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Hesi Rn Fundamentals Exit Exam Latest 2025-2026 Actual
Exam Questions And Rationale Comprehensive 2026
Questions Exam Latest Version Solved Questions &
Answers Verified 100 %
The nurse transcribes the postoperative prescriptions for a client who returns
to the unit following surgery and notes that an antihypertensive medication
that was prescribed preoperatively is not listed. Which action should the nurse
take?
A.
Consult with the pharmacist about the need to continue the medication.
B.
Administer the antihypertensive medication as prescribed preoperatively.
C.
Withhold the medication until the client is fully alert and vital signs are stable.
D.
Contact the health care provider to renew the prescription for the medication.
D
Rationale: Medications prescribed preoperatively must be renewed postoperatively,
so the nurse should contact the health care provider if the antihypertensive
medication is not included in the postoperative prescriptions. The pharmacist does
not prescribe medications or renew prescriptions. The nurse must have a current
prescription before administering any medications.
Get all HESI test banks for Exam preparation for 2026. The test banks include
comprehensive preparation for both Exam I and Exam II, and are designed to
significantly enhance your likelihood of passing all exams on the first attempt,
with a success rate of up to 97%. start preparing for your upcoming exams
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Get all HESI test banks for Exam preparation for 2026. The test banks include
comprehensive preparation for both Exam I and Exam II, and are designed to
significantly enhance your likelihood of passing all exams on the first attempt, with a
success rate of up to 97%.
An older client who had abdominal surgery 3 days earlier was given a
barbiturate for sleep and is now requesting to go to the bathroom. What is the
priority nursing action for this client?
A.
, Page 2 of 45
Assist the client to walk to the bathroom and do not leave the client alone.
B.
Request that the UAP assist the client onto a bedpan.
C.
Ask if the client needs to have a bowel movement or void.
D.
Assess the client's bladder to determine if the client needs to urinate.
A
Rationale: Barbiturates cause central nervous system (CNS) depression, and
individuals taking these medications are at greater risk for falls. The nurse should
assist the client to the bathroom. A bedpan is not necessary as long as safety is
ensured. Whether the client needs to void or have a bowel movement, option C is
irrelevant in terms of meeting this client's safety needs. There is no indication that
this client cannot voice her or his needs, so assessment of the bladder is not
needed.
The nurse is planning care for a client with an indwelling urinary catheter.
Which nursing action has the highest priority?
A.
Assist the client with daily cleansing.
B.
Tell the client that incontinence happens with aging.
C.
Offer 200 mL of fluid every 2 hours while awake.
D.
Take the client's temperature every 4 hours.
D
Rationale: Indwelling urinary catheters are a major source of infection. Option A is a
problem that may develop from having an indwelling catheter. Option B may or may
not be true for the client. Option C is not affected by an indwelling catheter.
When bathing an uncircumcised boy older than 3 years, which action should
the nurse take?
A.
Remind the child to clean his genital area.
B.
Defer perineal care because of the child's age.
C.
Retract the foreskin gently to cleanse the penis.
D.
Ask the parents why the child is not circumcised.
C
Rationale: The foreskin (prepuce) of the penis should be gently retracted to cleanse
all areas that could harbor bacteria. The child's cognitive development may not be at
the level at which option A would be effective. Perineal care needs to be provided
daily regardless of the client's age. Option D is not indicated and may be perceived
as intrusive.
A nurse is assigned to care for a close friend in the hospital setting. Which
action should the nurse take first when given the assignment?
A.
Notify the friend that all medical information will be kept confidential.
B.
, Page 3 of 45
Explain the relationship to the charge nurse and ask for reassignment.
C.
Approach the client and ask if the assignment is uncomfortable.
D.
Accept the assignment but protect the client's confidentiality.
B
Rationale: Caring for a close friend can violate boundaries for nurses and should be
avoided when possible (B). If the assignment is unavoidable (there are no other
nurses to care for the client) then C, A, and D should be addressed.
The nurse selects the best site for insertion of an IV catheter in the client's
right arm. Which documentation should the nurse use to identify placement of
the IV access?
A.
Left brachial vein
B.
Right cephalic vein
C.
Dorsal side of the right wrist
D.
Right upper extremity
B
Rationale: The cephalic vein is large and superficial and identifies the anatomic
name of the vein that is accessed, which should be included in the documentation.
The basilic vein of the arm is used for IV access, not the brachial vein, which is too
deep to be accessed for IV infusion. Although veins on the dorsal side of the right
wrist are visible, they are fragile and using them would be painful, so they are not
recommended for IV access. Option D is not specific enough for documenting the
location of the IV access.
When emptying 350 mL of pale yellow urine from a client's urinal, the nurse
notes that this is the first time the client has voided in 4 hours. Which action
should the nurse take next?
A.
Record the amount on the client's fluid output record.
B.
Encourage the client to increase oral fluid intake.
C.
Notify the health care provider of the findings.
D.
Palpate the client's bladder for distention.
A
Rationale: The amount and appearance of the client's urine output is within normal
limits, so the nurse should record the output, but no additional action is needed.
The client states to the nurse, "This medication makes my mouth so dry."
What are the nurse's suggestions to quench the client's thirst? (Select all that
apply.)
A.
Drink 2, 8 ounce glasses of lemon-lime soda every day.
B.
Infuse your water with fresh citrus fruits to quench your thirst.
C.
, Page 4 of 45
Freeze strawberries and water together in popsicle mold.
D.
Add ginger ale to your daily glass of juice every day.
E.
Keep a few pieces of hard candy with you to suck on.
B, C, E
Rationale: Sodas do not tend to be thirst quenching because of the amount of sugar
in them that draws fluid into the GI system. Citrus infused water quenches thirst, as
does consuming frozen liquids. Hard candy can produce moisture in the mouth.
The nurse notes in the client's plan of care altered sleep patterns related to
nocturia. Which nursing actions are important for the nurse to provide? (Select
all that apply.)
A.
Decrease intake of fluids after the evening meal.
B.
Drink a glass of cranberry juice every day.
C.
Drink a glass of warm decaffeinated beverage at bedtime.
D.
Consult the health care provider about a sleeping pill.
E.
Assess the client's usual sleep pattern.
A, E
Rationale: Nocturia is urination during the night. Option A is helpful to decrease the
production of urine, thus decreasing the need to void at night. Option E gives the
nurse the client's baseline sleep pattern. Option B helps prevent bladder infections.
Option C may promote sleep, but the fluid will contribute to nocturia. Option D may
result in urinary incontinence if the client is sedated and does not awaken to void.
The nurse is counting a client's respiratory rate. During a 30-second interval,
the nurse counts six respirations and the client coughs three times. In
repeating the count for a second 30-second interval, the nurse counts eight
respirations. Which respiratory rate will the nurse document?
A. 15
B. 16
C. 17
D. 28
B
Rationale: The most accurate respiratory rate is the second count obtained by the
nurse, which was not interrupted by coughing. Because it was counted for 30
seconds, the rate should be doubled. Options A, C, and D are inaccurate recordings.
The nurse is preparing to administer a bolus tube feeding. What steps must
the nurse include prior to administering the feeding? (Select all that apply.)
A.
Aspirate the stomach contents.
B.
Assess bowel sounds.
C.
Position the client in semi-Fowler's position.
D.
Irrigate the lumen after the contents are replaced.
Hesi Rn Fundamentals Exit Exam Latest 2025-2026 Actual
Exam Questions And Rationale Comprehensive 2026
Questions Exam Latest Version Solved Questions &
Answers Verified 100 %
The nurse transcribes the postoperative prescriptions for a client who returns
to the unit following surgery and notes that an antihypertensive medication
that was prescribed preoperatively is not listed. Which action should the nurse
take?
A.
Consult with the pharmacist about the need to continue the medication.
B.
Administer the antihypertensive medication as prescribed preoperatively.
C.
Withhold the medication until the client is fully alert and vital signs are stable.
D.
Contact the health care provider to renew the prescription for the medication.
D
Rationale: Medications prescribed preoperatively must be renewed postoperatively,
so the nurse should contact the health care provider if the antihypertensive
medication is not included in the postoperative prescriptions. The pharmacist does
not prescribe medications or renew prescriptions. The nurse must have a current
prescription before administering any medications.
Get all HESI test banks for Exam preparation for 2026. The test banks include
comprehensive preparation for both Exam I and Exam II, and are designed to
significantly enhance your likelihood of passing all exams on the first attempt,
with a success rate of up to 97%. start preparing for your upcoming exams
Get all HESI test banks for Exam preparation for 2026. The test banks include
comprehensive preparation for both Exam I and Exam II, and are designed to
significantly enhance your likelihood of passing all exams on the first attempt, with a
success rate of up to 97%.
An older client who had abdominal surgery 3 days earlier was given a
barbiturate for sleep and is now requesting to go to the bathroom. What is the
priority nursing action for this client?
A.
, Page 2 of 45
Assist the client to walk to the bathroom and do not leave the client alone.
B.
Request that the UAP assist the client onto a bedpan.
C.
Ask if the client needs to have a bowel movement or void.
D.
Assess the client's bladder to determine if the client needs to urinate.
A
Rationale: Barbiturates cause central nervous system (CNS) depression, and
individuals taking these medications are at greater risk for falls. The nurse should
assist the client to the bathroom. A bedpan is not necessary as long as safety is
ensured. Whether the client needs to void or have a bowel movement, option C is
irrelevant in terms of meeting this client's safety needs. There is no indication that
this client cannot voice her or his needs, so assessment of the bladder is not
needed.
The nurse is planning care for a client with an indwelling urinary catheter.
Which nursing action has the highest priority?
A.
Assist the client with daily cleansing.
B.
Tell the client that incontinence happens with aging.
C.
Offer 200 mL of fluid every 2 hours while awake.
D.
Take the client's temperature every 4 hours.
D
Rationale: Indwelling urinary catheters are a major source of infection. Option A is a
problem that may develop from having an indwelling catheter. Option B may or may
not be true for the client. Option C is not affected by an indwelling catheter.
When bathing an uncircumcised boy older than 3 years, which action should
the nurse take?
A.
Remind the child to clean his genital area.
B.
Defer perineal care because of the child's age.
C.
Retract the foreskin gently to cleanse the penis.
D.
Ask the parents why the child is not circumcised.
C
Rationale: The foreskin (prepuce) of the penis should be gently retracted to cleanse
all areas that could harbor bacteria. The child's cognitive development may not be at
the level at which option A would be effective. Perineal care needs to be provided
daily regardless of the client's age. Option D is not indicated and may be perceived
as intrusive.
A nurse is assigned to care for a close friend in the hospital setting. Which
action should the nurse take first when given the assignment?
A.
Notify the friend that all medical information will be kept confidential.
B.
, Page 3 of 45
Explain the relationship to the charge nurse and ask for reassignment.
C.
Approach the client and ask if the assignment is uncomfortable.
D.
Accept the assignment but protect the client's confidentiality.
B
Rationale: Caring for a close friend can violate boundaries for nurses and should be
avoided when possible (B). If the assignment is unavoidable (there are no other
nurses to care for the client) then C, A, and D should be addressed.
The nurse selects the best site for insertion of an IV catheter in the client's
right arm. Which documentation should the nurse use to identify placement of
the IV access?
A.
Left brachial vein
B.
Right cephalic vein
C.
Dorsal side of the right wrist
D.
Right upper extremity
B
Rationale: The cephalic vein is large and superficial and identifies the anatomic
name of the vein that is accessed, which should be included in the documentation.
The basilic vein of the arm is used for IV access, not the brachial vein, which is too
deep to be accessed for IV infusion. Although veins on the dorsal side of the right
wrist are visible, they are fragile and using them would be painful, so they are not
recommended for IV access. Option D is not specific enough for documenting the
location of the IV access.
When emptying 350 mL of pale yellow urine from a client's urinal, the nurse
notes that this is the first time the client has voided in 4 hours. Which action
should the nurse take next?
A.
Record the amount on the client's fluid output record.
B.
Encourage the client to increase oral fluid intake.
C.
Notify the health care provider of the findings.
D.
Palpate the client's bladder for distention.
A
Rationale: The amount and appearance of the client's urine output is within normal
limits, so the nurse should record the output, but no additional action is needed.
The client states to the nurse, "This medication makes my mouth so dry."
What are the nurse's suggestions to quench the client's thirst? (Select all that
apply.)
A.
Drink 2, 8 ounce glasses of lemon-lime soda every day.
B.
Infuse your water with fresh citrus fruits to quench your thirst.
C.
, Page 4 of 45
Freeze strawberries and water together in popsicle mold.
D.
Add ginger ale to your daily glass of juice every day.
E.
Keep a few pieces of hard candy with you to suck on.
B, C, E
Rationale: Sodas do not tend to be thirst quenching because of the amount of sugar
in them that draws fluid into the GI system. Citrus infused water quenches thirst, as
does consuming frozen liquids. Hard candy can produce moisture in the mouth.
The nurse notes in the client's plan of care altered sleep patterns related to
nocturia. Which nursing actions are important for the nurse to provide? (Select
all that apply.)
A.
Decrease intake of fluids after the evening meal.
B.
Drink a glass of cranberry juice every day.
C.
Drink a glass of warm decaffeinated beverage at bedtime.
D.
Consult the health care provider about a sleeping pill.
E.
Assess the client's usual sleep pattern.
A, E
Rationale: Nocturia is urination during the night. Option A is helpful to decrease the
production of urine, thus decreasing the need to void at night. Option E gives the
nurse the client's baseline sleep pattern. Option B helps prevent bladder infections.
Option C may promote sleep, but the fluid will contribute to nocturia. Option D may
result in urinary incontinence if the client is sedated and does not awaken to void.
The nurse is counting a client's respiratory rate. During a 30-second interval,
the nurse counts six respirations and the client coughs three times. In
repeating the count for a second 30-second interval, the nurse counts eight
respirations. Which respiratory rate will the nurse document?
A. 15
B. 16
C. 17
D. 28
B
Rationale: The most accurate respiratory rate is the second count obtained by the
nurse, which was not interrupted by coughing. Because it was counted for 30
seconds, the rate should be doubled. Options A, C, and D are inaccurate recordings.
The nurse is preparing to administer a bolus tube feeding. What steps must
the nurse include prior to administering the feeding? (Select all that apply.)
A.
Aspirate the stomach contents.
B.
Assess bowel sounds.
C.
Position the client in semi-Fowler's position.
D.
Irrigate the lumen after the contents are replaced.
