EXIT HESI Comprehensive B Evolve Practice Questions AND CORRECT
ANSWERS (100% CORRECT ANSWERS) WITH RATIONALES/ EVOLVE HESI
FUNDAMENTALS EXAM 2026 -2027 (NEWEST!)
Which monitored pattern of fetal heart rate alerts the nurse to seek immediate
intervention by the health care provider?
A.Accelerations in response to fetal movement
B.Early decelerations in the second stage of labor
C.Fetal heart rate of 130 beats/min between contractions
D.Late decelerations with absent variability and tachycardia
D
Rationale:
Late decelerations indicate uteroplacental insufficiency and can be indicative
of complications. When occurring with absent variability and tachycardia, the
situation is ominous (D). 130 beats/min is an expected heart rate (C). The others are
not as critical (A and B).
Which disaster management intervention by the nurse is an example of primary
prevention?
A.Emergency department triage
B.Follow-up care for psychological problems
C.Education of rescue workers in first aid
D.Treatment of clients who are injured
C
Rationale:
Primary prevention is aimed at preventing disease or injury. Training rescue
workers prior to a disaster is an example of minimizing or preventing injury
(C). (A) is an example of secondary prevention. (B) is an example of tertiary prevention.
(D) is an example of secondary prevention.
,The nurse is caring for a client who is experiencing severe pain. The expected
outcome the nurse writes for the client reads, "The client will state my pain is less
than 2 within 45 minutes after pain medication has been administered."
Formulating the expected outcome is an example of which step in the nursing
process?
A.Assessment
B.Planning
C.Implementation
D.Evaluation
B
Rationale:
Planning (B) allows the nurse to set goals for care and elicit the expected
outcome by identifying appropriate nursing actions. Assessment,
implementation, and evaluation are part of the care for the client but are not the
appropriate actions for formulating the expected outcome (A, C, and D).
,The nurse is planning the care for a client who is admitted with syndrome of
inappropriate antidiuretic hormone secretion (SIADH). Which intervention(s)
should the nurse include in this client's plan of care? (Select all that apply.)
A.Salt-free diet
B.Quiet environment
C.Deep tendon reflex assessments D.Neurologic
checks
E.Daily weights
B,C,D,E
Rationale:
Correct responses are (B, C, D, and E). SAIDH results in water retention and
dilutional hyponatremia, which causes neurologic changes when serum
sodium levels are less than 115 mEq/L. The nurse should maintain a quiet
environment (B) to prevent overstimulation and assess deep tendon reflexes
(C) and perform neurologic checks (D) to monitor for neurologic deterioration.
Daily weights (E) should be monitored to assess for fluid overload. (A) would
contribute to dilutional hyponatremia.
, A client in the psychiatric setting with an anxiety disorder reports chest pain.
Which action should the nurse take first?
A. Administer an antianxiety medication PRN.
B. Assess the client's vital signs.
C. Notify the primary health care provider.
D.Determine coping mechanisms used in the past.
B
Rationale:
Although increased heart rate, palpitations, and chest pain may be caused by
anxiety, it is important that the nurse assess the patient and rule out physiologic
causes (B). Nonpharmacologic measures should be taken first
(A). (C and D) may be considered but are not as high priority as the initial physiologic
assessment.
ANSWERS (100% CORRECT ANSWERS) WITH RATIONALES/ EVOLVE HESI
FUNDAMENTALS EXAM 2026 -2027 (NEWEST!)
Which monitored pattern of fetal heart rate alerts the nurse to seek immediate
intervention by the health care provider?
A.Accelerations in response to fetal movement
B.Early decelerations in the second stage of labor
C.Fetal heart rate of 130 beats/min between contractions
D.Late decelerations with absent variability and tachycardia
D
Rationale:
Late decelerations indicate uteroplacental insufficiency and can be indicative
of complications. When occurring with absent variability and tachycardia, the
situation is ominous (D). 130 beats/min is an expected heart rate (C). The others are
not as critical (A and B).
Which disaster management intervention by the nurse is an example of primary
prevention?
A.Emergency department triage
B.Follow-up care for psychological problems
C.Education of rescue workers in first aid
D.Treatment of clients who are injured
C
Rationale:
Primary prevention is aimed at preventing disease or injury. Training rescue
workers prior to a disaster is an example of minimizing or preventing injury
(C). (A) is an example of secondary prevention. (B) is an example of tertiary prevention.
(D) is an example of secondary prevention.
,The nurse is caring for a client who is experiencing severe pain. The expected
outcome the nurse writes for the client reads, "The client will state my pain is less
than 2 within 45 minutes after pain medication has been administered."
Formulating the expected outcome is an example of which step in the nursing
process?
A.Assessment
B.Planning
C.Implementation
D.Evaluation
B
Rationale:
Planning (B) allows the nurse to set goals for care and elicit the expected
outcome by identifying appropriate nursing actions. Assessment,
implementation, and evaluation are part of the care for the client but are not the
appropriate actions for formulating the expected outcome (A, C, and D).
,The nurse is planning the care for a client who is admitted with syndrome of
inappropriate antidiuretic hormone secretion (SIADH). Which intervention(s)
should the nurse include in this client's plan of care? (Select all that apply.)
A.Salt-free diet
B.Quiet environment
C.Deep tendon reflex assessments D.Neurologic
checks
E.Daily weights
B,C,D,E
Rationale:
Correct responses are (B, C, D, and E). SAIDH results in water retention and
dilutional hyponatremia, which causes neurologic changes when serum
sodium levels are less than 115 mEq/L. The nurse should maintain a quiet
environment (B) to prevent overstimulation and assess deep tendon reflexes
(C) and perform neurologic checks (D) to monitor for neurologic deterioration.
Daily weights (E) should be monitored to assess for fluid overload. (A) would
contribute to dilutional hyponatremia.
, A client in the psychiatric setting with an anxiety disorder reports chest pain.
Which action should the nurse take first?
A. Administer an antianxiety medication PRN.
B. Assess the client's vital signs.
C. Notify the primary health care provider.
D.Determine coping mechanisms used in the past.
B
Rationale:
Although increased heart rate, palpitations, and chest pain may be caused by
anxiety, it is important that the nurse assess the patient and rule out physiologic
causes (B). Nonpharmacologic measures should be taken first
(A). (C and D) may be considered but are not as high priority as the initial physiologic
assessment.
