1
BSN 266
BSN 266 FALL (2025/2026) - HESI
FUNDAMENTALS EXAM QUESTIONS
WITH CORRECT VERIFIED SOLUTIONS
100% GUARANTEED PASS
The healthcare provider prescribes enteral feeds of Jevity 1.2
cal at 66mL/hour over 20 hours, and free water flushes of 225
mL q 4 hours x 24 hr via nasogastric tube. How many mL of
total fluid will the client receive in 24 hours? (Enter numerical
value only. If rounding is required, round to one decimal place.)
- ANS ✓2670 mL
Rationale:
66mL/hour x 20 hours = 1320 mL
Then it is necessary to calculate the amount of fluid from the
free water flushes.
Free water flushes every 4 hours for 24 hours = 6 flushes
225 mL x 65 flushes = 1350 mL
Finally, add the two sums together:
1320 mL + 1350 mL = 2670 mL in 24 hours
The nurse prepares to administer a medication that comes in
tablet for through a client's gastrostomy tube. Which actions
should the nurse implement? (Select all that apply)
a. Position client in Fowler's position
BSN 266
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BSN 266
b. Aspirate gastric contents at the start and end of the
procedure
c. Mix crushed medication with tube feeding
d. Pour dissolved medication into a syringe and inject into G
tube
e. Flush tube with 30 cc of lukewarm water prior and after the
medication administration - ANS ✓a. Position client in Fowler's
position
e. Flush tube with 30 cc of lukewarm water prior to and after the
medication administration
Rationale:
Choices A and E describe the correct execution of the listed
steps of medication administration. Fowler's position promotes
the downward flow of the medication into the stomach and
decreases the risk for medication reflux and aspiration. The
client should be maintained in Fowler's position during the
procedure and for 30 minutes after the medication
administration. The tube should be flushed before and after the
medication administration to clean the tubing and prevent
blockage. Lukewarm water (room temperature) should be used
to prevent abdominal cramping. To prevent volume overload,
no more than 30 ml should be administered per flush.
The nurse should follow a specific protocol to promote client
safety and medication efficacy when providing medication using
a G-tube. The appropriate steps include:
1. positioning the client in Fowler's position
2. verifying tube placement and GI function through aspiration
of stomach contents
3. flushing the tube with water prior to medication
administration
4. preparing the medication by crushing and dissolving it into
water
5. allowing the solution to drain into the G-tube by gravity
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6. flushing the tube with water after the medication
administration
7. reclamping the tube after the administration is completed and
the tube has been flushed.
The nurse notes that a client who is receiving oxygen by nasal
cannula continues to remove the oxygen prongs from the
nares. What action should the nurse take?
a. tape the oxygen tubing to the client's nares
b. assess why the client removes the nasal cannula
c. increase the oxygen flow rate
d. change the nasal cannula to a mask - ANS ✓b. assess why
the client removes the nasal cannula
Rationale:
Using the nursing process, the nurse would first assess why the
client is removing the nasal cannula from the nares. Nasal
prongs can cause discomfort in the nose or around the ears. If
the client reports discomfort, the nurse can troubleshoot based
on their symptoms to ensure proper oxygen delivery (e.g., if
nasal irritation is present, the air can be humidified, etc.)
The nurse is concerned that a blood pressure reading is
dangerously elevated for an obese client. What should the
nurse do first before contacting the health care provider with
the reading?
a. reassess the blood pressure using a larger cuff
b. reassess the blood pressure using a smaller cuff
c. reassess the blood pressure while the client is standing
d. reassess the blood pressure while the client is lying down -
ANS ✓a. reassess the blood pressure using a larger cuff
Rationale:
BSN 266
, 4
BSN 266
Blood pressure cuffs are sensitive and will provide either falsely
high or falsely low readings if an incorrect size is used. since
the client is obese and the reading was dangerously elevated,
the nurse should first assure that the correct size of cuff was
used for the reading and then reassess the client's blood
pressure. The nurse should use a larger cuff to accurately
assess this client's blood pressure.
BP - 136/80 mmHg
HR - 88 beats/min
RespR - 20 breaths/min
O2% sat - 92 % on 2L O2
Temp - 37 C (99.6 F) oral
A client with tracheostomy is admitted with pneumonia. The
client has a productive cough with thick yellow sputum, bilateral
crackles on lung auscultation, and vital sign as listed above.
When creating this client's care plan, which client outcome
should be the nurse identify as a priority?
a. client will be able to effectively cough secretions via
tracheostomy
b. client will have clear lungs sounds
c. client will be afebrile
d. client will have oxygen saturation greater than 90% during
hospitalization - ANS ✓a. client will be able to effectively cough
secretions via tracheostomy
Rationale:
A tracheostomy is an opening in the trachea that bypasses an
obstructed upper airway. There are multiple indications for and
types of tracheostomies but regardless of these variations, the
nurse should focus care planning using the ABC (airway,
breathing, circulation) framework, combined with the nursing
process. The first step is assessment, during which the nurse
BSN 266
BSN 266
BSN 266 FALL (2025/2026) - HESI
FUNDAMENTALS EXAM QUESTIONS
WITH CORRECT VERIFIED SOLUTIONS
100% GUARANTEED PASS
The healthcare provider prescribes enteral feeds of Jevity 1.2
cal at 66mL/hour over 20 hours, and free water flushes of 225
mL q 4 hours x 24 hr via nasogastric tube. How many mL of
total fluid will the client receive in 24 hours? (Enter numerical
value only. If rounding is required, round to one decimal place.)
- ANS ✓2670 mL
Rationale:
66mL/hour x 20 hours = 1320 mL
Then it is necessary to calculate the amount of fluid from the
free water flushes.
Free water flushes every 4 hours for 24 hours = 6 flushes
225 mL x 65 flushes = 1350 mL
Finally, add the two sums together:
1320 mL + 1350 mL = 2670 mL in 24 hours
The nurse prepares to administer a medication that comes in
tablet for through a client's gastrostomy tube. Which actions
should the nurse implement? (Select all that apply)
a. Position client in Fowler's position
BSN 266
, 2
BSN 266
b. Aspirate gastric contents at the start and end of the
procedure
c. Mix crushed medication with tube feeding
d. Pour dissolved medication into a syringe and inject into G
tube
e. Flush tube with 30 cc of lukewarm water prior and after the
medication administration - ANS ✓a. Position client in Fowler's
position
e. Flush tube with 30 cc of lukewarm water prior to and after the
medication administration
Rationale:
Choices A and E describe the correct execution of the listed
steps of medication administration. Fowler's position promotes
the downward flow of the medication into the stomach and
decreases the risk for medication reflux and aspiration. The
client should be maintained in Fowler's position during the
procedure and for 30 minutes after the medication
administration. The tube should be flushed before and after the
medication administration to clean the tubing and prevent
blockage. Lukewarm water (room temperature) should be used
to prevent abdominal cramping. To prevent volume overload,
no more than 30 ml should be administered per flush.
The nurse should follow a specific protocol to promote client
safety and medication efficacy when providing medication using
a G-tube. The appropriate steps include:
1. positioning the client in Fowler's position
2. verifying tube placement and GI function through aspiration
of stomach contents
3. flushing the tube with water prior to medication
administration
4. preparing the medication by crushing and dissolving it into
water
5. allowing the solution to drain into the G-tube by gravity
BSN 266
, 3
BSN 266
6. flushing the tube with water after the medication
administration
7. reclamping the tube after the administration is completed and
the tube has been flushed.
The nurse notes that a client who is receiving oxygen by nasal
cannula continues to remove the oxygen prongs from the
nares. What action should the nurse take?
a. tape the oxygen tubing to the client's nares
b. assess why the client removes the nasal cannula
c. increase the oxygen flow rate
d. change the nasal cannula to a mask - ANS ✓b. assess why
the client removes the nasal cannula
Rationale:
Using the nursing process, the nurse would first assess why the
client is removing the nasal cannula from the nares. Nasal
prongs can cause discomfort in the nose or around the ears. If
the client reports discomfort, the nurse can troubleshoot based
on their symptoms to ensure proper oxygen delivery (e.g., if
nasal irritation is present, the air can be humidified, etc.)
The nurse is concerned that a blood pressure reading is
dangerously elevated for an obese client. What should the
nurse do first before contacting the health care provider with
the reading?
a. reassess the blood pressure using a larger cuff
b. reassess the blood pressure using a smaller cuff
c. reassess the blood pressure while the client is standing
d. reassess the blood pressure while the client is lying down -
ANS ✓a. reassess the blood pressure using a larger cuff
Rationale:
BSN 266
, 4
BSN 266
Blood pressure cuffs are sensitive and will provide either falsely
high or falsely low readings if an incorrect size is used. since
the client is obese and the reading was dangerously elevated,
the nurse should first assure that the correct size of cuff was
used for the reading and then reassess the client's blood
pressure. The nurse should use a larger cuff to accurately
assess this client's blood pressure.
BP - 136/80 mmHg
HR - 88 beats/min
RespR - 20 breaths/min
O2% sat - 92 % on 2L O2
Temp - 37 C (99.6 F) oral
A client with tracheostomy is admitted with pneumonia. The
client has a productive cough with thick yellow sputum, bilateral
crackles on lung auscultation, and vital sign as listed above.
When creating this client's care plan, which client outcome
should be the nurse identify as a priority?
a. client will be able to effectively cough secretions via
tracheostomy
b. client will have clear lungs sounds
c. client will be afebrile
d. client will have oxygen saturation greater than 90% during
hospitalization - ANS ✓a. client will be able to effectively cough
secretions via tracheostomy
Rationale:
A tracheostomy is an opening in the trachea that bypasses an
obstructed upper airway. There are multiple indications for and
types of tracheostomies but regardless of these variations, the
nurse should focus care planning using the ABC (airway,
breathing, circulation) framework, combined with the nursing
process. The first step is assessment, during which the nurse
BSN 266
