HESI Fundamentals Practice Exam Prep:
Comprehensive Study Guide 7th Edition by Sandra
Upchurch, Linda Anne Silvestri, and Angela Silvestri
– Pass on Your First Attempt and Avoid Resits
1. A nurse is preparing to administer a blood transfusion to a patient with a history of multiple
transfusions. The patient suddenly develops chills, fever, and lower back pain 15 minutes after the
infusion begins. Which type of transfusion reaction is most consistent with these findings, and what
is the priority nursing action?
A. Acute hemolytic reaction; stop the transfusion immediately and maintain IV access with normal saline.
B. Febrile non-hemolytic reaction; slow the transfusion and administer antipyretics as prescribed.
C. Allergic reaction; stop the transfusion and administer diphenhydramine.
D. Bacterial contamination; discontinue the transfusion and obtain blood cultures.
Answer: A
Rationale: The combination of chills, fever, and lower back pain within minutes of starting a transfusion
is classic for an acute hemolytic reaction, often due to ABO incompatibility. The priority action is to stop
the transfusion immediately to prevent further hemolysis, then maintain IV access with normal saline for
potential hypotension. Febrile reactions typically present with fever and chills but not back pain;
allergic reactions involve urticaria and itching; bacterial contamination would cause high fever and
hypotension but not specifically back pain.
2. A nurse is caring for a patient who has a nasogastric (NG) tube set to low intermittent suction.
The patient develops nausea and abdominal distention. Which assessment finding would indicate
that the NG tube is not functioning properly?
A. The patient's gastric pH is 5.0.
B. The suction gauge reads 80 mm Hg.
C. The nurse notes that the tube is secured to the patient's gown.
D. The drainage output is 50 mL over the past 8 hours.
Answer: D
Rationale: Expected NG drainage for low intermittent suction is 100-200 mL per shift (8 hours). Output
of only 50 mL suggests the tube is not draining effectively, possibly due to clogging, improper
placement, or suction malfunction. Gastric pH of 5.0 is slightly above normal (1-4) but not diagnostic.
Suction at 80 mm Hg is within typical range (60-80 mm Hg for low suction). Securing the tube to the
gown is appropriate to prevent dislodgment.
Page 1
,3. A nurse is assessing a patient who has just returned from the post-anesthesia care unit (PACU)
after an abdominal surgery. The patient's vital signs are: BP 100/60 mm Hg, HR 110/min, RR
22/min, O2 sat 94% on room air. The patient reports pain at the surgical site rated 7/10. Which
action should the nurse take first?
A. Administer the prescribed analgesic.
B. Increase the IV fluid rate.
C. Apply supplemental oxygen via nasal cannula.
D. Reposition the patient to a semi-Fowler's position.
Answer: A
Rationale: The patient's vital signs are slightly elevated but within acceptable range for post-operative
status; the O2 sat of 94% is borderline but not critical. The priority is pain management, as unrelieved
pain can increase oxygen demand and heart rate. After administering analgesic, the nurse should
reassess vital signs. Increasing IV fluids may be indicated if hypotension is significant, but BP 100/60 is
acceptable. Oxygen may be applied if sat drops below 92%. Repositioning is important but not the first
action in this scenario.
4. A nurse is preparing to administer a medication via a nasogastric tube. The medication is an
extended-release capsule. What is the nurse's best action?
A. Crush the capsule and mix with water before administration.
B. Open the capsule and sprinkle the contents into the tube.
C. Contact the prescriber to request a different formulation.
D. Administer the capsule whole if the tube size is adequate.
Answer: C
Rationale: Extended-release capsules should never be crushed or opened because doing so destroys the
delivery mechanism and can cause rapid absorption, leading to toxicity or subtherapeutic effect. The
nurse must contact the prescriber to change the medication to an immediate-release liquid or tablet that
can be crushed and given via NG tube. Administering whole is not appropriate because capsules are not
designed for tube delivery and may clog.
5. A nurse is evaluating a patient's risk for falls using the Morse Fall Scale. The patient has a
history of falling, uses a cane, has an IV line, and has an unsteady gait. Which additional factor
would increase the fall risk score the most?
A. The patient is oriented to person, place, and time.
B. The patient is receiving a diuretic.
C. The patient has a history of hypertension.
D. The patient wears glasses for reading.
Answer: B
Rationale: The Morse Fall Scale assigns points for history of falling, secondary diagnosis, ambulatory
aid, IV/heparin lock, gait, and mental status. Receiving a diuretic increases the risk due to frequent
urination and potential orthostatic hypotension, adding to the score. Orientation is a protective factor
(low score). Hypertension and glasses are not directly scored in the Morse scale.
Page 2
,6. A nurse is caring for a patient with a pressure ulcer on the sacrum. The wound is covered with
yellow slough and has a moderate amount of serosanguinous drainage. The surrounding skin is
intact but erythematous. Which wound care product is most appropriate for debridement?
A. Calcium alginate dressing
B. Hydrocolloid dressing
C. Enzymatic debriding agent
D. Transparent film dressing
Answer: C
Rationale: The presence of yellow slough indicates necrotic tissue that requires debridement. An
enzymatic debriding agent (e.g., collagenase) selectively breaks down necrotic tissue while preserving
healthy tissue. Calcium alginate is used for moderate to heavy exudate, not primarily for debridement.
Hydrocolloid and transparent film are for clean, dry wounds or light exudate and are not debriding
agents.
7. A nurse is to administer a unit of packed red blood cells to a patient. The patient has a history of
congestive heart failure. Which action is most important for the nurse to take?
A. Administer a diuretic before the transfusion.
B. Infuse the blood over 4 hours.
C. Prime the blood tubing with normal saline.
D. Obtain a baseline set of vital signs.
Answer: B
Rationale: Patients with CHF are at risk for fluid overload (transfusion-associated circulatory overload,
TACO). To minimize this risk, the blood should be infused slowly, typically over 4 hours (maximum
allowed for RBCs). Administering a diuretic may be prescribed but is not the most important action; it is
a dependent intervention. Priming with saline is standard but not specific to CHF. Baseline vital signs
are always obtained but do not directly prevent TACO.
8. A nurse is assessing a patient with a chest tube connected to a water seal drainage system. The
nurse notes continuous bubbling in the water seal chamber. What is the most likely cause?
A. An air leak in the system
B. The suction pressure is too high
C. The tubing is kinked
D. The patient has a pneumothorax
Answer: A
Rationale: In a water seal drainage system, intermittent bubbling in the water seal chamber is normal
when the patient exhales or coughs (indicating air evacuation). Continuous bubbling indicates an air
leak somewhere in the system (e.g., loose connection, crack in tubing, or dislodged chest tube). High
suction may cause excessive bubbling in the suction control chamber, not the water seal. Kinked tubing
would cause no drainage or fluctuation. A pneumothorax would cause intermittent bubbling, not
continuous.
Page 3
, 9. A nurse is teaching a patient with a new colostomy about dietary modifications. Which
statement by the patient indicates a need for further teaching?
A. I will avoid foods that cause gas, such as beans and cabbage.
B. I should chew my food thoroughly to prevent blockages.
C. I can eat high-fiber foods to help regulate my bowel movements.
D. I will drink plenty of fluids to prevent dehydration.
Answer: C
Rationale: Initially after colostomy surgery, high-fiber foods should be avoided because they can cause
blockage or excessive gas. The patient should gradually introduce fiber and monitor tolerance.
Gas-producing foods (beans, cabbage) are often avoided, chewing food thoroughly prevents blockages,
and adequate fluid intake prevents dehydration—all correct statements.
10. A nurse is assessing a patient who has been on bed rest for several days. The patient suddenly
develops dyspnea, chest pain, and hemoptysis. Which intervention should the nurse perform first?
A. Administer oxygen via non-rebreather mask at 15 L/min.
B. Notify the healthcare provider immediately.
C. Place the patient in a high Fowler's position.
D. Prepare for intubation.
Answer: A
Rationale: The symptoms suggest a pulmonary embolism (PE), a life-threatening emergency. The priority
is to support oxygenation; administering high-flow oxygen is the first action. After oxygen, the nurse
should notify the provider and prepare for further interventions (e.g., anticoagulation, thrombolytics).
Positioning is secondary. Intubation may be needed but is not the first step.
11. A nurse is evaluating a patient's readiness for discharge after a total hip arthroplasty. Which
assessment finding indicates the patient can safely perform activities of daily living independently?
A. The patient can ambulate 20 feet with a walker and pivot to a chair.
B. The patient can independently perform range-of-motion exercises for the affected hip.
C. The patient can don and doff an elastic compression stocking unassisted.
D. The patient can reach the floor to pick up a dropped object using a grabber.
Answer: C
Rationale: Donning and doffing compression stockings requires fine motor coordination and balance,
indicating ability to manage self-care. Ambulation with a walker (A) is expected but does not guarantee
ADL independence. ROM exercises (B) may be part of therapy but not comprehensive. Reaching the
floor (D) is not recommended post-hip arthroplasty due to dislocation risk.
12. A patient with a history of chronic obstructive pulmonary disease (COPD) is admitted with
acute respiratory failure. Arterial blood gas results show pH 7.28, PaCO2 60 mm Hg, PaO2 50 mm
Hg, HCO3- 26 mEq/L. Which intervention should the nurse implement first?
A. Initiate noninvasive positive pressure ventilation (NIPPV).
B. Increase the oxygen flow rate to 5 L/min via nasal cannula.
C. Administer a bronchodilator via nebulizer.
Page 4
Comprehensive Study Guide 7th Edition by Sandra
Upchurch, Linda Anne Silvestri, and Angela Silvestri
– Pass on Your First Attempt and Avoid Resits
1. A nurse is preparing to administer a blood transfusion to a patient with a history of multiple
transfusions. The patient suddenly develops chills, fever, and lower back pain 15 minutes after the
infusion begins. Which type of transfusion reaction is most consistent with these findings, and what
is the priority nursing action?
A. Acute hemolytic reaction; stop the transfusion immediately and maintain IV access with normal saline.
B. Febrile non-hemolytic reaction; slow the transfusion and administer antipyretics as prescribed.
C. Allergic reaction; stop the transfusion and administer diphenhydramine.
D. Bacterial contamination; discontinue the transfusion and obtain blood cultures.
Answer: A
Rationale: The combination of chills, fever, and lower back pain within minutes of starting a transfusion
is classic for an acute hemolytic reaction, often due to ABO incompatibility. The priority action is to stop
the transfusion immediately to prevent further hemolysis, then maintain IV access with normal saline for
potential hypotension. Febrile reactions typically present with fever and chills but not back pain;
allergic reactions involve urticaria and itching; bacterial contamination would cause high fever and
hypotension but not specifically back pain.
2. A nurse is caring for a patient who has a nasogastric (NG) tube set to low intermittent suction.
The patient develops nausea and abdominal distention. Which assessment finding would indicate
that the NG tube is not functioning properly?
A. The patient's gastric pH is 5.0.
B. The suction gauge reads 80 mm Hg.
C. The nurse notes that the tube is secured to the patient's gown.
D. The drainage output is 50 mL over the past 8 hours.
Answer: D
Rationale: Expected NG drainage for low intermittent suction is 100-200 mL per shift (8 hours). Output
of only 50 mL suggests the tube is not draining effectively, possibly due to clogging, improper
placement, or suction malfunction. Gastric pH of 5.0 is slightly above normal (1-4) but not diagnostic.
Suction at 80 mm Hg is within typical range (60-80 mm Hg for low suction). Securing the tube to the
gown is appropriate to prevent dislodgment.
Page 1
,3. A nurse is assessing a patient who has just returned from the post-anesthesia care unit (PACU)
after an abdominal surgery. The patient's vital signs are: BP 100/60 mm Hg, HR 110/min, RR
22/min, O2 sat 94% on room air. The patient reports pain at the surgical site rated 7/10. Which
action should the nurse take first?
A. Administer the prescribed analgesic.
B. Increase the IV fluid rate.
C. Apply supplemental oxygen via nasal cannula.
D. Reposition the patient to a semi-Fowler's position.
Answer: A
Rationale: The patient's vital signs are slightly elevated but within acceptable range for post-operative
status; the O2 sat of 94% is borderline but not critical. The priority is pain management, as unrelieved
pain can increase oxygen demand and heart rate. After administering analgesic, the nurse should
reassess vital signs. Increasing IV fluids may be indicated if hypotension is significant, but BP 100/60 is
acceptable. Oxygen may be applied if sat drops below 92%. Repositioning is important but not the first
action in this scenario.
4. A nurse is preparing to administer a medication via a nasogastric tube. The medication is an
extended-release capsule. What is the nurse's best action?
A. Crush the capsule and mix with water before administration.
B. Open the capsule and sprinkle the contents into the tube.
C. Contact the prescriber to request a different formulation.
D. Administer the capsule whole if the tube size is adequate.
Answer: C
Rationale: Extended-release capsules should never be crushed or opened because doing so destroys the
delivery mechanism and can cause rapid absorption, leading to toxicity or subtherapeutic effect. The
nurse must contact the prescriber to change the medication to an immediate-release liquid or tablet that
can be crushed and given via NG tube. Administering whole is not appropriate because capsules are not
designed for tube delivery and may clog.
5. A nurse is evaluating a patient's risk for falls using the Morse Fall Scale. The patient has a
history of falling, uses a cane, has an IV line, and has an unsteady gait. Which additional factor
would increase the fall risk score the most?
A. The patient is oriented to person, place, and time.
B. The patient is receiving a diuretic.
C. The patient has a history of hypertension.
D. The patient wears glasses for reading.
Answer: B
Rationale: The Morse Fall Scale assigns points for history of falling, secondary diagnosis, ambulatory
aid, IV/heparin lock, gait, and mental status. Receiving a diuretic increases the risk due to frequent
urination and potential orthostatic hypotension, adding to the score. Orientation is a protective factor
(low score). Hypertension and glasses are not directly scored in the Morse scale.
Page 2
,6. A nurse is caring for a patient with a pressure ulcer on the sacrum. The wound is covered with
yellow slough and has a moderate amount of serosanguinous drainage. The surrounding skin is
intact but erythematous. Which wound care product is most appropriate for debridement?
A. Calcium alginate dressing
B. Hydrocolloid dressing
C. Enzymatic debriding agent
D. Transparent film dressing
Answer: C
Rationale: The presence of yellow slough indicates necrotic tissue that requires debridement. An
enzymatic debriding agent (e.g., collagenase) selectively breaks down necrotic tissue while preserving
healthy tissue. Calcium alginate is used for moderate to heavy exudate, not primarily for debridement.
Hydrocolloid and transparent film are for clean, dry wounds or light exudate and are not debriding
agents.
7. A nurse is to administer a unit of packed red blood cells to a patient. The patient has a history of
congestive heart failure. Which action is most important for the nurse to take?
A. Administer a diuretic before the transfusion.
B. Infuse the blood over 4 hours.
C. Prime the blood tubing with normal saline.
D. Obtain a baseline set of vital signs.
Answer: B
Rationale: Patients with CHF are at risk for fluid overload (transfusion-associated circulatory overload,
TACO). To minimize this risk, the blood should be infused slowly, typically over 4 hours (maximum
allowed for RBCs). Administering a diuretic may be prescribed but is not the most important action; it is
a dependent intervention. Priming with saline is standard but not specific to CHF. Baseline vital signs
are always obtained but do not directly prevent TACO.
8. A nurse is assessing a patient with a chest tube connected to a water seal drainage system. The
nurse notes continuous bubbling in the water seal chamber. What is the most likely cause?
A. An air leak in the system
B. The suction pressure is too high
C. The tubing is kinked
D. The patient has a pneumothorax
Answer: A
Rationale: In a water seal drainage system, intermittent bubbling in the water seal chamber is normal
when the patient exhales or coughs (indicating air evacuation). Continuous bubbling indicates an air
leak somewhere in the system (e.g., loose connection, crack in tubing, or dislodged chest tube). High
suction may cause excessive bubbling in the suction control chamber, not the water seal. Kinked tubing
would cause no drainage or fluctuation. A pneumothorax would cause intermittent bubbling, not
continuous.
Page 3
, 9. A nurse is teaching a patient with a new colostomy about dietary modifications. Which
statement by the patient indicates a need for further teaching?
A. I will avoid foods that cause gas, such as beans and cabbage.
B. I should chew my food thoroughly to prevent blockages.
C. I can eat high-fiber foods to help regulate my bowel movements.
D. I will drink plenty of fluids to prevent dehydration.
Answer: C
Rationale: Initially after colostomy surgery, high-fiber foods should be avoided because they can cause
blockage or excessive gas. The patient should gradually introduce fiber and monitor tolerance.
Gas-producing foods (beans, cabbage) are often avoided, chewing food thoroughly prevents blockages,
and adequate fluid intake prevents dehydration—all correct statements.
10. A nurse is assessing a patient who has been on bed rest for several days. The patient suddenly
develops dyspnea, chest pain, and hemoptysis. Which intervention should the nurse perform first?
A. Administer oxygen via non-rebreather mask at 15 L/min.
B. Notify the healthcare provider immediately.
C. Place the patient in a high Fowler's position.
D. Prepare for intubation.
Answer: A
Rationale: The symptoms suggest a pulmonary embolism (PE), a life-threatening emergency. The priority
is to support oxygenation; administering high-flow oxygen is the first action. After oxygen, the nurse
should notify the provider and prepare for further interventions (e.g., anticoagulation, thrombolytics).
Positioning is secondary. Intubation may be needed but is not the first step.
11. A nurse is evaluating a patient's readiness for discharge after a total hip arthroplasty. Which
assessment finding indicates the patient can safely perform activities of daily living independently?
A. The patient can ambulate 20 feet with a walker and pivot to a chair.
B. The patient can independently perform range-of-motion exercises for the affected hip.
C. The patient can don and doff an elastic compression stocking unassisted.
D. The patient can reach the floor to pick up a dropped object using a grabber.
Answer: C
Rationale: Donning and doffing compression stockings requires fine motor coordination and balance,
indicating ability to manage self-care. Ambulation with a walker (A) is expected but does not guarantee
ADL independence. ROM exercises (B) may be part of therapy but not comprehensive. Reaching the
floor (D) is not recommended post-hip arthroplasty due to dislocation risk.
12. A patient with a history of chronic obstructive pulmonary disease (COPD) is admitted with
acute respiratory failure. Arterial blood gas results show pH 7.28, PaCO2 60 mm Hg, PaO2 50 mm
Hg, HCO3- 26 mEq/L. Which intervention should the nurse implement first?
A. Initiate noninvasive positive pressure ventilation (NIPPV).
B. Increase the oxygen flow rate to 5 L/min via nasal cannula.
C. Administer a bronchodilator via nebulizer.
Page 4
