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2023 HESI RN Fundamentals v1
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A policy requiring the removal of acrylic nails by all nursing personnel was
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implemented 6 months ago. Which assessment measure best determines if the
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intended outcome of the policy is being achieved.
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a. Number of staff induced injury
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b. Client satisfaction survey
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c. Health care-associated infection rate.
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d. Rate of needle-stick injuries by nurse.
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The nurse is preparing to assist a newly admitted client with personal hygiene
measures. The client...the client’s gag reflex. Which action should the nurse include?
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A. Offer smalls sips of water through a straw
Place tongue blade on back half of tongue
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B.
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C. Use a penlight to observe back of oral cavity
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D. Auscultate breath sounds after client
swallows 3.The father of an 11-year-old boy….
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inform the father that it is most important to let the son that nocturnal
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emissions are normal 4.The nurse explains to an older adult male the procedure for
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collecting a 24-hour urine specimen for creatinine
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clearance.
Assess the client for confusion and reteach the procedure
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A.
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Check the urine for color and texture
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B.
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C. Empty the urinal contents into the 24-hour collection container
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Discard the contents of the urinal
54-year-old male client and his wife were informed this morning that he has
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terminal cancer. Which nursing intervention is likely to be most
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Ask her how she would like to participate in the client’s care
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A.
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B. Provide the wife with information about hospice
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C. Encourage the wife to visit after painful treatments are completed
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D. Refer her to support group for family members of those dying of cancer
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la
A client who has a body mass index (BMI) of 30 is requesting information on the
initial approach to a weight loss plan. Which action should the nurse recommend?
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Sp
A. Plan low carbohydrate and high protein meals
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B. Engage in strenuous activity for an hour daily
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C. Keep a record of food and drinks consumed daily
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sh
Sp
D. Participated in a group exercise class 3 times a week
ne
The nurse assesses a client who has a nasal cannula delivering oxygen at 2 L/min.
la
To assess for skin damage related to the cannula, which areas should the nurse
observe?
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Sp
A. Tops of the ear
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B. Bridge of the nose
la
C. Around the nostrils
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Sp
D. Over the cheeks
Across the forehead
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E.
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A female client’s significant other has been at her bedside providing reassurance and
support for past 3 days, as desired by the client. The client’s estranged husband arrives and
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demands the significant other not be allowed to visit or be given condition updates. Which
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intervention should the nurse implement?
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A) Communicate the client’s wishes tall members of the multidisciplinary team.
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B) Encourage the client to speak with her husband regarding his disruptive behavior.
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C) Request a consultation with the ethics committee for resolution of the situation.
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sh
Sp
D) Obtain a prescription from the healthcare provider regarding visitation privilages.
ne
la
sh
Sp
ne
The nurse observes that there are reddened areas on the cheekbones of a client
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receiving oxygen per nasal cannula at 3L/minute, and the client’s oxygen saturation
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level is 92%. What intervention should the nurse implement?
sh
Sp
A) Decrease the flow rate to 1 L/minute.
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B) Discontinue the use of the nasal cannula. la
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Sp
C) Apply lubricant to the cannula tubing.
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Sp
D) Place padding around the cannula tubing.
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Sp
A female nursing home resident and her family only speak Spanish. During a visit, the
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entire family begins to cry hysterically. When unable to determine why the family is upset,
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Sp
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la
, t
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what intervention is most important for the nurse to implement?
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A) Ask a Spanish speaking staff member to talk with the family.
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B) Use a Spanish translation reference to interview the family.
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2023 HESI RN Fundamentals v1
la
tz
sh
A policy requiring the removal of acrylic nails by all nursing personnel was
Sp
implemented 6 months ago. Which assessment measure best determines if the
ne
intended outcome of the policy is being achieved.
la
a. Number of staff induced injury
sh
Sp
b. Client satisfaction survey
ne
c. Health care-associated infection rate.
la
d. Rate of needle-stick injuries by nurse.
tz
sh
Sp
The nurse is preparing to assist a newly admitted client with personal hygiene
measures. The client...the client’s gag reflex. Which action should the nurse include?
ne
A. Offer smalls sips of water through a straw
Place tongue blade on back half of tongue
la
sh
B.
Sp
C. Use a penlight to observe back of oral cavity
ne
la
D. Auscultate breath sounds after client
swallows 3.The father of an 11-year-old boy….
tz
sh
Sp
inform the father that it is most important to let the son that nocturnal
ne
emissions are normal 4.The nurse explains to an older adult male the procedure for
la
collecting a 24-hour urine specimen for creatinine
sh
Sp
clearance.
Assess the client for confusion and reteach the procedure
ne
A.
la
tz
sh
Sp
ne
la
sh
Sp
la
, t
h ne
as
e
hn
l
Check the urine for color and texture
tz
B.
Sp
C. Empty the urinal contents into the 24-hour collection container
as
D. ne
Discard the contents of the urinal
54-year-old male client and his wife were informed this morning that he has
l
sh
terminal cancer. Which nursing intervention is likely to be most
Sp
Ask her how she would like to participate in the client’s care
ne
A.
la
B. Provide the wife with information about hospice
tz
C. Encourage the wife to visit after painful treatments are completed
sh
Sp
D. Refer her to support group for family members of those dying of cancer
ne
la
A client who has a body mass index (BMI) of 30 is requesting information on the
initial approach to a weight loss plan. Which action should the nurse recommend?
sh
Sp
A. Plan low carbohydrate and high protein meals
ne
B. Engage in strenuous activity for an hour daily
la
C. Keep a record of food and drinks consumed daily
tz
sh
Sp
D. Participated in a group exercise class 3 times a week
ne
The nurse assesses a client who has a nasal cannula delivering oxygen at 2 L/min.
la
To assess for skin damage related to the cannula, which areas should the nurse
observe?
sh
Sp
A. Tops of the ear
ne
B. Bridge of the nose
la
C. Around the nostrils
tz
sh
Sp
D. Over the cheeks
Across the forehead
ne
E.
la
A female client’s significant other has been at her bedside providing reassurance and
support for past 3 days, as desired by the client. The client’s estranged husband arrives and
sh
Sp
ne
la
tz
sh
Sp
ne
la
sh
Sp
la
, t
h ne
as
e
hn
l
demands the significant other not be allowed to visit or be given condition updates. Which
tz
Sp
intervention should the nurse implement?
as
ne
A) Communicate the client’s wishes tall members of the multidisciplinary team.
l
sh
Sp
B) Encourage the client to speak with her husband regarding his disruptive behavior.
ne
la
C) Request a consultation with the ethics committee for resolution of the situation.
tz
sh
Sp
D) Obtain a prescription from the healthcare provider regarding visitation privilages.
ne
la
sh
Sp
ne
The nurse observes that there are reddened areas on the cheekbones of a client
la
receiving oxygen per nasal cannula at 3L/minute, and the client’s oxygen saturation
tz
level is 92%. What intervention should the nurse implement?
sh
Sp
A) Decrease the flow rate to 1 L/minute.
ne
B) Discontinue the use of the nasal cannula. la
sh
Sp
C) Apply lubricant to the cannula tubing.
ne
la
tz
sh
Sp
D) Place padding around the cannula tubing.
ne
la
sh
Sp
A female nursing home resident and her family only speak Spanish. During a visit, the
ne
entire family begins to cry hysterically. When unable to determine why the family is upset,
la
tz
sh
Sp
ne
la
sh
Sp
la
, t
h ne
as
e
hn
l
what intervention is most important for the nurse to implement?
tz
Sp
A) Ask a Spanish speaking staff member to talk with the family.
as
ne
B) Use a Spanish translation reference to interview the family.
l
sh
Sp
ne
la
tz
sh
Sp
ne
la
sh
Sp
ne
la
tz
sh
Sp
ne
la
sh
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