HESI Fundamentals V.2 Questions And Correct Detailed Answers (Verified Answers) Already Graded A+

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HESI Fundamentals V.2 Questions And Correct Detailed Answers (Verified Answers) Already Graded A+

• When performing blood pressure measurement to assess for orthostatic

hypotension, which action should the nurse implement first?

• Apply the blood pressure cuff securely.
• Record the client's pulse rate and rhythm.
• Position the client supine for a few minutes.
• Assist the client to stand at bedside.

Correct Answer: C) Position the client supine for a few minutes.

• A client who has been diagnosed with terminal cancer tells the nurse, "The doctor

told me I have cancer and do not have long to live." Which response is best for the nurse to provide?

• "That's correct, you do not have long to live."
• "Would you like me to call your minister?"
• "Don't give up, you still have chemotherapy to try."
• "Yes, your condition is serious."

Correct Answer: D) "Yes, your condition is serious."

• To assess the quality of an adult client's pain, what approach should the nurse use?
• Observe body language and movement.
• Provide a numeric pain scale.
• Ask the client to describe the pain.
• Identify effective pain relief measures.

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Correct Answer: C) Ask the client to describe the pain.

• A client is discharged to a long-term care facility with an indwelling urinary catheter.

Which nursing action should be included in the plan to reduce the client's risk for infection related to the catheter?

• Flush the catheter daily with sterile saline.
• Encourage increased intake of oral fluids.
• Administer a PRN antipyretic if a fever develops.
• Secure the drainage bag at bladder level during transport.

Correct Answer: B) Encourage increased intake of oral fluids.

• The home health nurse is reviewing the personal care of an elderly client who lives

alone. Which client assessment findings indicate the need to assign unlicensed assistive personnel (UAP) to provide routine foot care and file the client's toenails?Select all that apply.

• Syncope when bending.
• Hand tremors.
• Diminished visual acuity.
• Urinary incontinence.
• Shuffling gait.

Correct Answer: A) Syncope when bending, B) Hand tremors, C) Diminished visual

acuity.

• When assessing a client who starts to wheeze related data should obtain?
• Presence of radiation.
• Heart sounds.
• Body temperature.
• Precipitating factors.

Correct Answer: D) Precipitating factors.

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• A client diagnosed with primary open-angle glaucoma received a prescription for

biotic eye drops, pilocarpine HCl (Pilocarpine). What instruction should the nurse plan to include in this client's teaching?

• "Do not allow the dropper bottle to touch the eye."
• "Administer the medication directly on the cornea."
• "Squeeze your eye closed after administering the drops."
• "Wash your hands after each administration of eye drops."

Correct Answer: A) "Do not allow the dropper bottle to touch the eye."

• An older woman with end stage heart disease is hospitalized for severe heart failure.

She is alert, oriented, and requests that no heroic measures are implemented if her breathing stops. What action should the nurse take first?

• Discuss with the client her meaning of heroic measures.
• Obtain a "do not resuscitate" (DNR) prescription.
• Set up a family conference to discuss the client's.
• Consult the palliative care team about client's care.

Correct Answer: A) Discuss with the client her meaning of heroic measures.

• While suctioning a client's nasopharynx, the nurse observes that the client's oxygen

saturation remains at 94%, which is the same reading obtained prior to starting the procedure. What action should the nurse take in response to this finding?

• Reposition the pulse oximeter clip to obtain a new reading.
• Stop suctioning until the pulse oximeter reading is above 95%.
• Complete the intermittent suction of the nasopharynx.
• Apply an oxygen mask over the client's nose and mouth.

Correct Answer: C) Complete the intermittent suction of the nasopharynx.

• The nurse observes a newly admitted older adult female take short steps and walk

very slowly while pushing a walker in front of her. What action should the nurse take in response to these observations?

• Complete a full fall risk assessment of the client.

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• Teach the client to take longer steps at faster pace.
• Suggest that the the client use a wheelchair instead of a walker.
• Place client on bedrest until the healthcare provider is notified.

Correct Answer: A) Complete a full fall risk assessment of the client.

• 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?

• Raise the bed to a comfortable working level.
• Bend the client's knee.
• Move the knee toward the chest as far as it will go.
• Cradle the client's heel.

Correct Answer: D) Cradle the client's heel.

• 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?

• Empty the client's urinary drainage bag.
• Draw up the irrigating solution into the syringe.
• Secure the client's catheter to the drainage tubing.
• Use aseptic technique to instill the irrigating solution.

Correct Answer: B) Draw up the irrigating solution into the syringe.

• Which client care requires the nurse to wear barrier gloves as required by the

protocol for Standard Precautions?

• Removing the empty food tray from a client with a urinary catheter.
• Washing and combing the hair of a client with a fractured leg in traction.
• Administering oral medications to a cooperative client with a wound infection.
• Emptying the urinary catheter drainage bag for a client with Alzheimer's disease.

Correct Answer: D) Emptying the urinary catheter drainage bag for a client with

Alzheimer's disease.