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Exam (elaborations)

HESI FUNDAMENTALS EXAM 2020

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1. A policy requiring the removal of acrylic nails by all nursing personnel was implemented 6 months ago. Which assessment measure best determines if the intended outcome of the policy is being achieved. a. Number of staff induced injury b. Client satisfaction survey c. Health care-associated infection rate. d. Rate of needle-stick injuries by nurse. 2. The nurse is preparing to assist a newly admitted client with personal hygiene measures. The client...the client’s gag reflex. Which action should the nurse include? A. Offer smalls sips of water through a straw B. Place tongue blade on back half of tongue C. Use a penlight to observe back of oral cavity D. Auscultate breath sounds after client swallows 3. The father of an 11-year-old boy…. inform the father that it is most important to let the son that nocturnal emissions are normal 4. The nurse explains to an older adult male the procedure for collecting a 24-hour urine specimen for creatinine clearance. A. Assess the client for confusion and reteach the procedure B. Check the urine for color and texture C. Empty the urinal contents into the 24-hour collection container D. Discard the contents of the urinal 5. A 54-year-old male client and his wife were informed this morning that he has terminal cancer. Which nursing intervention is likely to be most A. Ask her how she would like to participate in the client’s care B. Provide the wife with information about hospice C. Encourage the wife to visit after painful treatments are completed D. Refer her to support group for family members of those dying of cancer 6. A client who has a body mass index (BMI) of 30 is requesting information on the initial approach to a weight loss plan. Which action should the nurse recommend? A. Plan low carbohydrate and high protein meals Engage in strenuous activity for an hour daily B. Keep a record of food and drinks consumed daily C. Participated in a group exercise class 3 times a week 7. The nurse assesses a client who has a nasal cannula delivering oxygen at 2 L/min. To assess for skin damage related to the cannula, which areas should the nurse observe? A. Tops of the ear ......................................CONTINUED.....................................

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HESI FUNDAMENTALS EXAM 2020

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1. A policy requiring the removal of acrylic nails by all
nursing personnel was implemented 6 months ago. Which
assessment measure best determines if the intended outcome of the
policy is being achieved.
a. Number of staff induced injury
b. Client satisfaction survey
c. Health care-associated infection rate.
d. Rate of needle-stick injuries by nurse.
2. The nurse is preparing to assist a newly admitted client with
personal hygiene measures. The client...the client’s gag reflex.
Which action should the nurse include?
A. Offer smalls
sips of water
through a straw B.
Place tongue blade
on back half of
tongue
C. Use a penlight to observe back
of oral cavity D. Auscultate breath sounds after
client swallows 3. The father of an 11-year-old
boy…. inform the father that it is most important to
let the son that nocturnal emissions are normal
4. The nurse explains to an older adult male the procedure for
collecting a 24-hour urine specimen for creatinine clearance.
A. Assess the client for confusion and reteach the
procedure
B. Check the urine for color and texture
C. Empty the urinal contents into the 24-hour
collection container
D. Discard the contents of the urinal
5. A 54-year-old male client and his wife were informed this
morning that he has terminal cancer. Which nursing
intervention is likely to be most
A. Ask her how she would like to participate in the
client’s care
B. Provide the wife with information about hospice

, C. Encourage the wife to visit after painful
treatments are completed
D. Refer her to support group for family members
of those dying of cancer
6. A client who has a body mass index (BMI) of 30 is requesting
information on the initial approach to a weight loss plan.
Which action should the nurse recommend?
A. Plan low carbohydrate and high protein meals
Engage in strenuous activity for an hour daily
B. Keep a record of food and drinks consumed
daily
C. Participated in a group exercise class 3 times a
week
7. The nurse assesses a client who has a nasal cannula delivering
oxygen at 2 L/min. To assess for skin damage related to the
cannula, which areas should the nurse observe?
A. Tops of the ear
B. Bridge of the nose
C. Around the nostrils
D. Over the cheeks
E. Across the forehead
8. The nurse observes an unlicensed assistive personnel (UAP) who
is providing a total bed bath for a confused and lethargic client.
The UAP is soaking the client’s foot in a basin of warm water
placed on the bed. What action should the nurse take?
a. Remove the basin of water from the client’s
bed immediately
b. Remind the UAP to dry between the client’s
toes completely
c. Advise the UAP that this procedure is
damaging to the skin
d. Add skin cream to the basin of water while the
foot is soaking
9. The nurse in the emergency department observes a colleague
viewing the electronic health record (EHR) of a client who holds
an elected position in the community. The client is not a part of
the colleague’s assignment. Which action should the nurse
implement?
a. Communicate the colleague’s actions to the
unit charge nurse

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