HESI - Fundamentals exam with question with answer
When turning an immobile bedridden client B
without assistance, which action by the Rationale: Because the nurse can only stand on one side of
nurse best ensures client safety? the bed, bed rails should be up on the opposite side to
A. Securely grasp the client's arm and leg. ensure that the client does not fall out of bed. Option A can
B. Put bed rails up on the side of bed cause client injury to the skin or joint. Options C and D are
opposite from the nurse. useful techniques while turning a client but have less priority
C. Correctly position and use a turn sheet. in terms of safety than use of the bed rails.
D. Lower the head of the client's bed slowly.
HESI - Fundamentals exam with question with answer
,HESI - Fundamentals exam with question with answer
The nurse identifies a potential for infection B
in a client with partial-thickness (second- Rationale: Careful handwashing technique is the single most
degree) and full-thickness (third-degree) effective intervention for the prevention of contamination to
burns. What intervention has the highest all clients. Option A reverses the hypovolemia that initially
priority in decreasing the client's risk of accompanies burn trauma but is not related to decreasing the
infection? proliferation of infective organisms. Options C and D are
A. Administration of plasma expanders recommended by various burn centers as possible ways to
B. Use of careful handwashing technique reduce the chance of infection. Option B is a proven
C. Application of a topical antibacterial technique to prevent infection.
cream
D. Limiting visitors to the client with burns
The nurse is aware that malnutrition is a A
common problem among clients served by Rationale: Long-term protein deficiency is required to cause
a community health clinic for the homeless. significantly lowered serum albumin levels. Albumin is made
Which laboratory value is the most reliable by the liver only when adequate amounts of amino acids (from
indicator of chronic protein malnutrition? protein breakdown) are available. Albumin has a long half-life,
A. Low serum albumin level so acute protein loss does not significantly alter serum levels.
B. Low serum transferrin level Option B is a serum protein with a half-life of only 8 to 10 days,
C. High hemoglobin level so it will drop with an acute protein deficiency. Options C and
D. High cholesterol level D are not clinical measures of protein malnutrition.
In completing a client's preoperative C
routine, the nurse finds that the operative Rationale: The surgeon should be informed immediately that
permit is not signed. The client begins to ask the permit is not signed. It is the surgeon's responsibility to
more questions about the surgical explain the procedure to the client and obtain the client's
procedure. Which action should the nurse signature on the permit. Although the nurse can witness an
take next? operative permit, the procedure must first be explained by the
A. Witness the client's signature to the health care provider or surgeon, including answering the
permit. client's questions. The client's questions should be addressed
B. Answer the client's questions about the before the permit is signed.
surgery.
C. Inform the surgeon that the operative
permit is not signed and the client has
questions about the surgery.
D. Reassure the client that the surgeon will
answer any questions before the anesthesia
is administered.
The nurse is assessing several clients prior B
to surgery. Which factor in a client's history Rationale:
poses the greatest threat for complications Anticoagulants increase the risk for bleeding during surgery,
to occur during surgery? which can pose a threat for the development of surgical
A. Taking birth control pills for the past 2 complications. The health care provider should be informed
years that the client is taking these drugs. Although clients who take
B. Taking anticoagulants for the past year birth control pills may be more susceptible to the
C. Recently completing antibiotic therapy development of thrombi, such problems usually occur
D. Having taken laxatives PRN for the last 6 postoperatively. A client with option C or D is at less of a
months surgical risk than with option B.
HESI - Fundamentals exam with question with answer
, HESI - Fundamentals exam with question with answer
When assisting a client from the bed to a B
chair, which procedure is best for the nurse Rationale: Option B describes the correct positioning of the
to follow? nurse and affords the nurse a wide base of support while
A. Place the chair parallel to the bed, with its stabilizing the client's knees when assisting to a standing
back toward the head of the bed and assist position. The chair should be placed at a 45-degree angle to
the client in moving to the chair. the bed, with the back of the chair toward the head of the
B. With the nurse's feet spread apart and bed. Clients should never be lifted under the axillae; this
knees aligned with the client's knees, stand could damage nerves and strain the nurse's back. The client
and pivot the client into the chair. should be instructed to use the arms of the chair and should
C. Assist the client to a standing position by never place his or her arms around the nurse's neck; this
gently lifting upward, underneath the axillae. places undue stress on the nurse's neck and back and
D. Stand beside the client, place the client's increases the risk for a fall.
arms around the nurse's neck, and gently
move the client to the chair.
Which step(s) should the nurse take when A, B
administering ear drops to an adult client? Rationale: The correct answers (A and B) are the appropriate
(Select all that apply.) administration of ear drops. The dropper should be held 1 cm
A. Place the client in a side-lying position. (½ inch) above the ear canal (C). A cotton ball should be
B. Pull the auricle upward and outward. placed in the outermost canal (D). The auricle is pulled down
C. Hold the dropper 6 cm above the ear and back for a child younger than 3 years of age, but not an
canal. adult (E).
D. Place a cotton ball into the inner canal.
E. Pull the auricle down and back.
The nurse is instructing a client in the proper B
use of a metered-dose inhaler. Which Rationale: The medication should be inhaled through the
instruction should the nurse provide the mouth simultaneously with compression of the inhaler. This will
client to ensure the optimal benefits from facilitate the desired destination of the aerosol medication
the drug? deep in the lungs for an optimal bronchodilation effect.
A. "Fill your lungs with air through your Options A, C, and D do not allow for deep lung penetration.
mouth and then compress the inhaler."
B. "Compress the inhaler while slowly
breathing in through your mouth."
C. "Compress the inhaler while inhaling
quickly through your nose."
D. "Exhale completely after compressing the
inhaler and then inhale."
HESI - Fundamentals exam with question with answer
When turning an immobile bedridden client B
without assistance, which action by the Rationale: Because the nurse can only stand on one side of
nurse best ensures client safety? the bed, bed rails should be up on the opposite side to
A. Securely grasp the client's arm and leg. ensure that the client does not fall out of bed. Option A can
B. Put bed rails up on the side of bed cause client injury to the skin or joint. Options C and D are
opposite from the nurse. useful techniques while turning a client but have less priority
C. Correctly position and use a turn sheet. in terms of safety than use of the bed rails.
D. Lower the head of the client's bed slowly.
HESI - Fundamentals exam with question with answer
,HESI - Fundamentals exam with question with answer
The nurse identifies a potential for infection B
in a client with partial-thickness (second- Rationale: Careful handwashing technique is the single most
degree) and full-thickness (third-degree) effective intervention for the prevention of contamination to
burns. What intervention has the highest all clients. Option A reverses the hypovolemia that initially
priority in decreasing the client's risk of accompanies burn trauma but is not related to decreasing the
infection? proliferation of infective organisms. Options C and D are
A. Administration of plasma expanders recommended by various burn centers as possible ways to
B. Use of careful handwashing technique reduce the chance of infection. Option B is a proven
C. Application of a topical antibacterial technique to prevent infection.
cream
D. Limiting visitors to the client with burns
The nurse is aware that malnutrition is a A
common problem among clients served by Rationale: Long-term protein deficiency is required to cause
a community health clinic for the homeless. significantly lowered serum albumin levels. Albumin is made
Which laboratory value is the most reliable by the liver only when adequate amounts of amino acids (from
indicator of chronic protein malnutrition? protein breakdown) are available. Albumin has a long half-life,
A. Low serum albumin level so acute protein loss does not significantly alter serum levels.
B. Low serum transferrin level Option B is a serum protein with a half-life of only 8 to 10 days,
C. High hemoglobin level so it will drop with an acute protein deficiency. Options C and
D. High cholesterol level D are not clinical measures of protein malnutrition.
In completing a client's preoperative C
routine, the nurse finds that the operative Rationale: The surgeon should be informed immediately that
permit is not signed. The client begins to ask the permit is not signed. It is the surgeon's responsibility to
more questions about the surgical explain the procedure to the client and obtain the client's
procedure. Which action should the nurse signature on the permit. Although the nurse can witness an
take next? operative permit, the procedure must first be explained by the
A. Witness the client's signature to the health care provider or surgeon, including answering the
permit. client's questions. The client's questions should be addressed
B. Answer the client's questions about the before the permit is signed.
surgery.
C. Inform the surgeon that the operative
permit is not signed and the client has
questions about the surgery.
D. Reassure the client that the surgeon will
answer any questions before the anesthesia
is administered.
The nurse is assessing several clients prior B
to surgery. Which factor in a client's history Rationale:
poses the greatest threat for complications Anticoagulants increase the risk for bleeding during surgery,
to occur during surgery? which can pose a threat for the development of surgical
A. Taking birth control pills for the past 2 complications. The health care provider should be informed
years that the client is taking these drugs. Although clients who take
B. Taking anticoagulants for the past year birth control pills may be more susceptible to the
C. Recently completing antibiotic therapy development of thrombi, such problems usually occur
D. Having taken laxatives PRN for the last 6 postoperatively. A client with option C or D is at less of a
months surgical risk than with option B.
HESI - Fundamentals exam with question with answer
, HESI - Fundamentals exam with question with answer
When assisting a client from the bed to a B
chair, which procedure is best for the nurse Rationale: Option B describes the correct positioning of the
to follow? nurse and affords the nurse a wide base of support while
A. Place the chair parallel to the bed, with its stabilizing the client's knees when assisting to a standing
back toward the head of the bed and assist position. The chair should be placed at a 45-degree angle to
the client in moving to the chair. the bed, with the back of the chair toward the head of the
B. With the nurse's feet spread apart and bed. Clients should never be lifted under the axillae; this
knees aligned with the client's knees, stand could damage nerves and strain the nurse's back. The client
and pivot the client into the chair. should be instructed to use the arms of the chair and should
C. Assist the client to a standing position by never place his or her arms around the nurse's neck; this
gently lifting upward, underneath the axillae. places undue stress on the nurse's neck and back and
D. Stand beside the client, place the client's increases the risk for a fall.
arms around the nurse's neck, and gently
move the client to the chair.
Which step(s) should the nurse take when A, B
administering ear drops to an adult client? Rationale: The correct answers (A and B) are the appropriate
(Select all that apply.) administration of ear drops. The dropper should be held 1 cm
A. Place the client in a side-lying position. (½ inch) above the ear canal (C). A cotton ball should be
B. Pull the auricle upward and outward. placed in the outermost canal (D). The auricle is pulled down
C. Hold the dropper 6 cm above the ear and back for a child younger than 3 years of age, but not an
canal. adult (E).
D. Place a cotton ball into the inner canal.
E. Pull the auricle down and back.
The nurse is instructing a client in the proper B
use of a metered-dose inhaler. Which Rationale: The medication should be inhaled through the
instruction should the nurse provide the mouth simultaneously with compression of the inhaler. This will
client to ensure the optimal benefits from facilitate the desired destination of the aerosol medication
the drug? deep in the lungs for an optimal bronchodilation effect.
A. "Fill your lungs with air through your Options A, C, and D do not allow for deep lung penetration.
mouth and then compress the inhaler."
B. "Compress the inhaler while slowly
breathing in through your mouth."
C. "Compress the inhaler while inhaling
quickly through your nose."
D. "Exhale completely after compressing the
inhaler and then inhale."
HESI - Fundamentals exam with question with answer
