HESI Nursing Foundations Practice Exam
A client is receiving alprazolam (Xanax) 0.75 mg PO bid for anxiety. Alprazolam is
available in 0.5 mg scored tablets. How many tablets should the nurse administer?
(Enter numeric value only.): 1.5
Rationale: Using the formula, Desired / Available x 1 tablet =
0.75 mg / 0.5 mg x 1 = 1.5 tablets
Which intervention is most important for the nurse to implement for a male client
who is experiencing urinary retention?: D. Assess for bladder distention.
Rationale: Urinary retention is the inability to void all urine collected in the bladder,
which leads to uncomfortable bladder distention. Assessing for distention is more
important than applying a catheter or applying skin protectant.
A male client with obesity discusses with the nurse his plans to begin a long-term
weight loss regimen. In addition to dietary changes, he plans to begin an intensive
aerobic exercise program 3 to 4 times a week and to take stress management
classes. After praising the client for his decision, which
instruction is most important for the nurse to provide?: A. "Be sure to have a
complete physical examination before beginning your planned exercise program."
Rationale:
A client with obesity who intends to begin a weight loss and exercise program may
be at risk for cardiovascular complications. The most important teaching is to
encourage the client to have a complete medical evaluation so that the client will
not begin a dangerous level of exercise when he is not sufficiently fit. Vigorous
exercise may result in chest pain, a heart attack, or stroke.
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, Which action is most important for the nurse to implement when donning sterile
gloves?: C. Keep gloved hands above the elbows.
Rationale: Gloved hands held below waist level are considered unsterile. While it
may be helpful to put the glove on the dominant hand first, it is not necessary to
ensure asepsis.
The nurse is evaluating a client learning about a low-sodium diet. Selection of which
meal would indicate to the nurse that this client understands the dietary
restrictions?: C. Skim milk, turkey salad, roll, vanilla ice cream.
Rationale: Skim milk, turkey, bread, and ice cream, while containing some sodium,
are considered low-sodium foods. Bacon, canned soups (especially those with
seafood), hard cheeses, macaroni, and most diet drinks are very high in sodium.
The nurse assigns an unlicensed assistive personnel (UAP) to obtain vital signs from
a very anxious client. What instructions should the nurse give the
UAP?: C. Report the results of the vital signs to the nurse.
Rationale: Interpretation of vital signs is the responsibility of the nurse, so the
unlicensed assistive personnel (UAP) should report vital sign measurements to the
nurse. Any instructions requiring the UAP to interpret the vital signs causes the UAP
to function beyond the scope of the UAP's authority.
A male client with a history of hypertension tells the nurse that he is tired of taking
antihypertensive medications and is going to try spiritual meditation instead. What
should be the nurse's first response?: A. "It is important that you continue your
medication while learning to meditate."
Rationale: The prolonged practice of meditation may lead to a reduced need for
antihypertensive medications. However, the medications must be continued while
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A client is receiving alprazolam (Xanax) 0.75 mg PO bid for anxiety. Alprazolam is
available in 0.5 mg scored tablets. How many tablets should the nurse administer?
(Enter numeric value only.): 1.5
Rationale: Using the formula, Desired / Available x 1 tablet =
0.75 mg / 0.5 mg x 1 = 1.5 tablets
Which intervention is most important for the nurse to implement for a male client
who is experiencing urinary retention?: D. Assess for bladder distention.
Rationale: Urinary retention is the inability to void all urine collected in the bladder,
which leads to uncomfortable bladder distention. Assessing for distention is more
important than applying a catheter or applying skin protectant.
A male client with obesity discusses with the nurse his plans to begin a long-term
weight loss regimen. In addition to dietary changes, he plans to begin an intensive
aerobic exercise program 3 to 4 times a week and to take stress management
classes. After praising the client for his decision, which
instruction is most important for the nurse to provide?: A. "Be sure to have a
complete physical examination before beginning your planned exercise program."
Rationale:
A client with obesity who intends to begin a weight loss and exercise program may
be at risk for cardiovascular complications. The most important teaching is to
encourage the client to have a complete medical evaluation so that the client will
not begin a dangerous level of exercise when he is not sufficiently fit. Vigorous
exercise may result in chest pain, a heart attack, or stroke.
1/7
, Which action is most important for the nurse to implement when donning sterile
gloves?: C. Keep gloved hands above the elbows.
Rationale: Gloved hands held below waist level are considered unsterile. While it
may be helpful to put the glove on the dominant hand first, it is not necessary to
ensure asepsis.
The nurse is evaluating a client learning about a low-sodium diet. Selection of which
meal would indicate to the nurse that this client understands the dietary
restrictions?: C. Skim milk, turkey salad, roll, vanilla ice cream.
Rationale: Skim milk, turkey, bread, and ice cream, while containing some sodium,
are considered low-sodium foods. Bacon, canned soups (especially those with
seafood), hard cheeses, macaroni, and most diet drinks are very high in sodium.
The nurse assigns an unlicensed assistive personnel (UAP) to obtain vital signs from
a very anxious client. What instructions should the nurse give the
UAP?: C. Report the results of the vital signs to the nurse.
Rationale: Interpretation of vital signs is the responsibility of the nurse, so the
unlicensed assistive personnel (UAP) should report vital sign measurements to the
nurse. Any instructions requiring the UAP to interpret the vital signs causes the UAP
to function beyond the scope of the UAP's authority.
A male client with a history of hypertension tells the nurse that he is tired of taking
antihypertensive medications and is going to try spiritual meditation instead. What
should be the nurse's first response?: A. "It is important that you continue your
medication while learning to meditate."
Rationale: The prolonged practice of meditation may lead to a reduced need for
antihypertensive medications. However, the medications must be continued while
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