2024/2025 ALL HESI
FUNDAMENTALS EXAMS
QUESTIONS AND ANSWERS
TEST
WITH RATIONALES
GRADED A+
The nurse is administering medications through a nasogastric tube (NGT) which is connected
to suction. After ensuring correct tube placement, what action should the nurse take next?
A. Clamp the tube for 20 minutes.
B. Flush the tube with water.
,C. Administer the medications as prescribed.
D. Crush the tablets and dissolve in sterile water. - The NGT should be flushed before, after and
in between each medication administered (B). Once all medications are administered, the NGT
should be clamped for 20 minutes (A). (C and D) may be implemented only after the tubing has
been flushed.
ACCURATE ANS: B
A patient who is in hospice care complains of increasing amounts of pain. The healthcare provider
prescribes an analgesic every four hours as needed. Which action should the nurse implement?
A. Give an around-the-clock schedule for administration of analgesics.
B. Administer analgesic medication as needed when the pain is severe.
C. Provide medication to keep the patient sedated and unaware of stimuli.
D. Offer a medication-free period so that the patient can do daily activities. - The most
effective management of pain is achieved using an around-the-clock schedule that provides
analgesic medications on a regular basis (A) and in a timely manner. Analgesics are less
effective if pain persists until it is severe, so an analgesic medication should be administered
before the patient's pain peaks (B). Providing comfort is a priority for the patient who is dying,
but sedation that impairs the patient's ability to interact and experience the time before life
ends should be minimized (C). Offering a medication-free period allows the serum drug level to
fall, which is notan effective method to manage chronic pain (D).
,ACCURATE ANS: A
When examining a patient with wrist restraints, the nurse observes that the fingers on the right
hand are blue. What action should the nurse implement first?
A. Loosen the right wrist restraint.
B. Apply a pulse oximeter to the right hand.
C. Compare hand color bilaterally.
D. Palpate the right radial pulse. - The priority nursing action is to restore circulation by loosening
the restraint (A), because blue fingers (cyanosis) indicates decreased circulation. (C and D) are
also important nursing interventions, but do not have the priority of (A). Pulse oximetry (B)
measures the saturation of hemoglobin with oxygen and is not indicated in situations where the
cyanosis is related to mechanical compression (the restraints).
ACCURATE ANS: A
The nurse is examining the nutritional status of several patients. Which patient has the greatest
nutritional need for additional intake of protein?
A. A college-age track runner with a sprained ankle.
B. A lactating woman nursing her 3-day-old infant.
C. A school-aged child with Type 2 diabetes.
, D. An elderly man being treated for a peptic ulcer. - A lactating woman (B) has the greatest
need for additional protein intake. (A, C, and D) are all conditions that require protein, but do
not have the increased metabolic protein demands of lactation.
ACCURATE ANS: B
A patient is in the radiology department at 0900 when the prescription levofloxacin (Levaquin)
500 mg IV q24h is scheduled to be administered. The patient returns to the unit at 1300. What is
the best intervention for the nurse to implement?
A. Contact the healthcare provider and complete a medication variance form.
B. Administer the Levaquin at 1300 and resume the 0900 schedule in the morning.
C. Notify the charge nurse and complete an incident report to explain the missed dose.
D. Give the missed dose at 1300 and change the schedule to administer daily at 1300. - To
ensure that a therapeutic level of medication is maintained, the nurse should administer the
missed dose as soon as possible, and revise the administration schedule accordingly to prevent
dangerously increasing the level of the medication in the bloodstream (D). The nurse should
document the reason for the late dose, but (A and C) are not warranted. (B) could result in
increased blood levels of the drug.
ACCURATE ANS: D
While instructing a male patient's wife in the performance of passive range-of-motion
exercises to his contracted shoulder, the nurse observes that she is holding his arm above and
below the elbow. What nursing action should the nurse implement?
FUNDAMENTALS EXAMS
QUESTIONS AND ANSWERS
TEST
WITH RATIONALES
GRADED A+
The nurse is administering medications through a nasogastric tube (NGT) which is connected
to suction. After ensuring correct tube placement, what action should the nurse take next?
A. Clamp the tube for 20 minutes.
B. Flush the tube with water.
,C. Administer the medications as prescribed.
D. Crush the tablets and dissolve in sterile water. - The NGT should be flushed before, after and
in between each medication administered (B). Once all medications are administered, the NGT
should be clamped for 20 minutes (A). (C and D) may be implemented only after the tubing has
been flushed.
ACCURATE ANS: B
A patient who is in hospice care complains of increasing amounts of pain. The healthcare provider
prescribes an analgesic every four hours as needed. Which action should the nurse implement?
A. Give an around-the-clock schedule for administration of analgesics.
B. Administer analgesic medication as needed when the pain is severe.
C. Provide medication to keep the patient sedated and unaware of stimuli.
D. Offer a medication-free period so that the patient can do daily activities. - The most
effective management of pain is achieved using an around-the-clock schedule that provides
analgesic medications on a regular basis (A) and in a timely manner. Analgesics are less
effective if pain persists until it is severe, so an analgesic medication should be administered
before the patient's pain peaks (B). Providing comfort is a priority for the patient who is dying,
but sedation that impairs the patient's ability to interact and experience the time before life
ends should be minimized (C). Offering a medication-free period allows the serum drug level to
fall, which is notan effective method to manage chronic pain (D).
,ACCURATE ANS: A
When examining a patient with wrist restraints, the nurse observes that the fingers on the right
hand are blue. What action should the nurse implement first?
A. Loosen the right wrist restraint.
B. Apply a pulse oximeter to the right hand.
C. Compare hand color bilaterally.
D. Palpate the right radial pulse. - The priority nursing action is to restore circulation by loosening
the restraint (A), because blue fingers (cyanosis) indicates decreased circulation. (C and D) are
also important nursing interventions, but do not have the priority of (A). Pulse oximetry (B)
measures the saturation of hemoglobin with oxygen and is not indicated in situations where the
cyanosis is related to mechanical compression (the restraints).
ACCURATE ANS: A
The nurse is examining the nutritional status of several patients. Which patient has the greatest
nutritional need for additional intake of protein?
A. A college-age track runner with a sprained ankle.
B. A lactating woman nursing her 3-day-old infant.
C. A school-aged child with Type 2 diabetes.
, D. An elderly man being treated for a peptic ulcer. - A lactating woman (B) has the greatest
need for additional protein intake. (A, C, and D) are all conditions that require protein, but do
not have the increased metabolic protein demands of lactation.
ACCURATE ANS: B
A patient is in the radiology department at 0900 when the prescription levofloxacin (Levaquin)
500 mg IV q24h is scheduled to be administered. The patient returns to the unit at 1300. What is
the best intervention for the nurse to implement?
A. Contact the healthcare provider and complete a medication variance form.
B. Administer the Levaquin at 1300 and resume the 0900 schedule in the morning.
C. Notify the charge nurse and complete an incident report to explain the missed dose.
D. Give the missed dose at 1300 and change the schedule to administer daily at 1300. - To
ensure that a therapeutic level of medication is maintained, the nurse should administer the
missed dose as soon as possible, and revise the administration schedule accordingly to prevent
dangerously increasing the level of the medication in the bloodstream (D). The nurse should
document the reason for the late dose, but (A and C) are not warranted. (B) could result in
increased blood levels of the drug.
ACCURATE ANS: D
While instructing a male patient's wife in the performance of passive range-of-motion
exercises to his contracted shoulder, the nurse observes that she is holding his arm above and
below the elbow. What nursing action should the nurse implement?
