HESI - Fundamentals Practice Questions With Complete
Solutions
"It shows the time needed for the SA node impulse to depolarize
the atria and travel through the AV node."
Explanation:
The PR interval is measured from the beginning of the P wave to
the beginning of the QRS complex and represents the time
needed for sinus node stimulation, atrial depolarization, and
conduction through the AV node before ventricular
depolarization. In a normal heart the impulses do not travel
backward. The PR interval does not include the time it take to
travel through the Purkinje fibers Correct Answers P-R interval
0.24 seconds
Explanation:
In adults, the normal range for the PR is 0.12 to 0.20 seconds. A
PR internal of 0.24 seconds would indicate a first-degree heart
block. Correct Answers Which PR interval presents a first-
degree heart block?
3 checks of safe medication administration Correct Answers 1)
Before you pour, mix, or draw up a medication
2) After you prepare the medication
3) At the bedside
5 stages of infection Correct Answers Incubation, prodromal,
illness, decline, convalescence
64.A low-sodium, low-protein diet is prescribed for a 45-year-
old client with renal insufficiency and hypertension, who gained
,3 pounds in the last month. The nurse determines that the client
has been noncompliant with the diet, based on which report
from the 24-hour dietary recall? (Select all that apply.)
A. Snack of potato chips, and diet soda.
B. Lunch of tuna fish sandwich, carrot sticks, fresh fruit, and
coffee.
C. Breakfast of eggs, bacon, toast, and coffee.
D. Dinner of vegetable lasagna, tossed salad, sherbet, and iced
tea.
E. Bedtime snack of crackers and milk. Correct Answers Potato
chips (A) are high in sodium. Tuna (B) is high in protein. Bacon
(C) and crackers (E) are high in sodium. Only (D) is a meal that
is in compliance with a low sodium, low protein diet.
Correct Answer: A, B, C, E
65.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?
A. Check capillary refill of toes on lower extremity with Unna's
paste boot.
B. Apply dressing to wound area before applying the Unna's
paste boot.
C. Wrap the leg from the knee down towards the foot.
D. Remove the Unna's paste boot q8h to assess wound healing.
Correct Answers The Unna's paste boot becomes rigid after it
dries, so it is important to check distally for adequate circulation
(A). Kerlix is often wrapped around the outside of the boot and
an ace bandage may be used to cover both, but no bandage
should be put under it (B). The Unna's paste boot should be
applied from the foot and wrapped towards the knee (C). The
,Unna's paste boot acts as a sterile dressing, and should not be
removed q8h. Weekly removal is reasonable (D).
Correct Answer: A
66.A 75-year-old client who has a history of end stage renal
failure and advanced lung cancer, recently had a stroke. Two
days ago the healthcare provider discontinued the client's
dialysis treatments, stating that death is inevitable, but the client
is disoriented and will not sign a DNR directive. What is the
priority nursing intervention?
A. Review the client's most recent laboratory reports.
B. Refer the client and family members for hospice care.
C. Notify the hospital ethics committee of the client situation.
D. Determine who is legally empowered to make decisions.
Correct Answers When death is impending, it is essential for
the nurse to determine who is legally empowered to make
decisions regarding the use of life-saving measures for the client
(D). (A) will be abnormal and will worsen without dialysis, so
are not of immediate concern. (B) may help improve the client's
quality of life prior to death, but is of less immediacy than
determining whether actions should be taken to save a client's
life. If the nurse remains unable to determine who is empowered
to make decisions in this situation, the nurse may choose to
contact the ethics committee (C) for a resolution.
Correct Answer: D
67.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?
A. Review the steps in the procedure manual.
, B. Ask another nurse to assist while implementing the
procedure.
C. Follow the agency's policy and procedure.
D. Refuse to perform the task that is beyond the nurse's
experience. Correct Answers According to states' nurse practice
acts, it is the responsibility of the nurse to function within the
scope of competency (D), and in this case safe nursing practice
constitutes refusal to perform the procedure because of a lack of
experience. Although state mandates, agency policies, and
continued education and experience identify tasks that are within
the scope of nursing practice, nurses should first refuse to
perform tasks that are beyond their proficiency, and then pursue
opportunities to enhance their competency (A, B, and C).
Correct Answer: D
68.Before administering a client's medication, the nurse assesses
a change in the client's condition and decides to withhold the
medication until consulting with the healthcare provider. After
consultation with the healthcare provider, the dose of the
medication is changed and the nurse administers the newly
prescribed dose an hour later than the originally scheduled time.
What action should the nurse implement in response to this
situation?
A. Notify the charge nurse that a medication error occurred.
B. Submit a medication variance report to the supervisor.
C. Document the events that occurred in the nurses' notes.
D. Discard the original medication administration record.
Correct Answers The nurse took the correct action and should
document the events that occurred in the nurses' notes (C). (A)
did not occur and (B) is not indicated. The medication
Solutions
"It shows the time needed for the SA node impulse to depolarize
the atria and travel through the AV node."
Explanation:
The PR interval is measured from the beginning of the P wave to
the beginning of the QRS complex and represents the time
needed for sinus node stimulation, atrial depolarization, and
conduction through the AV node before ventricular
depolarization. In a normal heart the impulses do not travel
backward. The PR interval does not include the time it take to
travel through the Purkinje fibers Correct Answers P-R interval
0.24 seconds
Explanation:
In adults, the normal range for the PR is 0.12 to 0.20 seconds. A
PR internal of 0.24 seconds would indicate a first-degree heart
block. Correct Answers Which PR interval presents a first-
degree heart block?
3 checks of safe medication administration Correct Answers 1)
Before you pour, mix, or draw up a medication
2) After you prepare the medication
3) At the bedside
5 stages of infection Correct Answers Incubation, prodromal,
illness, decline, convalescence
64.A low-sodium, low-protein diet is prescribed for a 45-year-
old client with renal insufficiency and hypertension, who gained
,3 pounds in the last month. The nurse determines that the client
has been noncompliant with the diet, based on which report
from the 24-hour dietary recall? (Select all that apply.)
A. Snack of potato chips, and diet soda.
B. Lunch of tuna fish sandwich, carrot sticks, fresh fruit, and
coffee.
C. Breakfast of eggs, bacon, toast, and coffee.
D. Dinner of vegetable lasagna, tossed salad, sherbet, and iced
tea.
E. Bedtime snack of crackers and milk. Correct Answers Potato
chips (A) are high in sodium. Tuna (B) is high in protein. Bacon
(C) and crackers (E) are high in sodium. Only (D) is a meal that
is in compliance with a low sodium, low protein diet.
Correct Answer: A, B, C, E
65.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?
A. Check capillary refill of toes on lower extremity with Unna's
paste boot.
B. Apply dressing to wound area before applying the Unna's
paste boot.
C. Wrap the leg from the knee down towards the foot.
D. Remove the Unna's paste boot q8h to assess wound healing.
Correct Answers The Unna's paste boot becomes rigid after it
dries, so it is important to check distally for adequate circulation
(A). Kerlix is often wrapped around the outside of the boot and
an ace bandage may be used to cover both, but no bandage
should be put under it (B). The Unna's paste boot should be
applied from the foot and wrapped towards the knee (C). The
,Unna's paste boot acts as a sterile dressing, and should not be
removed q8h. Weekly removal is reasonable (D).
Correct Answer: A
66.A 75-year-old client who has a history of end stage renal
failure and advanced lung cancer, recently had a stroke. Two
days ago the healthcare provider discontinued the client's
dialysis treatments, stating that death is inevitable, but the client
is disoriented and will not sign a DNR directive. What is the
priority nursing intervention?
A. Review the client's most recent laboratory reports.
B. Refer the client and family members for hospice care.
C. Notify the hospital ethics committee of the client situation.
D. Determine who is legally empowered to make decisions.
Correct Answers When death is impending, it is essential for
the nurse to determine who is legally empowered to make
decisions regarding the use of life-saving measures for the client
(D). (A) will be abnormal and will worsen without dialysis, so
are not of immediate concern. (B) may help improve the client's
quality of life prior to death, but is of less immediacy than
determining whether actions should be taken to save a client's
life. If the nurse remains unable to determine who is empowered
to make decisions in this situation, the nurse may choose to
contact the ethics committee (C) for a resolution.
Correct Answer: D
67.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?
A. Review the steps in the procedure manual.
, B. Ask another nurse to assist while implementing the
procedure.
C. Follow the agency's policy and procedure.
D. Refuse to perform the task that is beyond the nurse's
experience. Correct Answers According to states' nurse practice
acts, it is the responsibility of the nurse to function within the
scope of competency (D), and in this case safe nursing practice
constitutes refusal to perform the procedure because of a lack of
experience. Although state mandates, agency policies, and
continued education and experience identify tasks that are within
the scope of nursing practice, nurses should first refuse to
perform tasks that are beyond their proficiency, and then pursue
opportunities to enhance their competency (A, B, and C).
Correct Answer: D
68.Before administering a client's medication, the nurse assesses
a change in the client's condition and decides to withhold the
medication until consulting with the healthcare provider. After
consultation with the healthcare provider, the dose of the
medication is changed and the nurse administers the newly
prescribed dose an hour later than the originally scheduled time.
What action should the nurse implement in response to this
situation?
A. Notify the charge nurse that a medication error occurred.
B. Submit a medication variance report to the supervisor.
C. Document the events that occurred in the nurses' notes.
D. Discard the original medication administration record.
Correct Answers The nurse took the correct action and should
document the events that occurred in the nurses' notes (C). (A)
did not occur and (B) is not indicated. The medication
