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HESI RN Fundamentals with NGN Exam
Questions & Correct Answers | Q&A
with Rationales | Grade A | Next
Generation NCLEX Style
Exam Structure:
Subject: Nursing / HESI RN Fundamentals with NGN Exam Review
Source: HESI RN Fundamentals with NGN Exam
Format: Comprehensive Question and Answer Review with Rationales
Legal and Ethical Issues
1. A 16-year-old emancipated client is being seen in the emergency
department following a minor automobile accident. The client's
parents arrive and are asking questions about the client's laboratory
results. Which response is best for the nurse to provide?
Answer: B. "I can only give medical information to your child because they
are legally an adult."
Rationale:
1. Emancipation means the minor is legally recognized as an adult for
healthcare decisions.
2. Patient confidentiality laws (HIPAA) protect the client's information.
3. The nurse must uphold the principles of patient autonomy and
confidentiality.
4. Providing information to parents without consent would violate
these laws.
Priority Setting and Clinical Judgment
2. The nurse is caring for a client with a history of neuropathy who
reports increasing numbness and tingling in the lower extremities.
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Which problem should the nurse determine is the priority for
promoting foot care at this time?
Answer: C. Risk for impaired skin integrity.
Rationale:
1. Neuropathy decreases sensation, so the client may not feel injuries.
2. Preventing skin breakdown is the priority to avoid ulcers and
infections.
3. Preventing infection is important, but preventing the wound itself
comes first.
4. Addressing skin integrity issues is crucial to avoid complications.
3. The nurse enters a client's room to perform a physical assessment
and finds the client crying. Which response is best for the nurse to
provide?
Answer: B. While touching the client's forearm, asks, "Would you like to
talk about it?"
Rationale:
1. This response demonstrates empathy and offers support.
2. Gentle touch can convey caring, but should be used with caution.
3. It allows the client to choose whether to discuss their feelings.
4. Acknowledging emotions is therapeutic.
4. The nurse is interviewing a client with lower abdominal pain and
dysuria, and needs to question the client about sexual activity. Which
approach is best for the nurse to use?
Answer: C. Begin with questions that are less sensitive in nature.
Rationale:
1. Starting with less sensitive questions helps build rapport.
2. Trust is established before addressing sensitive topics.
3. Vague questions may cause confusion.
4. Sharing personal values is not appropriate.
Pain Management
5. The nurse is using guided imagery with a client who is experiencing
chronic pain. The nurse should direct the client's attention on which
focus?
Answer: A. Positive external places.
Rationale:
1. Guided imagery involves visualizing calming, peaceful scenes.
, 3|Page
2. This technique diverts attention away from pain.
3. It promotes relaxation and reduces pain perception.
4. Examples: beach, forest, peaceful garden.
6. The nurse is caring for a client who is postoperative and receiving
supplemental oxygen at 2 L/minute via nasal cannula. The oxygen
saturation is 89%. Which action should the nurse implement?
Answer: B. Verify placement of pulse oximeter.
Rationale:
1. Always verify the accuracy of the reading before intervening.
2. The probe may be loose or on a poorly perfused digit.
3. Check for nail polish, edema, or poor circulation.
4. If reading is accurate, then increase oxygen as ordered.
7. A client with chronic fecal incontinence is crying because of being
embarrassed for not getting to the bathroom in time to avoid soiling
the bed and clothing. When establishing a bowel training regimen,
which intervention should the nurse implement?
Answer: B. Assist to a bedside commode 30 minutes after meals.
Rationale:
1. The gastrocolic reflex increases bowel motility after eating.
2. Timing toileting after meals promotes regular bowel movements.
3. This helps establish a predictable pattern.
4. Reduces episodes of incontinence.
8. A confused older adult client is having trouble sleeping at night and
is sometimes found wandering in the hallway. Which nursing
intervention should the nurse implement first?
Answer: A. Provide a back rub at bedtime.
Rationale:
1. Non-pharmacological interventions should be tried first.
2. Back rub promotes relaxation and comfort.
3. Restraints and sedatives are last resorts.
4. Environmental modifications may also help.
Wound Care
9. The nurse is caring for a client one week postsurgery. Which finding
should the nurse expect to see if the surgical incision is healing
properly?
, 4|Page
Answer: A. A well approximated incision site.
Rationale:
1. Well-approximated edges indicate primary intention healing.
2. Minimal drainage and no redness/swelling are expected.
3. Erythema and exudate may indicate infection.
4. Eschar and slough indicate delayed healing.
Documentation
10. After completing daily charting at 1400, the nurse realizes that a
0900 occurrence was not entered. Which is the best way for the nurse
to enter computer documentation of the 0900 occurrence?
Answer: D. Make an electronic addendum following the 1400
documentation.
Rationale:
1. An addendum adds missing information without altering original
entries.
2. It should be clearly identified as a late entry.
3. Never delete or alter previously entered data.
4. Follow facility policy for addendums.
Range of Motion
11. The nurse is teaching a client how to do active range of motion
(ROM) exercises. To exercise the hinge joints, which action should the
nurse instruct the client to perform?
Answer: C. Bend the arm by flexing the ulna to the humerus.
Rationale:
1. Hinge joints allow flexion and extension.
2. The elbow is a hinge joint.
3. Flexing the arm demonstrates elbow movement.
4. Turning head, rotating arms, and tilting pelvis involve other joint
types.
Restraints
12. The nurse observes the unlicensed assistive personnel (UAP)
securing a client's wrist restraints to the bedside rails. Which action is
most important for the nurse to implement?
HESI RN Fundamentals with NGN Exam
Questions & Correct Answers | Q&A
with Rationales | Grade A | Next
Generation NCLEX Style
Exam Structure:
Subject: Nursing / HESI RN Fundamentals with NGN Exam Review
Source: HESI RN Fundamentals with NGN Exam
Format: Comprehensive Question and Answer Review with Rationales
Legal and Ethical Issues
1. A 16-year-old emancipated client is being seen in the emergency
department following a minor automobile accident. The client's
parents arrive and are asking questions about the client's laboratory
results. Which response is best for the nurse to provide?
Answer: B. "I can only give medical information to your child because they
are legally an adult."
Rationale:
1. Emancipation means the minor is legally recognized as an adult for
healthcare decisions.
2. Patient confidentiality laws (HIPAA) protect the client's information.
3. The nurse must uphold the principles of patient autonomy and
confidentiality.
4. Providing information to parents without consent would violate
these laws.
Priority Setting and Clinical Judgment
2. The nurse is caring for a client with a history of neuropathy who
reports increasing numbness and tingling in the lower extremities.
, 2|Page
Which problem should the nurse determine is the priority for
promoting foot care at this time?
Answer: C. Risk for impaired skin integrity.
Rationale:
1. Neuropathy decreases sensation, so the client may not feel injuries.
2. Preventing skin breakdown is the priority to avoid ulcers and
infections.
3. Preventing infection is important, but preventing the wound itself
comes first.
4. Addressing skin integrity issues is crucial to avoid complications.
3. The nurse enters a client's room to perform a physical assessment
and finds the client crying. Which response is best for the nurse to
provide?
Answer: B. While touching the client's forearm, asks, "Would you like to
talk about it?"
Rationale:
1. This response demonstrates empathy and offers support.
2. Gentle touch can convey caring, but should be used with caution.
3. It allows the client to choose whether to discuss their feelings.
4. Acknowledging emotions is therapeutic.
4. The nurse is interviewing a client with lower abdominal pain and
dysuria, and needs to question the client about sexual activity. Which
approach is best for the nurse to use?
Answer: C. Begin with questions that are less sensitive in nature.
Rationale:
1. Starting with less sensitive questions helps build rapport.
2. Trust is established before addressing sensitive topics.
3. Vague questions may cause confusion.
4. Sharing personal values is not appropriate.
Pain Management
5. The nurse is using guided imagery with a client who is experiencing
chronic pain. The nurse should direct the client's attention on which
focus?
Answer: A. Positive external places.
Rationale:
1. Guided imagery involves visualizing calming, peaceful scenes.
, 3|Page
2. This technique diverts attention away from pain.
3. It promotes relaxation and reduces pain perception.
4. Examples: beach, forest, peaceful garden.
6. The nurse is caring for a client who is postoperative and receiving
supplemental oxygen at 2 L/minute via nasal cannula. The oxygen
saturation is 89%. Which action should the nurse implement?
Answer: B. Verify placement of pulse oximeter.
Rationale:
1. Always verify the accuracy of the reading before intervening.
2. The probe may be loose or on a poorly perfused digit.
3. Check for nail polish, edema, or poor circulation.
4. If reading is accurate, then increase oxygen as ordered.
7. A client with chronic fecal incontinence is crying because of being
embarrassed for not getting to the bathroom in time to avoid soiling
the bed and clothing. When establishing a bowel training regimen,
which intervention should the nurse implement?
Answer: B. Assist to a bedside commode 30 minutes after meals.
Rationale:
1. The gastrocolic reflex increases bowel motility after eating.
2. Timing toileting after meals promotes regular bowel movements.
3. This helps establish a predictable pattern.
4. Reduces episodes of incontinence.
8. A confused older adult client is having trouble sleeping at night and
is sometimes found wandering in the hallway. Which nursing
intervention should the nurse implement first?
Answer: A. Provide a back rub at bedtime.
Rationale:
1. Non-pharmacological interventions should be tried first.
2. Back rub promotes relaxation and comfort.
3. Restraints and sedatives are last resorts.
4. Environmental modifications may also help.
Wound Care
9. The nurse is caring for a client one week postsurgery. Which finding
should the nurse expect to see if the surgical incision is healing
properly?
, 4|Page
Answer: A. A well approximated incision site.
Rationale:
1. Well-approximated edges indicate primary intention healing.
2. Minimal drainage and no redness/swelling are expected.
3. Erythema and exudate may indicate infection.
4. Eschar and slough indicate delayed healing.
Documentation
10. After completing daily charting at 1400, the nurse realizes that a
0900 occurrence was not entered. Which is the best way for the nurse
to enter computer documentation of the 0900 occurrence?
Answer: D. Make an electronic addendum following the 1400
documentation.
Rationale:
1. An addendum adds missing information without altering original
entries.
2. It should be clearly identified as a late entry.
3. Never delete or alter previously entered data.
4. Follow facility policy for addendums.
Range of Motion
11. The nurse is teaching a client how to do active range of motion
(ROM) exercises. To exercise the hinge joints, which action should the
nurse instruct the client to perform?
Answer: C. Bend the arm by flexing the ulna to the humerus.
Rationale:
1. Hinge joints allow flexion and extension.
2. The elbow is a hinge joint.
3. Flexing the arm demonstrates elbow movement.
4. Turning head, rotating arms, and tilting pelvis involve other joint
types.
Restraints
12. The nurse observes the unlicensed assistive personnel (UAP)
securing a client's wrist restraints to the bedside rails. Which action is
most important for the nurse to implement?
