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HESI Fundamentals Assignment Quiz
The nurses determines a client's IV solution is infusing at 250 ml/hr. The prescribed rate is 125
ml/hr. What action should the nurse take first?
A. Determine when the IV solution was started.
B. Slow the IV infusion to keep vein open rate.
C. Assess the IV insertion site for swelling.
D. Report the finding to the healthcare provider.
B. Slow the IV infusion to keep vein open rate.
The nurse is preparing to give a client dehydration IV fluids delivered at a continuous rate of
175 ml/hour. Which infusion device should the nurse use?
A. Portable syringe pump.
B. Cassette infusion pump.
C. Volumetric controller.
D. Nonvolumetric controller.
B. Cassette infusion pump
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A 75-year-old client who has a history of end stage renal failure and advanced lung cancer,
recently had a stroke. Two days ago the healthcare provider discontinued the client's dialysis
treatments, stating that death is inevitable, but the client is disoriented and will not sign a DNR
directive. What is the priority nursing intervention?
A. Review the client's most recent laboratory reports.
B. Refer the client and family members for hospice care.
C. Notify the hospital ethics committee of the client situation.
D. Determine who is legally empowered to make decisions.
D. Determine who is legally empowered to make decisions.
When assessing a client with a nursing diagnosis of fluid volume deficit, the nurse notes that
the client's skin over the sternum "tents" when gently pinched. Which action should the nurse
implement?
A. Confirm the finding by further assessing the client for jugular vein distention.
B. Offer the client high protein snacks between regularly scheduled mealtimes.
C. Continue the planned nursing interventions to restore the client's fluid volume.
D. Change the plan of care to include a nursing diagnosis of impaired skin integrity.
C. Continue the planned nursing interventions to restore the client's fluid volume.
A 4-year-old boy who is scheduled for a tonsillectomy and adenoidectomy asks the nurse, "Will
it hurt to have my tonsils and adenoids taken out?" Which response is best for the nurse to
provide?
A. "It may hurt a little because of the incision made in your throat."
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B. "It won't hurt because you're such a big boy."
C. "It won't hurt because we put you to sleep."
D. "It may hurt but we'll give you medicine to help you feel better."
D. "It may hurt but we'll give you medicine to help you feel better."
A client who has been on bedrest for several days now has a prescription to progress activity as
tolerated. When the nurse assists the client out of bed for the first time, the client becomes
dizzy. What action should the nurse implement?
A. Encourage the client to take several slow, deep breaths while ambulating.
B. Help the client to remain standing by the bedside until the dizziness is relieved.
C. Instruct the client to remain on bedrest until the healthcare provider is contacted.
D. Advise the client to sit on the side of the bed for a few minutes before standing again.
D. Advise the client to sit on the side of the bed for a few minutes before standing again.
Which statement best describes durable power of attorney for health care?
A. The client signs a document that designates another person to make legally binding
healthcare decisions if client is unable to do so.
B. The healthcare decisions made by another person designated by the client are not legally
binding.
C. Instructions about actions to be taken in the event of a client's terminal or irreversible
condition are not legally binding.
D. Directions regarding care in the event of a terminal or irreversible condition must be
documented to ensure that they are legally binding.
A. The client signs a document that designates another person to make legally binding
healthcare decisions if client is unable to do so.
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While preparing to insert a rectal suppository in a male adult client, the nurse observes that the
client is holding his breath while bearing down. What action should the nurse implement?
A. Advise the client to continue to bear down without holding his breath.
B. Gently insert the lubricated suppository four inches into the rectum.
C. Perform a digital exam to determine if a fecal impaction is present.
D. Instruct the client to take slow deep breaths and stop bearing down.
D. Instruct the client to take slow deep breaths and stop bearing down.
A male client has a nursing diagnosis of "spiritual distress." What intervention is best for the
nurse to implement when caring for this client?
A. Use distraction techniques during times of spiritual stress and crisis.
B. Reassure the client that his faith will be regained with time and support.
C. Consult with the staff chaplain and ask that the chaplain visit with the client.
D. Use reflective listening techniques when the client expresses spiritual doubts.
D. Use reflective listening techniques when the client expresses spiritual doubts.
A female client who has breast cancer with metastasis to the liver and spine is admitted with
constant, severe pain despite around-the-clock use of oxycodone (Percodan) and amitriptyline
(Elavil) for pain control at home. During the admission assessment, which information is most
important for the nurse to obtain?
A. Sensory pattern, area, intensity, and nature of the pain.
B. Trigger points identified by palpation and manual pressure of painful areas.
C. Schedule and total dosages of drugs currently used for breakthrough pain.
D. Sympathetic responses consistent with onset of acute pain.
A. Sensory pattern, area, intensity, and nature of the pain.
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HESI Fundamentals Assignment Quiz
The nurses determines a client's IV solution is infusing at 250 ml/hr. The prescribed rate is 125
ml/hr. What action should the nurse take first?
A. Determine when the IV solution was started.
B. Slow the IV infusion to keep vein open rate.
C. Assess the IV insertion site for swelling.
D. Report the finding to the healthcare provider.
B. Slow the IV infusion to keep vein open rate.
The nurse is preparing to give a client dehydration IV fluids delivered at a continuous rate of
175 ml/hour. Which infusion device should the nurse use?
A. Portable syringe pump.
B. Cassette infusion pump.
C. Volumetric controller.
D. Nonvolumetric controller.
B. Cassette infusion pump
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A 75-year-old client who has a history of end stage renal failure and advanced lung cancer,
recently had a stroke. Two days ago the healthcare provider discontinued the client's dialysis
treatments, stating that death is inevitable, but the client is disoriented and will not sign a DNR
directive. What is the priority nursing intervention?
A. Review the client's most recent laboratory reports.
B. Refer the client and family members for hospice care.
C. Notify the hospital ethics committee of the client situation.
D. Determine who is legally empowered to make decisions.
D. Determine who is legally empowered to make decisions.
When assessing a client with a nursing diagnosis of fluid volume deficit, the nurse notes that
the client's skin over the sternum "tents" when gently pinched. Which action should the nurse
implement?
A. Confirm the finding by further assessing the client for jugular vein distention.
B. Offer the client high protein snacks between regularly scheduled mealtimes.
C. Continue the planned nursing interventions to restore the client's fluid volume.
D. Change the plan of care to include a nursing diagnosis of impaired skin integrity.
C. Continue the planned nursing interventions to restore the client's fluid volume.
A 4-year-old boy who is scheduled for a tonsillectomy and adenoidectomy asks the nurse, "Will
it hurt to have my tonsils and adenoids taken out?" Which response is best for the nurse to
provide?
A. "It may hurt a little because of the incision made in your throat."
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B. "It won't hurt because you're such a big boy."
C. "It won't hurt because we put you to sleep."
D. "It may hurt but we'll give you medicine to help you feel better."
D. "It may hurt but we'll give you medicine to help you feel better."
A client who has been on bedrest for several days now has a prescription to progress activity as
tolerated. When the nurse assists the client out of bed for the first time, the client becomes
dizzy. What action should the nurse implement?
A. Encourage the client to take several slow, deep breaths while ambulating.
B. Help the client to remain standing by the bedside until the dizziness is relieved.
C. Instruct the client to remain on bedrest until the healthcare provider is contacted.
D. Advise the client to sit on the side of the bed for a few minutes before standing again.
D. Advise the client to sit on the side of the bed for a few minutes before standing again.
Which statement best describes durable power of attorney for health care?
A. The client signs a document that designates another person to make legally binding
healthcare decisions if client is unable to do so.
B. The healthcare decisions made by another person designated by the client are not legally
binding.
C. Instructions about actions to be taken in the event of a client's terminal or irreversible
condition are not legally binding.
D. Directions regarding care in the event of a terminal or irreversible condition must be
documented to ensure that they are legally binding.
A. The client signs a document that designates another person to make legally binding
healthcare decisions if client is unable to do so.
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While preparing to insert a rectal suppository in a male adult client, the nurse observes that the
client is holding his breath while bearing down. What action should the nurse implement?
A. Advise the client to continue to bear down without holding his breath.
B. Gently insert the lubricated suppository four inches into the rectum.
C. Perform a digital exam to determine if a fecal impaction is present.
D. Instruct the client to take slow deep breaths and stop bearing down.
D. Instruct the client to take slow deep breaths and stop bearing down.
A male client has a nursing diagnosis of "spiritual distress." What intervention is best for the
nurse to implement when caring for this client?
A. Use distraction techniques during times of spiritual stress and crisis.
B. Reassure the client that his faith will be regained with time and support.
C. Consult with the staff chaplain and ask that the chaplain visit with the client.
D. Use reflective listening techniques when the client expresses spiritual doubts.
D. Use reflective listening techniques when the client expresses spiritual doubts.
A female client who has breast cancer with metastasis to the liver and spine is admitted with
constant, severe pain despite around-the-clock use of oxycodone (Percodan) and amitriptyline
(Elavil) for pain control at home. During the admission assessment, which information is most
important for the nurse to obtain?
A. Sensory pattern, area, intensity, and nature of the pain.
B. Trigger points identified by palpation and manual pressure of painful areas.
C. Schedule and total dosages of drugs currently used for breakthrough pain.
D. Sympathetic responses consistent with onset of acute pain.
A. Sensory pattern, area, intensity, and nature of the pain.
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