HESI RN FUNDAMENTALS EXAM 2024

HESI RN FUNDAMENTALS EXAM 2024

WITH 300+ QUESTIONS AND CORRECT

DETAILED ANSWERS GRADED A+ / HESI

RN FUNDAMENTALS LATEST EXAM 2024 -

2025 (BRAND NEW!!)

The PN and RN team leader identify a priority problem for the client's plan of care as "impaired skin integrity." Which etiology identified by the nurse is accurate?

• Noncompliance with turning schedule.
• Poor nutritional intake.
• Impaired physical mobility.
• Impaired adjustment. - ANSWER-C. Impaired physical mobility.

After establishing the priority diagnosis, the nurse identifies goals and expected outcomes.Which goal should the nurses include in the client's plan of care?

• The client's skin will remain intact without deterioration.
• The client's motor function will be restored.
• Client teaching will be provided.
• Impaired skin integrity will not occur. - ANSWER-A. The client's skin will

remain intact without deterioration.

At the end of the appointment, the nurse provides client teaching about measures to promote healing and to prevent further tissue destruction. 1 / 4

To provide pressure relief at night, the nurse teaches the client to sleep in which position?

• Supine with the head of the bed elevated.
• Supine with a foam wedge between the knees.
• Thirty-degree lateral inclined position.
• Full side-lying position supported with pillows. - ANSWER-C. Thirty-degree

lateral inclined position.

Upon learning that the client has a pressure-reducing gel chair cushion for their wheelchair, which action should the nurse take?

• Encourage them to continue to use this device in their wheelchair at all times.
• Recommend that they replace the gel pad with a donut-shaped foam cushion.
• Advise them to avoid the use of any form of pressure cushion on their

wheelchair.

• Teach them that regular use of skin moisturizer is more important than cushion

use. - ANSWER-A. Encourage them to continue to use this device in their wheelchair at all times.

The nurse teaches the client to apply a dressing over the sacral area. Which type of dressing is most likely to be used over the stage 1 PI?

• Transparent film dressing.
• Aherent film dressing.
• Gauze dressing.
• Hydrogel covered with a foam dressing. - ANSWER-A. Transparent film

dressing.

A month later, the client arrives in the emergency department at the local hospital and reports having had the flu and has spent most of their time in bed for the last several days. The client has been experiencing vomiting and diarrhea. The nurse 2 / 4

observes that the sacral PI is open, has a crater-like appearance, and is draining a large amount of thick yellow-tan fluid with an unpleasant odor. A small amount of eschar is present. The client is admitted to the hospital with a fever, fluid volume deficit, and possible sepsis.How should the nurse describe the drainage in documenting the wound?

• Infectious.
• Purulent.
• Serous.
• Sanguineous. - ANSWER-B. Purulent.

The nurse observes that the reddish area is round and is directly over the client's sacrum. The skin is intact.In addition to measuring the length of time the redness lasts, which assessment measure(s) should the nurse perform? (Select all that apply. One, some, or all options may be correct.)

• Apply light pressure to the area with the fingertips.
• Measure the diameter of the redness.
• Obtain a wound culture.
• Gently lift a fold of skin.
• Observe for wound approximation. - ANSWER-A. Apply light pressure to the

area with the fingertips.

• Measure the diameter of the redness.

The sacral area has remained red for 2 hours and does not blanch when tested.Which is the best description for the nurse to document?

• Excessive pallor.
• Unusual skin mottling.
• Dependent sacral rubor. 3 / 4

• Reactive hyperemia. - ANSWER-D. Reactive hyperemia.

The nurse identifies that the client has developed a Stage 1 pressure injury and is concerned that the client may have other pressure injuries.Which areas are most important for the nurse to observe for additional pressure injuries (PI)?

• Distal tips of the toes.
• Lower abdominal folds.
• Ischial tuberosities.
• Thighs and calves. - ANSWER-C. Ischial tuberosities.

During the assessment of these high-risk areas, the nurse finds no redness, but the underlying tissue feels spongy.What action should the nurse implement?

• Apply heat to reduce the inflammation that has occurred at these sites.
• Notify the healthcare provider (HCP) that the client is retaining excess fluid.
• Reassure the client that no pressure damage is present at these sites.
• Identify these areas as sites where pressure damage has occurred. - ANSWER-
• Identify these areas as sites where pressure damage has occurred.

To reduce the effects of moisture on the client's skin, which intervention should be implemented?

• Apply a moisture-repellent ointment to intact skin areas.
• Rinse ulcerated areas with an alcohol-based irrigating solution.
• Position a plastic-lined pad under the buttocks.
• Apply moist heat to the area following exposure to feces. - ANSWER-A. Apply

a moisture-repellent ointment to intact skin areas.

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