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HESI Fundamentals Practice Exam 2023 Questions And Correct Detailed Answers (Verified Answers) Already Graded A+
Question: What action should the nurse implement when adding sterile liquids to a sterile field?Correct Answer: Consider the sterile field contaminated if it becomes wet during the procedure.Question: 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?Correct Answer: Instruct the client to take slow deep breaths and stop bearing down.Question: The nurse is providing passive range of motion (ROM) exercises to the hip and knee for a client who is unconscious. After supporting the client's knee with one hand, what action should the nurse take next?
Correct Answer: Cradle the client's heel.
Question: Which statement correctly identifies a written learning objective for a client with peripheral vascular disease?Correct Answer: Upon discharge, the client will list three ways to protect the feet from injury.Question: When the nurse enters a client's room to do an initial assessment, the client shouts, "Get out of my room! I'm tired of being bothered!" How should the nurse respond?
Correct Answer: "What is concerning you this morning?"
Question: 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?Correct Answer: "It may hurt but we'll give you medicine to help you feel better."
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Question: A male client with an infected wound tells the nurse that he follows a macrobiotic diet. Which type of foods should the nurse recommend that the client select from the hospital menu?
Correct Answer: Combination of plant proteins to provide essential amino acids.
Question: An older client who is able to stand but not to ambulate receives a prescription to be mobilized into a chair as tolerated during each day. What is the best action for the nurse to implement when assisting the client from the bed to the chair?Correct Answer: Place a transfer belt around the client, assist to stand, and pivot to a chair that is placed at a right angle to the bed.Question: The nurse is discussing dietary preferences with a client who adheres to a vegan diet. Which dietary supplement should the nurse encourage the client to include in the dietary plan?
Correct Answer: Vitamin B12.
Question: The nurse encounters resistance when inserting the tubing into a client's rectum for a tap water enema. What action should the nurse implement?Correct Answer: Ask the client to relax and run a small amount of fluid into the rectum.Question: 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?Correct Answer: Continue the planned nursing interventions to restore the client's fluid volume.Question: A client is admitted to the hospital with intractable pain. What instruction should the nurse provide the unlicensed assistive personnel (UAP) who is preparing to assist this client with a bed bath?
Correct Answer: Take measures to promote as much comfort as possible.
Question: The nurse is preparing to irrigate a client's indwelling urinary catheter using an open technique. What action should the nurse take after applying gloves?
Correct Answer: Draw up the irrigating solution into the syringe.
Question: The nurse is administering an intermittent infusion of an antibiotic to a client whose intravenous (IV) access is an antecubital saline lock. After the nurse opens the roller
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clamp on the IV tubing, the alarm on the infusion pump indicates an obstruction. What action should the nurse take first?
Correct Answer: Reposition the client's arm.
Question: What intervention should the nurse include in the plan of care for a client who is being treated with an Unna’s paste boot for leg ulcers due to chronic venous insufficiency?Correct Answer: Check capillary refill of toes on lower extremity with Unna's paste boot.Question: A client is admitted with a stage four pressure ulcer that has a black, hardened surface and a light-pink wound bed with a malodorous green drainage. Which dressing is best for the nurse to use first?
Correct Answer: Wet to moist dressing.
Question: A female client informs the nurse that she uses herbal therapies to supplement her diet and manage common ailments. What information should the nurse offer the client about general use of herbal supplements?Correct Answer: Herbs should be obtained from manufacturers with a history of quality control of their supplements.Question: The nurse removes the dressing on a client's heel that is covering a pressure sore one-inch in diameter and finds that there is straw-colored drainage seeping from the wound. What description of this finding should the nurse include in the client's record?
Correct Answer: One-inch pressure sore draining serous fluid.
Question: The charge nurse assigns a nursing procedure to a new staff nurse who has not previously performed the procedure. What action is most important for the new staff nurse to take?Correct Answer: Refuse to perform the task that is beyond the nurse's experience.Question: 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?
Correct Answer: Sensory pattern, area, intensity, and nature of the pain.
Question: What action by the nurse demonstrates culturally sensitive care?
Correct Answer: Asks permission before touching a client.
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Question: A client in hospice care develops audible gurgling sounds on inspiration. Which nursing action has the highest priority?
Correct Answer: Inform the family that death is imminent.
Question: A client who has moderate, persistent, chronic neuropathic pain due to diabetic neuropathy takes gabapentin (Neurontin) and ibuprofen (Motrin, Advil) daily. If Step 2 of the World Health Organization (WHO) pain relief ladder is prescribed, which drug protocol should be implemented?
Correct Answer: Continue gabapentin.
Question: When preparing to administer an intravenous medication through a central venous catheter, the nurse aspirates a blood return in one of the lumens of the triple lumen catheter. Which action should the nurse implement?Correct Answer: Flush the lumen with the saline solution and administer the medication through the lumen.Question: How should the nurse handle linens that are soiled with incontinent feces?Correct Answer: Place the soiled linens in a pillow case and deposit them in the dirty linen hamper.Question: An older female client with rheumatoid arthritis is complaining of severe joint pain that is caused by the weight of the linen on her legs. What action should the nurse implement first?
Correct Answer: Drape the sheets over the footboard of the bed.
Question: A healthcare provider is performing a sterile procedure at a client’s bedside.Near the end of the procedure, the nurse observes the healthcare provider contaminate a sterile glove and the sterile field. What is the best action for the nurse to implement?Correct Answer: Identify the break in surgical asepsis and provide another set of sterile supplies.Question: The nurse notes that a client consistently coughs while eating and drinking.Which nursing diagnosis is most important for the nurse to include in this client's plan of care?
