. The nurse could feed the newborn
glucose water or provide more frequent, regular feedings.
4. Although the nurse should determine why the newborn will not
stop crying, the new- born who is showing signs of hypoglycemia
warrants immediate intervention.
◉ 50. The nurse is performing a nutritional assessment on an 80-
year-old patient. The nurse knows that physiological changes that
directly affect the nutritional status of the elderly include:
A) slowed gastrointestinal motility.
B) hyperstimulation of the salivary glands.
C) an increased sensitivity to spicy and aromatic foods.
D) decreased gastrointestinal absorption causing esophageal reflux.
Answer: A) slowed gastrointestinal motility.
Page: 176. Normal physiological changes in aging adults that affect
nutritional status include slowed gastrointestinal motility, decreased
, gastrointestinal absorption, diminished olfactory and taste
sensitivity, decreased saliva production, decreased visual acuity, and
poor dentition.
◉ 53. The nurse who has never worked on the maternity ward has
been pulled from the surgical unit to work in the newborn nursery.
Which assignment would be most appropriate for the nurse to
accept?
1. Perform an assessment on the newborn.
2. Assist the pediatrician with a circumcision. 3. Gavage feed a
newborn who is 8 hours old. 4. Transport newborns to the mothers'
room.
Answer: 1.The nurse should not accept any assign- ment for which
he or she is unqualified.
A newborn assessment requires specialized knowledge and skills to
detect potential complications.
2. The nurse who is not familiar with the pro- cedure or the unit
should not be assigned to assist a pediatrician to perform a
procedure.
3. This is a dangerous procedure because the nurse must insert a
tube into the newborn's stomach. A nurse who is not familiar with
this procedure should refuse the assignment.
**4. Any nurse can take an infant to the mother's room and check the
bands to ensure the right infant is with the right mother. This is an
appropriate task for a nurse who has never worked in the nursery.
