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An elderly client with a fractured left hip is on strict ✅- To avoid shearing forces when
repositioning, the client should be lifted
bedrest. Which nursing measure is essential to the client's gently across a surface (D).
Reddened areas should not be massaged (A) since nursing care? this may increase the
damage to already traumatized skin. To control pain and
A. Massage any reddened areas for at least five minutes. muscle spasms, active range of motion
(B) may be limited on the affected leg. The
B. Encourage active range of motion exercises on position described in (C) is
contraindicated for a client with a fractured left hip. extremities. Correct Answer: D
C. Position the client laterally,
prone, and dorsally in sequence.
D. Gently lift the client when
moving into a desired position.
The nurse is administering medications through a ✅- The NGT should be flushed
before, after and in between each medication nasogastric tube (NGT) which is
connected to suction. administered (B). Once all medications are
administered, the NGT should be
After ensuring correct tube placement, what action clamped for 20 minutes (A). (C and
D) may be implemented only after the tubing should the nurse take next? has been
,flushed.
A. Clamp the tube for 20 minutes. Correct Answer: B
B. Flush the tube with water.
C. Administer the medications as prescribed.
D. Crush the tablets and dissolve in sterile water.
A client who is in hospice care complains of increasing ✅- The most effective
management of pain is achieved using an around-the- amounts of pain. The healthcare
provider prescribes an clock schedule that provides analgesic medications on
a regular basis (A) and in a analgesic every four hours as needed. Which action
timely manner. Analgesics Hesi Fundamentals 2025
exam. Correctly answered. are should the nurse implement? less effective if pain persists
until it is severe, so an analgesic medication should
A. Give an around-the-clock schedule for administration be administered before the
client's pain peaks (B). Providing comfort is a priority of analgesics. for the client who is
dying, but sedation that impairs the client's ability to interact
B. Administer analgesic medication as needed
when the and experience the time before life ends should be
minimized (C). Offering a pain is severe. medication-free period allows the serum
drug level to fall, which is not an
C. Provide medication to keep the client sedated and effective
method to manage chronic pain (D). unaware of stimuli.
Correct Answer: A
D. Offer a medication-free period so
that the client can do daily
activities.
, When assessing a client with wrist restraints, the nurse ✅- The priority nursing action
is to restore circulation by loosening the restraint observes that the fingers on the right hand
are blue. What (A), because blue fingers (cyanosis) indicates
decreased circulation. (C and D) are action should the nurse implement first? also
important nursing interventions, but do not have the priority of(A). Pulse
A. Loosen the right wrist restraint. oximetry (B) measures the saturation of hemoglobin
with oxygen and is not
B. Apply a pulse oximeter to the right hand. indicated in
situations where the cyanosis is related to mechanical compression
C. Compare hand color bilaterally. (the restraints).
D. Palpate the right radial pulse. Correct Answer: A
The nurse is assessing the nutritional status of several ✅- A lactating woman (B) has
the greatest need for additional protein intake. (A, clients. Which client has the greatest
nutritional need for C, and D) are all conditions that require protein,
but do not have the increased
additional intake of protein? metabolic protein demands of lactation.
A. A college-age track runner with a sprained ankle. Correct Answer: B
B. A lactating woman nursing her 3-day-old infant.
C. A school-aged child with Type 2 diabetes.
D.An elderly man being treated for a peptic ulcer.
A client is in the radiology department at 0900 when the ✅- To ensure that a
therapeutic level of medication is maintained, the nurse prescription levofloxacin
(Levaquin) 500 mg IV q24h is should administer the missed dose as soon as
possible, and revise the